How to File Claims from Multiple Health Insurance Policies?

Multiple health insurance policies mean increased coverage for the policyholder. This in turn means that in case one policy coverage gets exhausted, you can still rely on the other to get your hospitalization costs covered.

When Should You Take Multiple Health Insurance Plans?

As stated above, it helps to buy multiple health insurance policies to avail more benefits from mediclaim. Here’s when you can consider buying plans from different insurers:

• When one single health insurance policy fails to provide adequate coverage to cover your total healthcare costs
• When the cost of hospitalization is too high and you may not be able to sufficiently cover expenses through one health plan
• When your organization provides the benefit of a group health insurance over and above the individual health cover that you already purchased

Can We Claim Multiple Health Insurance Then?

Yes! You are free to claim your hospital bill costs with more than one insurance provider, if you feel that one plan may not be able to adequately cover the expenses. However, note that you cannot raise the same claim with two different insurers.

In other words, you cannot settle the same medical claim with two insurance companies at the same time. You would first need to settle the hospitalization bills with one provider up to the total coverage limit. You can then approach the second company for the remaining settlement, if so needed.

How to File Claims from Multiple Health Insurance Policies?

Before we proceed with explaining the process of raising claims from more than one insurance company, let us take a quick look at the Contribution Clause in health insurance which existed before 2013.

The Insurance Regulatory and Development Authority of India (IRDAI) had earlier mandated all the concerned insurance providers to share the total amount for claim-settlement proportional to the sum assured by each plan. This was the usual norm before 2013 and was known as the Contribution Clause.

After 2013, the IRDAI introduced a change in the clause to help policyholders receive benefits from multiple insurance policies. Now, the insured has the free will to approach either of the two or more insurance providers to settle the medical claim, as per their choice or preference.

However, as per the new guidelines, the policyholder can only file a claim with one insurance company at a time and not parallely with both for the same claim. This means that you would first need to raise the claim with one health insurance provider to cover the costs for the treatment up to the coverage amount assured under the plan.

The insurer would then issue a summary of the claim-settlement process. You need to submit this summary, along with an attestation of the hospital bills, to the second insurance company for settlement of the remaining costs, if any.

Also, in case of two insurance policies – individual and employer-sponsored, it is always advisable to get claims settled with the company-sponsored health insurance first before using up your individual cover.

Procedure to File Claims from Two or More Health Insurance Plans:

There are two simple ways to claim your medical care costs from health insurance if you have purchased more than one plan with different insurers:

1. Cashless claims
2. Reimbursement claims

Also understand that you would need to approach more than one insurance provider for claim-settlement only if your claim amount is more than the sum assured under a single health insurance policy. If the hospital bills can be easily settled under one plan, you can raise a claim with just one insurer.

Now let’s learn about how to raise claims if your medical costs to be covered are more than the sum assured under a single plan and you need to approach more than one insurer.

• Cashless claim-settlement: This is a more convenient procedure for claim-settlement because it is hassle-free for the policyholder. In case of a medical emergency requiring immediate hospitalization, the insured need not be worried about paying a huge amount for the admission process first. They can focus only on getting the treatment and the rest is taken care of by the insurer through the tie-up with the network hospital under the cashless hospitalization benefit of health insurance. In this case too, the policyholder can first file a cashless claim with one insurance provider. Once the latter provides a claim-settlement summary, the insured can submit it along with the required attested hospital bills to the second insurer. The second company would then proceed with settlement of the remaining expenses.
• Reimbursement claim-settlement: If you choose to avail treatment at a hospital outside of the network of the insurance company, then you need to pay the hospital bills at the time of discharge from your own pocket. However, with health insurance, the benefit is that you can claim a reimbursement for this amount from your insurer up to the sum assured by the company.In case of more than one insurers too, the same procedure can be followed. You would need to submit the claim form and all the attested required documents to the first insurance company for a reimbursement. After the company issues a claim-settlement summary, you can submit the same to the second insurance provider for the remaining expense settlement.

Documents Required for Claim-Settlement Through Reimbursement

As stated above, in the reimbursement method of claim-settlement, you need to settle the hospital bills first and then request the insurer to reimburse the amount later. Your insurer would ask you to submit a few essential attested documents in this case for claim settlement. These include:

• Discharge summary from the hospital
• Claim form
• Original bills and receipts of all costs incurred during hospitalization
• Doctor prescriptions for the treatment for which the claim is being filed
• X-rays and lab test reports, if applicable
• Summary of claim settlement (in case of raising claims with multiple insurers)