How to Claim under Multiple Health Insurance Policies?

There are people who understand the importance of health insurance and buy multiple health insurance policies from more than one insurance company. Some policyholders get coverage under the group health insurance policies.

You can hold multiple health policies if the coverage and benefits vary from one another. While buying multiple policies, it is extremely important to inform the second insurer about the existence of the first policy. This factor will be considered by the insurer as a part of the underwriting process.

Contribution Clause

Well, if you are reading this article it means you want to know every fact related to multiple health policies, and the “Contribution Clause” is the latest best thing that happens to people. In the year 2013, the Insurance Regulatory & Development Authority of India made changes in its rules & regulations taking into view the people that they can insure themselves with two different policies. According to IRDA, it is mandatory that the total medical expenses had to be shared by the insurance companies in proportion to the sum assured by them and this is known as the “Contribution Clause”.

But after some time the rule was eradicated and now policyholders can approach anyone to settle their claim if you are insured with two different policies of the same company then it’s fine because you will get the claim of at least one. But how you will claim for two different policies company to get settled?

Settle Claim under Multiple Health Policies

For Indemnity Cover

Usually, the health insurance policies provide the indemnity cover that will pay your hospitalization expenses.

When it comes to settling the health-related expenses, you need not approach all the insurers. You can just ask any one of the insurers to settle your hospitalization expenses. You can settle the hospital bills up to the sum assured available with the health policy and after exhaustion of the cover from one insurer, you can approach the other insurer.

For getting claims, you need to provide the original hospital bills and discharge summary to the insurer. When claiming from the second insurer, you can submit the self-attested copies of documents and claim settlement letter from the first insurer.

For Fixed-benefit Cover

Critical Illness health insurance policies offer fixed-benefit coverage, on the occurrence of the insured event as specified under the terms and conditions of the policies. According to Section 24 of the Health Insurance Regulations as defined by IRDAI, each insurer shall pay the amount of the claim irrespective of the expenses incurred in the diagnosis or treatment of illness covered under the policy.

Partly Settlement

There are instances when an insurance company pays a certain amount and to settle the balance of the claim amount, you have the right to approach the second insurer. Your claim for the remaining amount will be settled by the second insurer, within the limit of the sum assured under the policy.

Which policy to choose

If you are insured under two different health policies, you must be thinking about which policy to approach first for settling the claims. When you have a group health policy and a retail health policy, you can simply claim first under the group health insurance policy. The reason is, that a group health policy does not accrue benefits like NCB, claim-free health checkups, etc. Moreover, group policies have wide coverage, especially in terms of the waiting period.

Reasons to buy Multiple Health Plans

• Because you are not okay with single health insurance policy coverage.
• Paying higher premiums amount for the existing health insurance plan and getting coverage almost half as you want.
• Bad claim experience with the insurance company, will also lead you to multiple health plans.
• To create a robust financial backup to avoid out of pocket expenses
• Claim rejection risk/fear will also lead you to play safe and insuring yourself with multiple health plans.
• Need-based health insurance plans to take care of different health contingencies

How to Claim Health Insurance from multiple insurers?

Well, you can claim health insurance from multiple insurers in two different ways. You will need certain things before claiming health insurance, like; Hospital bills & medical bills. With these documents, you can claim with anyone, and the rest expenses will be covered by another insurance company. But it’s on you how you are claiming for a medical condition against multiple insurance companies.

Claims Procedure

It is of utmost importance to inform the insurance companies (in case of multiple insurance policies)  in the event of a claiming the amount.

For Reimbursement

To get a claim through reimbursement, it is important to gather all essential documents from the hospital and submit the mandated documents to your insurer. Some important documents include:

• Claim Form which is completely and correctly filled and signed
• Medical Certificate confirming the diagnosis of the ailment or disease
• Discharge Summary
• Medical investigation reports
• Other supporting documents related to illness.

(The requirement of documents may vary from insurer to insurer)

For Cashless Treatment

The insurance company which you have chosen for claim settlement will settle the claim directly with the network hospital as per the procedure up to the limit of indemnity. After that, the insurance company can exercise the “contribution clause” as per the insurance company’s discretion. The policyholder may also follow the claims procedure to claim the balance amount from another health insurance policy.

Aspects to consider while filing multiple claims at a time

• Claims efficiency of the insurers
• Turn around the time of the insurer for settling the claim
• List of the network hospitals for cashless treatment
• Claim settlement procedure of the insurer
• Efficiency and efficacy of the partnered TPA of the insurer
• Previous claim experience with the insurance companies
• Check on No claim Bonus status
• Check and read the co-payment clause, sub-limits, and other related clauses in your respective policies
• If you have a Group Health Insurance Policy, make a claim from it first. It saves your NCB of the personal policy.

Conclusion

The intent of filing a claim should be genuine and not earn profits by having multiple insurance policies. You are advised to consult your insurer in advance in case of planned hospitalization and intimate them within the specified timeline, in the event of sudden hospitalization to settle the claim amount. When you are buying multiple health insurance policies, you should inform the insurer about the existing policies.