Claiming Health Insurance Benefits from Two Policies

Can You Make a Medical Claim With Two Insurance Companies?

Yes, you can claim health insurance from two different insurance companies for the same medical treatment. The Insurance Regulatory and Development Authority of India (IRDAI) allows policyholders to utilise multiple health policies. However, there are certain conditions and guidelines that you need to follow.

If you have more than one mediclaim insurance policy, you must inform both health insurance companies about the existence of the other policy. This is important in order to avoid health insurance claim rejection or complications in the future.

When Should You File a Claim With Two Health Insurance Policies?

In the most common scenario, if your hospital bills exceed the sum insured by one policy, you will need to claim the remaining amount from the second insurance policy.

Here, it is important to note that you need to inform the existing insurance company about buying a second policy. If you fail to do so, your claim can be rejected, or you can receive a reduced claim settlement.

What is a “Contribution Clause”?

The “Contribution Clause” applies when a policyholder has multiple health insurance policies. As per this clause, the total health insurance claim amount is shared among insurers in proportion to their respective sum insured. This means that if a person is covered by more than one policy, each insurer will contribute a portion of the claim based on the coverage provided.

However, in 2013, the Insurance Regulatory and Development Authority of India (IRDAI) revised the rules and removed the Contribution Clause. Now, policyholders can choose to file the entire claim with a single insurer without requiring contributions from other insurers, unless explicitly stated in the policy terms.

How to Claim Health Insurance Benefits from Two Policies?

Most people are aware of how to claim health insurance from one policy but are not clear on claiming from two insurance companies. For making claims from two insurance providers, follow the steps below:

Step 1: Inform each insurance company about your claim. Provide them with the necessary details to ensure a smooth process.

Step 2: Collect all essential documents, including medical bills, receipts, reports, and any other supporting paperwork.

Step 3: Decide which insurance company you will file the claim with first. You can choose based on the sum insured, ease of claim settlement, etc.

Step 4: File your claim with the chosen primary insurer, ensuring that all documents are accurate and complete.

Step 5: Once the primary insurer processes your claim, they will provide a settlement statement indicating the amount reimbursed.

Step 6: Submit the settlement statement along with the required claim documents to the second insurer to claim the remaining eligible amount.

Step 7: The secondary insurer will process your claim based on their policy terms and reimburse the remaining eligible amount.

Claiming mediclaim insurance benefits from two health insurance companies can be better understood with the help of an example.

For instance, Rahul has two health insurance policies, one from Insurer A with a ₹3 lakh sum insured and another from Insurer B with ₹2 lakh coverage. When he undergoes surgery costing ₹4 lakh, he uses both policies to cover the expense. First, he claims from Insurer A, which reimburses ₹3 lakh. He then submits the remaining ₹1 lakh claim to Insurer B, ensuring his full medical expense is covered.

Here, it is important to note that a secondary claim can only be made after the initial claim has been settled. Additionally, Rahul cannot claim ₹2 lakh from the second insurer, as claiming more than the actual expense would be considered fraud.

Understand more: How to Make Claims on Multiple Health Policies

What to do When there are Cashless Claims?

With the rising advent of cashless claims in health insurance, you will need to consider how to claim health insurance benefits on cashless policies. The process is quite simple!

Initiate a cashless claim with one insurer by submitting the necessary documents and a pre-authorization form. The hospital will then coordinate with the insurer to settle the bill directly. If the total medical expenses exceed the amount covered by the first insurer, you can claim the remaining amount from the second insurer through reimbursement.

In some cases, hospitals may facilitate direct billing with both insurers if you fill out the necessary authorization forms.

How to Claim Health Insurance from Two Policies with the Same Insurer?

Although taking two polices from the same insurance company is convenient as the claim process will be less cumbersome and you will require less paperwork. But nonetheless, there might be different guidelines that will require you to raise separate claims. So, before purchasing plans, read the offer carefully to understand the terms and conditions stipulated by the insurer.

In case your claim is denied by one insurance provider, you can approach the second company as well for settling your claim. The best possible way to avoid any rejections and ensure a smooth claim process is to exercise transparency and make proper disclosures beforehand.

Tips for Claiming from Multiple Health Insurance Policies

Check out the tips below to utilise multiple mediclaim insurance policies without complications:

• Notify both insurance companies about your hospitalisation and intent to claim as early as possible.
• Choose your primary insurer based on factors like sum insured, ease of settlement, and policy benefits.
• Keep original bills, prescriptions, medical reports, and hospital receipts as they are essential for claim approval.
• Once your primary insurer processes the claim, collect a settlement statement, as it is required for raising claim with the second insurer.
• You can only claim up to the actual expense incurred. Any attempt to claim more from multiple insurers is considered insurance fraud.
• Submit your claims within the specified time limit of each insurer to avoid rejections.