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How to claim from multiple Health Insurance plans ?

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Published on Sept 16, 2020. EST READ TIME: 5 MIN   

There has been a steep increase in healthcare costs, and meeting them can burn a hole in the pocket. Hence, an adequate health plan makes a big difference in providing financial backup during medical emergencies. The main reasons for this can be the age of the insured and the underlying guidelines of theinsurancecompany. In such a scenario, an individual ends up buying a second policy to stay fully protected. Many also have separate health insurance for parents , spouse, and children.

Are you planning to take anadditional health plan? Keep these points in mind.

• Insurers expect you to trust them and appreciate transparency and full disclosures. Make sure you inform the new insurance company about your existing health plans. If you do not do so, youcan get into unnecessary hassle at the time of claims.

• Even if you have multiple health plans, you cannot claim more than the amount insured in one policy.

• In case the treatment expenses are more than the sum insured, you can use the other health plan to pay for the remaining amount.

• Know how you can use multiple plans to your advantage while filing a health insurance claim.

Contribution Clause in health insurance

The contribution clause applies when you hold multiple health insurance policies. Before 2013, the Insurance Regulatory and Development Authority of India (IRDA) made it mandatory for the insurance companies to share a policyholder’s medical expenses in proportion to the amount insured by him/her. However, this clause was amended in 2013 to make things easier for policyholders. Now, if you have multiple health plans, you can approach the insurance company as per your choicefor claim settlement.

For instance,if you hold two health plans for Rs. 1,00,000 each and have a claim of Rs. 1,50,000. In this case, you can choose any one policy and claim Rs. 1,00,000 from it. Once the claim is settled, take the claim settlement certificate from the insurance company. You can now approach the insurer and claim the remaining amount of Rs. 50,000/- from the other policy. For this, you have to submit the first insurer’s claim settlement certificate and other necessary documents to the insurer.

Procedure to claim health insurance from two or more policies

If you have two or more health plans and the hospital bills exceed the sum insured of one health insurance policy , you can file a claim using these methods:

• Cashless Claim: Under this claim, you need not pay the hospital bills as the insurer reimburses it. Some hospitals have a tie-up with insurance companies for cashless claims. They are commonly known as “network hospitals”. In case of an accident or health emergency, you can avail of cashless hospitalisation at one of the network hospitals. After the treatment,file a claim withinsurance company. Once the claim is settled and you have the settlement summary, you must submit it to the second insurer along with attested hospital bills. The second insurer will check the same and settle the balance amount.

• Reimbursement Claim: If you are admitted to a non-network hospital, the claim is settled through the reimbursement method. In this case, you have to pay the hospital bills from your pocket and then get in touch with the insurance companies for reimbursement. Your insurer will ask you to submit the claim application form and certain attested documents and medical bills for claim settlement.

Documents for reimbursement claim

When you make a reimbursement claim, you have to fill the claim form and submit various original documents to the first insurance company. The documents include:

• Discharge summary

• Hospitalisation and treatment bills and receipts

• Prescriptions

• Lab reports, x-rays, and slides

• Claim settlement summary

A small tip: If you have an employer’s health plan as well as a personal one, use the employer’s plan first for claim settlement. It is quicker, and you will not lose the no-claim bonus on the personal one.

Conclusion:

Having adequate health coveragekeeps you at peace during medical emergencies.Having multiple health insurance plans is a way of increasing coverage. However, if you want to upgrade your health coverage with a new health insurance plan, we advise you to take it with the sameinsurancecompany. Doing this will reduce the paperwork and make claim settlement smooth and quicker.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.