You can split a health insurance claim across multiple insurers. Here’s how

Faced with a medical exigency and that too of a relatively high amount, you can still be relieved if you are proactive and maintain multiple health insurance policies. The Insurance Regulatory and Development Authority of India (IRDAI) rules allow you to split your health insurance claim across insurers. The facility provides a cushion after the limit or sum insured value in one of the plans gets exhausted and covers the remainder of the balance.

Example: To understand it, say, your medical bill or treatment cost is ₹15 lakh then in such a case, you can make a claim with an insurer with a sum insured value of ₹10 lakh for ₹10 lakh claim. Now the balance can be claimed from another insurer which can pay off the remaining ₹5 lakh balance against the claim. This facility is allowed by the IRDAI and helps split claims across insurers when a single policy's sum insured value does not suffice.

Here is a step-by-step way to make the claim:

Step 1: Inform insurers on an immediate basis- For making the claim, you need to inform your insurers almost immediately upon hospitalisation. Remember to also disclose your other policies for avoiding any rejection in claim.

Step 2: Choose the primary insurer- You can go for the insurer offering a higher sum insured value and choose an individual plan as against the group cover for making the initial claim. Also you can opt for an insurer offering cashless claims against the insurance cover.

Step 3: Apply for claim with the primary insurer- For getting your initial claim processed, you need to submit the pre-authorisation form for cashless claim or a claim form for the reimbursement with the hospital's insurance desk. Also, you need to furnish the other requisite documents.

Step 4: Get the claim settled and collect settlement documents- After the initial claim is settled and you obtain the payment from your primary insurer, you need to get the claim settlement statement as well as attested copies of the original discharge summary and hospital bills.

Step 5: File claim with secondary insurer for balance amount- For the remainder balance, you need to make the claim with your secondary insurer and submit the following:

Claim settlement statement from the first insurer

Attested copies of original hospital bill, discharge summary, test reports.

Alongside, you need to furnish the claim form together with the required documents.

Important points to remember

Mandatory disclosure: When buying or making a claim, always ensure that you inform both insurers about having another active policy in place. This is a mandatory disclosure for avoiding any claim rejection later on.

You can choose primary insurer as per your discretion: The IRDAI did away with the contribution clause in indemnity-based health insurance policies, meaning in case you hold several health insurance policies, you can choose the primary insurer yourself without any restriction.

Settlement follows a sequence: Only after your initial claim is processed by the primary insurer, your subsequent claim with the second insurer can be filed and processed.

Adhere to time limits: Submit claims within insurers' specified timeline to avoid any chances of claim rejection.

Splitting claims is not for profiting or making a double claim: Only your original and eligible expenses can be claimed by splitting the claim across insurers. Simply said, total claims from insurers should be equal to the original and eligible hospital bill and claiming anything over and above it will account for fraudulent activity.