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Taking health insurance base policy and super top up from different company

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13 Oct, 2020 by  shobhit

Hi Sir/Maam ,

If I wan to buy Heath base policy and super topup from different company then how does claim process work ?

I am confused because both companies will require original documents .

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Parents-Health-Insurance

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13 Oct, 2020

Hey Shobhit,

Ideally you should buy base and super topup from same insurer.

Health insurance policies are indemnity policies, meaning, these policies pay upto the bill amount. You can club several policies together to cover the bill amount.

Think of all policies in a standalone manner. So when you claim from one policy, it pays for certain items, and leaves out several others saying those are not covered or not enough cover is available to pay for those items. These details are listed in a document called as Claim Settlement Letter (CSL).

When policy 1 leaves unpaid expenses, you take those unpaid expenses to policy 2. This 2nd policy requires CSL to figure out which items remain unpaid.

When you have policy 1 & 2 from the same insurer, then it is quick for them to source the CSL within the company by just the reference of claim ID. But when you have policy 1 & 2 from different insurers, then you have to wait for policy 1 to issue CSL to you and that you submit to policy 2 for claim processing. This process can take 5-8 weeks. So buying policies from same insurer cuts down this time.

Also, think of a scenario when it is cashless admission and cover in policy 1 exhausts and only partially covers the cost of admission. If you have policy 2 from same insurer, then they can extend the sum insured of policy 2 within the same cashless admission. Else you have to pay the unpaid amount of policy 1 in cashless, wait for CSL to be issued in 5-8 weeks and then receive the unpaid amount from policy 2.

I hope this helps you to make your decision. Happy to answer any followups you may have, please share more specific data (cover and plans you are thinking of buying) so that I can give more accurate answer.

Anuj Jindal

Co-founder

SureClaim

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13 Oct, 2020
shobhit
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26 Oct, 2020
Bosch
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15 Oct, 2020
But now I came to know importance of medical before taking Health Insurance and tata is not doing any medical due to pandemic situations. now I am confused , should I take tata medicare base policy without medical ?


Hello Shobhit,


We have answered this question in detail here:

Many insurers are not conducting medical tests before providing a policy. How does it impact claims?

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