Expert Speaks: Can one use personal and corporate health insurance policy to cover hospital expenses?

It is always advised not to depend solely on a corporate health insurance policy for covering medical needs.  It should be supported by a personal health insurance plan, especially to cover the period when one is between jobs or after retirement when it becomes difficult to get a cover due to old age.  However, when one has both the policies one of the most frequently asked questions is about which policy one should use first. Can one claim from both the policies?  Here is a similar question raised by Sujata from Gurgaon which is answered by our expert S K Sethi, Director, Ria Insurance Brokers.

I have to undergo surgery. Can I use both personal as well as my office insurance policy to cover expenses? What should be the best approach? -Sujata 

Our suggestion is that first the claim should be lodged under the corporate group policy and the limit up to the sum assured should be used. The person should find out from the HR department whether the corporate policy has a corporate buffer amount available in the policy -if yes then even that amount can be used by the employee. As a last step for the balance amount, the individual policy should be used.
 

To clarify further, yes claim is payable under corporate group policy as well as an individual policy. This concept is frequently used by us for our clients in the case of cataract surgery, where many insurance policies under the individual policy are having sub-limit say Rs 35,000. The balance amount in one case Rs 90,000 has been paid under the corporate policy. The original bills /documents will go to First Insurer and a photocopy will go to the second insurer along with the settlement letter of the first insurer, which is proof of the genuineness of the claim. 

I strongly recommend that getting 2 original bills/documents from the hospital and submitting them to 2 different insurers should not be attempted as it will be treated as fraud. This has to be 100 per cent provided avoided.

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