Health Policy from One Insurer

In India, many families begin with a basic mediclaim policy or a standard health insurance policy to cover hospitalisation expenses. Over time, as medical costs rise and treatment needs expand, the base coverage may not feel sufficient. This is when policyholders consider a top-up or super top-up plan to extend their financial safety net. A common question arises: can you buy the base policy from one insurer and the top-up from another? The short answer is yes, but it comes with important considerations.

Why people choose top-up health plans

Medical costs have been increasing steadily. A basic health cover that once seemed adequate may no longer match the expenses of a modern hospital. Top-up plans address this gap by offering higher coverage at relatively lower premiums. They act as an additional layer of protection once the base sum insured is exhausted.

For example, if a person has a base cover of five lakh rupees and a top-up of ten lakh rupees, hospital expenses beyond the initial five lakh are taken care of by the top-up plan. This ensures wider protection without paying the high premium of a very large base policy.

Flexibility of buying from different insurers

Regulations allow policyholders to hold multiple health covers from different companies. This means you can buy a health insurance policy from one insurer and a top-up plan from another without restriction. Many people do this for reasons such as:

  • Premium affordability: A more competitively priced top-up may be available with another insurer.
  • Product features: Some companies offer top-ups with attractive benefits like no room rent limits or broader disease coverage.
  • Service experience: Policyholders may prefer one insurer for claim settlement speed but another for add-on features.
  • Diversity of risk: Splitting policies reduces dependency on a single insurer.

This flexibility allows individuals to customise their insurance portfolio according to their needs.

How claims are settled with multiple insurers

The most important aspect of mixing policies is understanding how claims work. When a hospital bill arises:

  1. Base policy applies first: The insurer of the basic mediclaim policy pays up to the sum insured.
  2. Top-up comes next: If expenses exceed this amount, the claim is passed to the insurer providing the top-up.

For example, if your hospital bill is eight lakh rupees and your base cover is five lakh, the first insurer will pay five lakh. The remaining three lakh will be settled by the insurer offering the top-up.

This process usually works smoothly, but policyholders should be prepared for coordination between two insurers, which may mean extra paperwork and communication.

Role of deductibles in top-up policies

Top-up and super top-up plans function with deductibles. A deductible is the threshold amount that the policyholder must bear or claim from the base cover before the top-up activates.

  • Top-up policy: The deductible applies to each claim.
  • Super top-up policy: The deductible applies to the total claims made in a policy year.

When the base policy and top-up come from different insurers, it is essential to ensure that the deductible aligns well with the base cover. For instance, if your base policy is five lakh, a deductible of five lakh in the top-up ensures seamless coverage.

Things to check before mixing insurers

While buying a base and top-up policy from different insurers is allowed, policyholders should carefully review:

  • Coverage terms: Ensure both policies complement each other without leaving gaps.
  • Cashless network: Check if hospitals are covered under both insurers’ networks.
  • Claim process: Understand the documentation and coordination steps if two insurers are involved in one claim.
  • Renewal terms: Verify premium stability and continuity benefits, especially for long-term planning.
  • Exclusions: Each insurer may have different exclusions, so ensure no critical areas are missed.

Advantages of using different insurers

  • Cost savings: You can combine the most affordable base policy with a competitively priced top-up.
  • Better features: Some insurers specialise in innovative top-ups with high flexibility.
  • Risk spread: If one insurer denies or delays, another is still available for the rest of the claim.

This customisation allows policyholders to design coverage suited to their financial and healthcare needs.

Potential drawbacks

  • Coordination issues: In large claims, families may need to liaise with two insurers.
  • Processing time: Settlements may take longer if documents are required by both companies.
  • Different service levels: Experiences with claim settlement speed and customer service may vary between insurers.

These challenges can be managed, but families should be aware before making a decision.

Best practices for policyholders

  • Always align the top-up deductible with the base policy sum insured.
  • Inform both insurers about each other’s policies to avoid confusion during claims.
  • Keep copies of all documents ready for faster settlement.
  • Compare benefits annually, as new products often enter the market.

Conclusion

Yes, you can purchase a mediclaim policy from one insurer and a top-up from another. This arrangement can help reduce costs, expand coverage, and provide flexibility. However, coordination between insurers, deductibles, and claim settlement procedures must be clearly understood. By carefully aligning the base and top-up, families can make their health insurance policy more comprehensive and cost-effective, ensuring they remain financially protected against rising medical expenses.