I’ve a ten lakh base coverage and a 15 lakh tremendous top-up (10 lakhs deductible) household floater coverage from oriental insurance coverage from 2008 overlaying me, my spouse, and my daughter. As you talked about within the article, – it has a room lease sub-limit of 1 % of the insured quantity. So, I purchased one other coverage from Liberty with a base coverage of three lakhs and a brilliant top-up of 1 crore.
My query is – sooner or later – if I declare medical bills from the primary coverage, if they didn’t pay the complete quantity due to the room lease sub-limit, can I declare that steadiness quantity (not paid due to the sub-limit) from liberty insurance coverage
It might be actually useful in case you reply right here or write an article about claiming medical bills from 2 insurance policies. I want to know how one can use the second coverage to beat sub-limit and co-pay clause limitations.
Concerning the creator: Ajay Pruthi is a fee-only SEBI registered funding advisor. He may be contacted by way of his web site plnr.in. Ajay is a part of the freefincal checklist of fee-only advisors and fee-only India.
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The query right here is whether or not you may declare from two insurance policies. The reply is sure, you may declare from two insurance policies.
First, allow us to perceive room lease sub-limit with an instance:
Room lease sub-limit is actually a cap in your room lease prices per day. Suppose you could have taken a medical insurance coverage with a sum insured of 10 lakhs. If the room lease sub-limit talked about within the coverage is 1% of the whole sum insured, because of this if you’re hospitalized, you may spend solely 10,000 per day on a room. This restrict just isn’t solely relevant to room lease but in addition impacts different prices proportionately.
Proportionate prices are the bills which can be utilized in proportion to your room lease limits if you’re admitted to the hospital.
Let’s say the surgical procedure value in a single room is 5 lakhs rupees. You could have a room lease restrict of 10,000, however you go for a room with a lease of 12,000. On this case, you’d be paid solely 4.17 lakhs for the surgical procedure.
Proportionate Expenses: Rs. 5,00,000 * (10,000/12,000) = Rs. 4,16,666
Now, coming again to the principle level: which coverage to make use of and how one can declare from two insurance policies. We’ll take the instance of the insurance policies talked about originally of the article.
Situation 1
Room Lease Sub-limit: Rs. 10,000 per day
Precise Room Lease: Rs. 8,000
Because the precise room lease is inside the room lease sub-limit of 1% of the sum insured of 10 Lakhs, it’s higher to say from the Oriental Insurance coverage coverage.
Situation 2
Room Lease Sub-limit: Rs. 10,000 per day
Precise Room Lease: Rs. 12,000
Let’s say the hospitalization value is 5 lakhs. Oriental Insurance coverage pays 4.17 lakhs on this case, because the precise room lease is greater than the sub-limit, and the proportionate quantity could be paid (although drugs payments are paid at precise value, let’s ignore that for calculation functions). The remaining quantity must get reimbursed from Liberty Well being Insurance coverage coverage
Situation 3– Taking instance of state of affairs 2, wouldn’t it higher to say from Liberty Insurance coverage?
Sure, it could be higher to say from Liberty Insurance coverage if the hospitalization is pre-planned. Pre-planned right here means, you already know that the whole bills could be round 5 Lakhs for the hospitalization. You may submit each coverage particulars to hospital to take a pre-approval.
One factor you want to bear in mind on this state of affairs is that the ready interval of pre-existing ailments within the coverage from Liberty Insurance coverage is over (if the coverage has been bought not too long ago and there are some pre-existing ailments)
Situation 4 – Unplanned hospitalization the place you have no idea the bills
On this state of affairs, verify the room lease first, whether it is lower than 10,000 per day. It’s higher to go for the Oriental Insurance coverage coverage.
If the room lease is barely greater than 10,000, it’s nonetheless higher to go for Oriental insurance coverage as it’s possible you’ll not get cashless declare kind Tremendous top-up coverage from Liberty insurance coverage if you don’t submit the main points of each base and tremendous top-up coverage from Liberty at the moment. I’ll write a separate article on how cashless claims work.
Situation 5 –
Room Lease Sub-limit: Rs. 10,000 per day
Precise Room Lease: Rs. 15,000 per day
Hospital Invoice – 12 Lakhs
The Oriental Base coverage pays 8 Lakhs right here (proportionate prices). You’ll have to pay 4 Lakhs from your individual pocket. This 4 Lakhs now may be both claimed via Liberty base and tremendous prime up coverage or 2 Lakhs from Liberty base coverage and remaining 2 Lakhs from Oriental Tremendous prime up coverage, which can once more have room lease sub-limits. So, it’s higher to make use of Liberty base and tremendous prime up coverage to start with itself.
To Summarize
- It’s all the time advisable to go for the Oriental Insurance coverage coverage if the precise room lease per day is lower than 10,000 and the estimated value for hospitalization is lower than 10 lakhs. Even when the hospitalization value is barely greater than 10 lakhs, you may nonetheless select the Oriental Insurance coverage coverage.
- It’s all the time advisable to go for the Liberty Insurance coverage coverage if the estimated value for hospitalization is considerably greater than 10 lakhs. Be certain that you submit particulars of each the bottom and tremendous top-up insurance policies collectively.
- It’s all the time higher to seek the advice of with the TPA (Third Celebration Administrator) in hospitals earlier than submitting the coverage particulars for claims.
*Disclaimer- Nothing contained within the article is a solicitation, suggestion, endorsement, or supply by me. You probably have any doubts as to the deserves of the article, you ought to search recommendation from an unbiased monetary advisor. Registration granted by SEBI, membership of BASL, and certification from NISM on no account assure the efficiency of the middleman or present any assurance of returns to buyers. Funding within the securities market is topic to market dangers. Learn all of the associated paperwork rigorously earlier than investing.
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