SACHA ADVICE. ACHA ADVISOR.
back arrow Back

co-pay rules for second insurance

reply Share
30 Nov, 2021 by  Playmob Meg

Hi All,

I am in a situation as below.


Total Hospital Expenditure : Rs 4,44,000

1st TPA paid : Rs 3,50,000 (settled)


After that, I made a

claim amount to the 2nd TPA : Rs 94,000 (Where Total sum assured is Rs 3,00,000)

Co-pay charged by 2nd TPA : Rs 44,000 (10% of Total Hospital expenditure)


My question, is the above co-pay charges by 2nd TPA correct.

The total amount claim to the 2nd TPA is only Rs 94,000, which is far below than total sum assured. How the co-pay can be calculated based on Total Hospital Expenditure Rs 4,44,000.


Please help.


like like
0
Health Insurance

1 Answer

Post
Regional Director, Amicus Insurance Broking

I assume, you had two policies and the second one had a copay clause. If that is so, please check your policy terms for the copay clause. If it says the copay is applicable on the claim amount on the particular policy, then the deduction is not correct. It should not be on the total claim under both policies.

like like
0
icon-comment 0 Comments
icon-reply Reply

Tired of dealing with call centers!

Get a professional advisor for life!

LIFETIME FREE

Rs. 1799

or

Discover the best tips for insurance every week!

Beshak is not regulated by the Insurance Regulatory and Development Authority of India (IRDAI) and does not have any alliance or association with any Insurance business.
© Copyright 2022 Beshak Solutions Pvt. Ltd. All Rights Reserved.

Disclaimer: The content on the website is purely for information purposes for the public at large, and does not constitute personal financial advice for a specific individual reader.
If you are reading this, it means you love reading the fine print. Why not get paid for what you love doing - Join us by writing to info@beshak.org now 🙂