Can We Use Multiple Health Insurance Policies for a Single Claim?

Wondering, Can we use multiple health policies for a single claim? The gruesome COVID-19 pandemic has forced people to understand the importance of health insurance which was underrated by many till years back. Many people required hospitalization or emergency treatment when the pandemic was at its peak. Even after 2 years, we are living with COVID-19 and according to the experts; the country is once again facing the fourth wave of the deadly pandemic. People who have comorbidities may need longer hospitalization to combat COVID-19 or any other diseases. At the end of the day, you need to pay a humongous hospital bill for your/your family members’ treatment.

But if you have multiple health insurance policies, then you may stay relaxed to some extent under medical contingencies. A medical claim policy will cover your hospital expenses without compromising the treatment. If you have more than one health insurance policies, they will not only enhance your coverage but also help you to save a chunk of money by using several benefits. As a policyholder, you are free to use various policies, including group health insurance policies from your employer, an individual health insurance policy and your first top-up health policy to claim a single hospitalization bill.

But certain terms and conditions you should follow before making a claim of policy.

To cope with the rising healthcare inflation and medical costs, a policyholder can purchase various health insurance policies from different insurance companies in the country. This is very much applicable when the policyholder needs a higher sum insured amount which can’t be fulfilled by a single health insurance policy.

While purchasing two indemnity policies, a policyholder can select the best cashless mediclaim policy under which he/she wants to initiate the claim first. If your claim amount is far above the sum insured under the policy on which you initiated the first claim, then you can claim the remaining amount from the second policy.

While purchasing a health insurance policy, every policyholder needs to fill out proposal forms where the insurance companies ask for disclosure of any existing policy. If you purchase two different policies from different insurance providers, then you should intimate both companies regarding your health insurance policies. Else the insurance company has every right to reject your claims as non-disclosure of policies due to the violation of the insurance contract.

Health insurance companies often need this information as most policies follow a contribution clause. According to the clause, if an insured person holds more than one policy, then all his/her health insurance policies will contribute in equal proportion to the sum insured to settle a claim.

To make the policy purchase process facile and utilize the benefits of multiple health insurance policies, the Insurance Regulatory and Development Authority of India (IRDA) has refurbished the rules and regulations. Before 2013, the IRDA mentioned that the total healthcare expenditures had to be shared by the insurance providers according to the sum assured by them. This is called the ‘Contribution Clause’ in the field of health insurance. But this clause is eliminated and now, a policyholder can go to any one of the insurance companies to settle the claim.

Can We Claim Health Insurance from Two Companies?

If you hold an employer health insurance and one personal health insurance policy, then you may think “can we claim insurance from two companies?” You will certainly claim from multiple insurers. You need to initiate a claim from the first health insurance provider towards all your healthcare expenses. Now, collect the summary of the claim settlement, attach the hospital bills and go to the second insurer to settle the remaining expenses.

Claim Settlement Process From Two or More Policies

If your initiated claim amount is less than the sum assured, then you may raise the claim under a single policy. But if hospital expenses surpass the sum assured of a single policy, then you can raise the claim in the below-mentioned ways.

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Cashless Claims

Under the type of claim policy, you may get cashless treatment facilities if you are admitted to an empaneled hospital. You can initiate the claim with one insurance provider and get the claim settlement summary. After receiving all these, now submit the claim settlement summary and attested hospital bills to the second insurance company. Approach the second company to settle your claims in the form of reimbursement.

Reimbursement Claims

Under some medical emergencies, you may need to admit to a hospital which is not included in the network of your insurance provider. Under this scenario, you need to opt for the reimbursement method to settle your claim. First, you need to pay the bill from your side and then get a reimbursement form from your insurer. Along with the claim form, you need to submit all imperative documents including the various test reports, bills for medication, the  discharge summary etc. After reviewing your claims and documents, the insurer will settle the claim amount.

Things to Keep in Mind Before Going for Two Health Insurance Policies

• Check the co-payment clause and deductibles before opting for health insurance policies. Under the co-payment clause, the policyholder needs to pay a certain percentage of the claim. For deductibles, your insurance company will pay the remaining amount after deducting a fixed amount.
• Check the older policy first, as your waiting period and pre-existing exclusions might be completed before utilizing it.
• If you have an individual policy and an employer’s health policy, utilize the employer’s policy first. Because the claim settlement process is quicker and faster for group policies.
•  If you hold two policies with cashless facilities, the hospital will offer you this option only for one policy and ask you to pay the remaining amount and get it repaid from another insurer.
• Choose cashless policies first as you don’t need to pay anything from your side and then, utilize the second policy to reimburse the additional amount.

Though there is no restriction regarding purchasing the number of health insurance policies, the experts suggest buying two health insurance policies that offer adequate sum insured amounts (one base policy and a top-up). This may help you to stay away from unnecessary confusion at the time of the claim settlement process.

 

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