Obtaining privileges from insurance and other banking products is certainly enjoyable and profitable. However, it's important to understand each term of the privilege offered to entice you to purchase the product.
Clearly explaining the benefits you'll receive without any misunderstandings will prevent you from regretting it later. Being a smart consumer is essential for financial well-being.
For example, the term "double claims" in health insurance often serves as a lure for people to purchase the product without fully understanding its meaning. At first glance, there's nothing wrong with the term. However, many people misunderstand the meaning of "double claims."
This can lead to them expecting more from additional health insurance than what the company already provides. Therefore, understanding the meaning of "double claims" in insurance is crucial.
So, what does "double claim" mean in insurance?
A double claim in insurance occurs when a policyholder files a claim for the same incident or loss with two different insurance companies simultaneously. This practice can be legal or illegal, depending on the type of policy, the terms of each insurance company, and the claim submission method.
In permitted situations, such as with health insurance, a double claim occurs when a participant has two policies (for example, one from a company and one from a personal insurance company). If one policy doesn't cover the entire cost, the remaining balance can be claimed from the other policy—as long as it doesn't exceed the total actual costs.
For example:
A person has two health insurance policies: one from their company (group insurance) and one from their personal insurance company.
They are hospitalized for a total of IDR 10 million.
The company insurance company covers IDR 7 million, and they submit the remaining IDR 3 million to their personal insurance company.
Because neither policy exceeds the actual costs, and there are no prohibitions in the policies, this is a valid double claim. Some personal insurance policies even offer a "coordination of benefits" system, or reimbursement for the difference not paid by the first party.
However, if someone attempts to obtain full payment from two insurance policies for the same loss (for example, in a car accident and claiming the same damages from both parties without basis), this is considered fraud and a violation of insurance law and ethics.
Examples of Misconceptions About Double Insurance Claims
A common misconception about double insurance claims often stems from the assumption that if someone has two insurance policies, they can receive double the claim amount for a single incident. However, this is incorrect and can lead to claim denials or even accusations of insurance fraud.
For example, a person has two vehicle insurance policies. When their car is damaged in an accident, they file a claim for Rp 10 million with Insurance Company A and receive full compensation. However, they also file a claim for the same damage with Insurance Company B, hoping to receive an additional Rp 10 million. However, the total loss is only Rp 10 million.
This is considered an illegal double claim because the intention is to gain more than the actual value of the loss.
Benefits of Double Claims Health Insurance
You should understand the following benefits of the double claim facility to feel comfortable participating in this insurance program:
You can receive treatment or care at any hospital that is not a partner of the insurance company with the double claim facility.
You can do this through reimbursement. Usually, you will be asked to pay the costs of treatment and care during your stay in the hospital. You can then claim the bill from the insurance company, and the insurance company will reimburse you for the amount you have spent, as stated on the receipt.
