Filing claims under two health insurance policies? Important factors you should know

A health insurance policy can save you from paying exorbitant hospital bills in case of emergency. The burden of skyrocketing medical expenses could be eased with suitable health insurance policies. Many people opt for more than one health insurance plan for better coverage of treatment cost and associated expenses in case of an emergency.

Generally salaries employees often prefer more than one health insurance plan. First one offered under a group health insurance plan by the employer and the other one often purchased as an individual policy.

When it comes to submitting claims under both health insurance plans many health insurance policyholders find few difficulties. Though you can file claims under more than one policy, much depends on the fine print of the insurance coverage.

Before 2013, the Insurance Regulatory and Development Authority of India (IRDAI) rules mandated that the total medical expenses have to be shared by the insurance companies in proportion to the sum they assured. This is known as the contribution clause in health insurance policy.

The rules were later changed to allow the policyholder to approach any one insurer to settle the claim when the claim amount was within the coverage limit.

In case, the claim exceeds the coverage limit, the contribution clause is still applicable. However, the policyholders get to choose the company with whom they want to make the first claim.

There are a few nuances you should understand before applying for claim settlements under two policies. In appropriate claims could also lead to rejection.

Can you file claims under two health insurance policies?

Let’s understand this through an example.

For instance, your total hospital bills amount to ₹13 lakh. Suppose you have a group insurance policy covering up to ₹10 lakh and an individual policy of ₹8-lakh limit. Here, you may use the group policy to ultilise the full limit up to ₹10 lakh and pay the balance ₹3 lakh through the individual policy.

To make claims with two different policies, you must keep the insurers in the loop and adhere to IRDAI guidelines for such situations. The policyholders usually prefer policies offering cashless services to be their first choice. This is because cashless claims have a smoother settlement process at the network hospitals.

How to make claims under two health insurance policies?

Once your claims are settled under the group policy, you need to obtain the claim settlement summary. Then submit a copy of it along with attested hospital bills to the second insurance company.

In case, you choose to use the reimbursement claim in the first policy, claim forms and original set of documents must be sent to the insurer you decide to approach first. The insurer will provide you with a claim settlement letter containing details of the amount released by them.

The claim settlement letter will have to be submitted to the second insurer along with all the required documents. Here, the second insurance company will review the claim and settle the balance amount accordingly.

Typically, when you have the same insurer for both your policies, the process of paperwork and making claims becomes easier.

For instance, when a policy has a sub-limit for paying expenses like room rent, you may claim the excess amount through the second policy.

In Conclusion

It must be noted that health insurance policies are meant to cover your actual hospital cost and the policyholders can make profit out of it. The policyholder cannot seek reimbursement if the mentioned cost has already been covered under one policy. Also, the claim settlement process is easier in case of fixed benefit plans compared to those cover variable components with flexible coverage limits.