I refer to your reply to a query regarding individual medical policy, where you have guided that it is better to have an enhanced policy cover rather than a different policy from a different insurer as claim settlement would become cumbersome since there will be two third-party administrators (TPAs) to deal with. But if one has two policies and two TPAs, how will the claims process work?
The insurance law says that if there is more than one insurance policy for the same person, then each insurance policy will pay the claim in the same proportion as its sum insured to the total sum insured of all the policies. For instance, if you have two policies, one with a sum insured of Rs 1 lakh and the other with Rs 2 lakh, the total sum insured is Rs 3 lakh. In case there is a claim of Rs 30,000, the first policy will pay Rs 10,000 and the second will pay Rs 20,000. Usually insurers take a more relaxed view considering the nature of loss and the personal trauma that the insured has to go through and generally do not invoke this clause.
This means that you can take the claim in any policy if the claim amount is less than the sum insured of any of the policies. In case the claim amount is more than the sum insured of the bigger policy, you can claim the sum insured amount from that policy and the remaining amount can be claimed from the other policy.
My mother has gone to the US for two months and may extend her stay by four months. She has taken a travel insurance for two months. Can the policy be extended while she is still abroad?
Travel insurance policies can be extended while the insured person is abroad. The policy can be extended up to a cumulative period of six months from the starting date of the policy. It should also be kept in mind that the extension has to be done before the expiry of the policy.
I want to buy a health policy. I would prefer to buy a policy that covers all heath expenses above a certain level, say Rs 5 lakh. Does such a plan exist?
The number and types of health plans available in India have increased tremendously in the last five years. A few insurers have introduced “top-up” plans that reimburse expenses incurred above a threshold level. The threshold limits can be chosen from two-three options that the insurers offer. For instance, if a person buys a policy for Rs 5 lakh with a threshold of Rs 5 lakh. After two years, if the person makes a claim of Rs 3 lakh, the policy will not reimburse any amount since the threshold limit is Rs 5 lakh and the policy reimburses expenses above the threshold limit. In the third year, if the person makes a claim of Rs 8 lakh, the policy will reimburse Rs 3 lakh, which is the amount above the threshold limit of Rs 5 lakh.
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