Health Insurance –How to Make Claims from Two Insurance Companies

Posted on: Dec 15, 2022 | | Written by:

Health Insurance –How to Make Claims from Two Insurance Companies

Published on December 12, 2022. EST READ TIME: 3 minutes

Health insurance is an important product that covers your hospital bills and associated expenses during medical emergencies. Considering the ever-increasing healthcare costs, you may want wider coverage and claim flexibility to keep your savings intact. This is when having two or more health insurance policies can help.

Multiple health insurance policies promise better coverage and come in quite handy during expensive medical procedures. In case your incurred medical expenses are more than the sum insured of one policy, you can use your second health insurance plan to cover the remaining bills. However, you must inform both insurance companies in advance about the other health plan. Non-disclosure of the existing health plan/s can make health insurance claim settlement difficult.

Contribution Clause in Health Insurance

Before 2013, insurance companies were asked to share the medical expenses of the policy in proportion to the sum insured by them. For instance, you have two health insurance policies of INR 1 lakh and INR 2 lakhs respectively and the claim amount is INR 75,000. In this scenario, the first insurance company will pay INR 25000 to the policyholder, while the second one with a sum insured of 2 lakhs will pay INR 50000. This is the contribution clause in health insurance.

However, IRDAI eradicated this rule in 2013 to make things easier for policyholders and insurance companies. As per the new rule, a policyholder can approach any insurance company for claim settlement. In case the claim amount is more than the sum insured, the policyholder can use one policy first and then the second one for settling their health insurance claim.

Tips to Claim Health Insurance from Multiple Insurers

First and foremost, if you have two health insurance policies, make sure you have informed both insurers about the other policy. This is done at the time of taking the second health plan. When it comes to claiming from multiple insurers, you can choose any one insurance company for claim settlement. If your medical expenses are more than the sum insured of one policy, you can use the second health plan to cover the remaining amount. Also, always use your group health insurance policy first and then the personal one for claim settlement.

For instance, you are covered under group health insurance and family health insurance policy for a sum insured of INR 1 lakh and INR 2 lakhs respectively. Suppose your hospital bills amount to INR 1,50,000. In this case, you can use your group health plan to settle the amount of INR 1 lakh and then use your family floater for the remaining amount of INR 50,000. In case anyone in your family falls sick within the same financial year, the family floater will come in handy to cover their hospital bills.

To claim from two insurance companies, you must obtain the claim settlement summary from the first insurance company, attest the hospital bills and then get in touch with the second insurance company to settle the remaining expenses.

Health Insurance Claim Settlement Process from Multiple Policies

When it comes to health insurance claim settlement from two or more policies, policyholders can opt for cashless claim settlement or reimbursement claim settlement. If the claim amount is less than the sum insured, you can choose any one policy to settle the claim. In case the sum insured of one policy is not enough to cover your hospital bills, you can use the second health plan to cover the remaining amount.

Health insurance claims can be settled in two ways:

1.Cashless claims:

For cashless claims, you must choose a network hospital for your medical procedure. Also, you must inform the insurance company in advance about your medical procedure by submitting a duly-filled pre-authorisation form at the insurance desk. For claim settlement from multiple policies, you must raise a claim with the first insurance company and get the claim settlement summary. Submit this claim settlement summary and the attested hospital bills to the second insurance company to claim the remaining amount. The second insurance company will verify the documents and settle your claim if everything looks fine.

2. Reimbursement claims:

If you choose a non-network hospital for a medical procedure, you must settle the hospital bills from your pocket and get a reimbursement from the insurer. For reimbursement claim settlement, submit the duly filled claim form along with certain attested documents, such as the discharge summary, medical bills and lab reports to the insurance company. The insurer will review the documents and settle your claim accordingly.

Documents Required for Reimbursement Claims

Policyholders must submit the following documents to the insurance company for reimbursement claim settlement:

• Duly filled claim form

• Discharge summary

• Lab or diagnostic reports

• Medicine bills and receipts

• Prescriptions

• Treatment papers

• X-ray films and slides, if any

• Claim settlement summary (to the second insurance company)

• Copy of health card

• Cancelled cheque

• KYC-PAN card and hospital registration card

• Consultant’s certificate with diagnosis

• Radiology, pathology and other relevant reports confirming the diagnosis

• Certificate from the attending doctor (stating the patient’s condition)

What to Do If You Have Different Insurance Plans from The Same Insurance Company?

Having two health insurance plans of the same company reduces paperwork and makes the claim settlement process a lot easier. However, different insurance companies may have different guidelines that you must follow before claiming from two policies. To avoid any confusion later, read the policy terms and conditions carefully before buying two health plans from the same insurance company. You can also clarify the same with the insurer and go ahead with the policy purchase accordingly.

Frequently Asked Questions

1. Can I take more than one health insurance policy?

Yes, you can take more than one health insurance policy for wider coverage. In case you end up using the entire sum insured of one policy during the policy period, you can use the second health plan to raise new claims during the same policy period.

2. I have employer insurance. Should I still take a separate health insurance policy?

Yes, you must keep a separate health insurance policy handy. Your employer or group health insurance policy will be valid only till the time you are employed with the company and then the health plan will cease to exist. If you buy health insurance after that, you will have to wait for the waiting period to get over before you can make any claims on your policy. In case there is amedical emergency in that period, you will be forced to spend huge bucks from your pocket.

3. What is the waiting period for health insurance policies?

Most insurance policies have a waiting period of one month or 30 days. However, the same may vary from insurer to insurer. Insurance companies do not accept any claims during this period. The waiting period for maternity coverage can be between 9 months and 4 years. Policyholders with pre-existing conditions may have to wait for 1-4 years before they can use their health insurance policy for covering their medical bills. Accidental injuries have no waiting period.

4. How many times can I claim health insurance in one year?

You can make any number of claims within the policy period. It basically depends on the sum insured of your health plan. Once the amount gets exhausted, you cannot make any more claims within the policy period. Some insurers also mention the number of claims policyholders can make during the policy period. Hence, make sure you read the policy terms and conditions before making a purchase.

5. Is there a time limit to submit a health insurance reimbursement claim?

In most cases, policyholders must submit the reimbursement claim within 15 to 30 days of discharge from the date of discharge from the hospital. Some insurance companies accept reimbursement claims for up to 3 months or more.

6. When should I make claims on two health insurance policies?

If your hospital bills are more than the sum insured of one policy, you can make a claim on the second policy to cover the remaining amount. For instance, your hospital bills are INR 3.5 lakhs and the sum insured of two health insurance policies are INR 2 lakhs and INR 3 lakhs respectively. In this case, you will have to use both your health insurance policies to cover the bills.

Conclusion

With healthcare expenses increasing by the day, it is wise to keep two health insurance policies handy. This is especially important for those with an inadequate health plan. However, inform both insurance companies about the other policy to avoid any issues during health insurance claim settlement.

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

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