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How to Make a Claim from Multiple Health Insurance Policies?

19 May 2022, 1:47 PM

The increased inflation in the prices of medical facilities has led to the need for higher sum insured among people. This has triggered the necessity to purchase multiple health insurance policies among the common people. Moreover, insurance providers are quite resistant in granting medical insurance policies beyond a specific sum insured which also increases the need for the purchase of multiple health insurance policies.

However, if you are holding multiple health insurance policies, it would be helpful only when the coverage and benefits provided by one are different from another. It is ideal when the coverage in multiple health insurance policies is mutually exclusive. While purchasing multiple health insurance policies, you would have to fill the insurance provider's forms which has a field for disclosure of any other health insurance policy being held by you. Not disclosing this can be considered as a violation of the terms of your insurance contract and the liability of your insurance provider would be limited only up to the sum insured. 

Contribution Clause

The disclosure of already having a health insurance policy is because of the Contribution Clause. According to this clause, if you are buying a new health insurance policy in India while you are holding a health insurance policy already, then you are abided to share the details. So, when you make a claim, the insurance providers would share the claim amount amongst themselves in the ratio of the sum insured of the different insurance policies. 

Recently, there have been some changes in the claim settlement procedure and these changes have been introduced for mitigating the contribution clause up to some extent. Previously, you would have to inform all your insurance providers about who would be paying your claim amount in terms of the ratio of the sum insured. However, with the change of regulations, it is necessary to inform anyone of the insurance provider about the claim. In case your claim amount is higher than the sum insured of a single medical insurance plan after taking into consideration the factors like co-pays and deductibles, you have the authority to decide on which insurance provider must be approached first.  

Steps to Make Claims from Multiple Health Insurance Policies

Let us check out the major steps which are involved in making claims from multiple health insurance policies. Multiple health insurance claims can either be cashless or reimbursement or one cashless and then one reimbursement. This could be either from an indemnity or a top-up/super top-up plan. 

Cashless Claim Procedure from Multiple Health Insurance Policies

  1. You can make your cashless health insurance claim from one insurance provider and obtain the summary of the claim settlement.
  2. Now, you must attest the copies of your bills and approach your second insurance provider with a request to reimburse the balance amount.
  3. In case you have clearly defined the cost of the treatment then you can duly fill both the authorization forms.
  4. The authorities at the hospital would send both the forms to their respective insurance providers.
  5. Based on the forms, the insurance providers would settle the bills with the hospital directly.

Reimbursement Claim Procedure from Multiple Health Insurance Policies

  1. Even if the cashless claim settlement procedure is quite common these days, some hospitals still prefer the reimbursement method of health insurance claim settlement.
  2. You would pay your bills first from your pocket and then the insurance provider would reimburse it.
  3. You must submit the original bills based on which your insurance providers would reimburse the medical expenses. These bills would be kept by your insurance providers.

Let us suppose, you have health insurance policies from two insurance providers. You can make your bill payment by using the health insurance plans from both the providers; however, you would have to submit all original bills and documents to your insurance providers.

For example, you have a medical bill of around INR 8 lakhs and you have health insurance policies from two insurance providers with a sum insured of INR 5 lakhs each. You would have to submit all original bills and documents to the first insurance provider. You must clearly state the amount you want to claim from this insurance provider. This could be a cashless or a reimbursement procedure.

After the amount has been paid by the first insurance provider, you should obtain the claim settlement summary and the photocopies of the bills. These photocopies must be attested by the hospital authorities and should be submitted to the second insurance provider along with the claim settlement summary. Now, the second insurance provider would pay the remaining amount.

Points to remember

In addition to the basic steps which need to be followed, there are some points which you must remember while making your claims from multiple health insurance policies.

  1. The claim settlement done by the first insurance provider could be cashless or reimbursement. However, the principal medical coverage team would figure out the amount to be paid which would comprise of the deductions and sub-limits against the claim while the rest of the claims are repaid later. 
    Later, the second insurance provider would also follow the same procedure and consider the claim to be made immediately.
  2. If you are covered under group mediclaim and individual health insurance plans, then it is suggested to contact your group insurance provider first. This is because group health insurance plans have faster claim settlement procedures as they do not have complicated clauses. These plans cover pre-existing conditions from day one and have a very low waiting period. The number of claims made in a year does not affect the policy premium at the time of renewal and your No Claim Bonus for individual cover is not affected at the time of renewal.
  3. If you are opting for top-up/super top-up plans or increasing the sum insured of the same policy during renewal, it would help in saving from the problem of making claims from different small insurance providers.
  4. If you have two individual health insurance plans, you should prefer the use of the older policy first for settlement of the claim amount since the waiting period for the pre-existing conditions would exhaust with time for the first policy earlier.

Conclusion

Hence, with the need and awareness to have adequate financial security at the times of medical emergency many people are opting for multiple health insurance policies. You must know in detail about every health insurance policy, its inclusions, exclusions, and terms. However, if feasible, it is always advisable to opt for a single health insurance policy with adequate cover to avoid time-consuming claim settlement procedures and paperwork.

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