I have 2 health insurance policies of 5 lakhs each. If my claim, let us say, is 4 lakhs and one company settles at 2 lakhs, can I claim with the second company for balance amount? One insurance company rejected my policy for some reason. Later, another company approached me, and I took a policy. I had only signed the document and I do not know the details. To this company, I have paid premiums for 10 years without break. Can this company reject my claim in the future?

Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

Ans: Hi Jyoti, hope you are doing well. As you have mentioned that the claim amount for each eye has been different, to understand the reason behind this disparity, you will have to check the documentation submitted to the insurer for both the surgeries. Request you to contact your insurance advisor and discuss the same with the insurer to understand this gap further and help you resolve this issue. 

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Ans: Claiming Copay from Another Health Insurance Policy
That's a good question! Unfortunately, you cannot claim the copay amount you pay under one health insurance policy from another provider. Here's why:

Copay is a fixed amount you share with your first insurer for covered medical expenses. It reduces your premium but requires you to pay upfront.
Each insurance policy works independently. They only cover your expenses as per their terms and conditions.
Here's how things work:

You file a claim with the insurer that has the copay clause.
They approve the claim amount after deducting the copay amount.
You pay the copay directly to the hospital or yourself (depending on the policy).
Alternatives to Consider:

Choose plans without copay: If copays are causing trouble, consider switching to plans with higher premiums but no copay requirement.
Increase coverage limits: If your current plans have low coverage limits, explore options with higher limits to minimize out-of-pocket expenses.
Speak to a CFP Professional:

A Certified Financial Planner can review your health insurance plans and suggest options that better suit your needs. They can also help you understand coverage details and claim procedures.

Remember: It's important to choose health insurance plans that complement each other and provide comprehensive coverage.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in