If a health insurance or mediclaim policy claim is filed in two overlapping policy periods, it will get the benefit of available sum insured in both of those two policy periods, including the deductibles for each policy period. However, such eligible claim payable to the policyholder shall be reduced to the extent of premium to be received for the renewal of such policy in the overlapping second year.
IRDAI Health Insurance Guidelines: If the claim event falls within two periods, the claims shall be paid taking into consideration the available sum insured in the two policy periods, including the deductibles for each policy period. Such eligible claim amount to be payable to the insured shall be reduced to the extent of premium to be received for the renewal/due date of premium of health insurance policy, if not received earlier.
Example – An insured has a health insurance policy with a sum insured of Rs. 10,00,000/- which is due for renewal on 20th August 2015. This insured person falls ill on 10th August, stays in hospital till 25th August and his total hospitalisation expenses bills comes to Rs. 11,00,000/-.
In such case the insured will get Rs. 10,00,000/- from the year before 19th August 2015 and Rs. 1,00,000 from the policy period starting 20th August 2015, subject to any other sub-limits imposed by the policy terms and conditions. If the insured has not paid the premium for this new policy period (renewal), then it will also be deducted from his claim amount.