How to Establish Claim Hierarchy for Multiple Health Insurance Policies

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🏥 Why Claim Hierarchy Matters

Establishing proper claim hierarchy across multiple health insurance policies:
✅ Prevents claim rejections (38% of dual policy claims get denied without proper sequence)
✅ Maximizes coverage benefits (Utilize all available policy limits)
✅ Reduces out-of-pocket costs (Proper sequencing can save 15-25% per claim)
✅ Maintains no-claim bonuses (Strategic claiming protects NCB on key policies)

*(72% of policyholders with multiple plans don’t optimize claim order – IRDAI 2023 Report)*

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📌 Standard Claim Hierarchy Framework

1️⃣ Employer-Provided Insurance

• Role: Primary coverage

• Use First For:

  • Planned hospitalizations

  • Annual health check-ups

  • Pre-existing conditions (if waiting period completed)

2️⃣ Personal Base Policy

• Role: Secondary coverage

• Use For:

  • Balance amounts after employer insurance

  • Treatments excluded from employer policy

  • Higher room rent limits

3️⃣ Super Top-Up Policy

• Role: Catastrophic coverage

• Activation: Only when bills exceed base policy limits

• Ideal For:

  • Major surgeries (₹5L+ bills)

  • Critical illness treatments

  • Multi-specialty care

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💡 5 Smart Claim Sequencing Strategies

1️⃣ The Cost-Based Approach

2️⃣ The Benefit-Specific Method

• Employer: Best for OPD/diagnostics

• Personal: Best for hospitalization

• Top-Up: Only for critical care

3️⃣ The Time-Based Strategy

• Early policy year: Use employer insurance

• Near renewal: Use personal policy

4️⃣ The Condition-Specific Model

• Chronic conditions: Personal policy first

• Accidents: Employer policy first

5️⃣ The Network Hospital Approach

• Use policy with best hospital network for each treatment

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📊 Claim Hierarchy Comparison Table

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⚠️ 3 Hierarchy Mistakes That Cost You

1. Claiming Small Bills (Erodes no-claim bonus unnecessarily)

2. Wrong Order Submission (Leaves higher-tier benefits unused)

3. Not Informing All Insurers (Can void coverage if undisclosed)

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❓ Claim Hierarchy FAQs

Q: Can I claim from two policies simultaneously?

✅ Only sequentially – Primary must pay first before secondary considers balance

Q: How does hierarchy affect premium hikes?

✔ More claims on personal policy = higher renewal increase than employer policy

Q: Should I change hierarchy as I age?

🔄 Yes – Shift more to employer coverage in 50s+ to protect personal NCB

Q: What if policies have different network hospitals?

⚠️ Hierarchy must follow hospital’s empaneled insurers (can override standard order)

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🛠️ How to Establish Your Custom Hierarchy

1️⃣ List All Active Policies

• Note sum insured, deductibles, sub-limits

2️⃣ Identify Policy Strengths

3️⃣ Create Claim Rules

• Example: “For cardiac care, use Apollo Hospital → claim under Employer → balance from Personal”

4️⃣ Document & Share

• Keep hierarchy instructions with medical records

• Inform family members/nominees

5️⃣ Review Annually

• Adjust for policy changes, new health conditions

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📝 Claim Hierarchy Checklist

• Verified all policy terms

• Compared network hospitals

• Calculated deductible impacts

• Set NCB protection thresholds

• Created emergency claim guide