Knowledge Centre

Can We Claim Health Insurance from Two Companies?

It is possible that you may have more than one health plan to cover your medical expenses. One reason could be that you have availed of an additional coverage over and above the group insurance offered by your employer. Alternatively, you may have an old policy and to procure higher coverage you may choose a second insurance plan. A third reason may be that you have two policies; one that covers your parents and the other covering your spouse and children.

Process to make multiple claims

In 2013, the Insurance Regulatory and Development Authority (IRDA) made some changes to the regulations. Before these modifications, every health insurance plan included a contribution clause. In the case of a claim, each insurer will contribute an amount equivalent to the ratio of the sum assured.

The modifications have made the procedure easier and simpler. Now, if the claim amount is less than the sum assured, the contribution clause is not applicable. However, for claims exceeding the sum assured, the clause is applicable. But, you may choose the insurance company from whom you want to make the first claim.

1. Cashless claims

For such claims, you make the claim for one insurance company and procure the settlement summary. On completion, you will need attested copies of all the bills. You may then approach the second company for claiming reimbursement of the balance amount.

2. Reimbursement claims

Cashless claims are convenient because the insurance company settles the hospital bills directly. Nonetheless, there are some hospitals that do not follow such procedures. Here you need to first pay the amount and then follow the health insurance claim process. You need to submit all original documents (that are retained by the insurer) along with the claim application form.

Documents needed to make reimbursement claims

When you make claims under multiple health insurance policies, you must intimate all the different companies at the time of hospitalization. After this, you may choose the company where you wish to make the first claim. Here is the list of original documents that must be attached with the claims form.

  • Bills and receipts
  • Discharge forms
  • Diagnostic tests
  • Prescriptions
  • Films and slides, if any

When you make a health insurance claim, it is recommended you choose your employer’s insurer as the process will be quicker. It is important you procure multiple attested copies of the aforementioned documents from the hospital. The first company will provide a claim settlement summary, which must be submitted to the next insurer to file the claim for the balance amount.

There is always a possibility that your health insurance claim is denied. This may be because you did not inform the insurer about existing policies at the time of buying the plan. Alternatively, the claim may exceed the contribution clause amount.

Having adequate health coverage is crucial as medical expenses are constantly rising. However, it is advisable to procure higher coverage under a single plan instead of purchasing smaller sum assured under multiple policies.

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