Making a Claim from Multiple Health Insurance Policies

It’s okay to have multiple health insurance policies, but understanding both of them is essential to ensure a smooth claim settlement process.
Making a Claim from Multiple Health Insurance Policies (1)
For many, it is an obvious choice to hold many health insurance policies for adequate coverage. While taking an added health insurance coverage, details of the existing policy must be disclosed in the proposal form. If not disclosed, there will be problems in the claim settlement. Thus, it is beneficial to hold more than one health insurance policy if the benefits and coverage of the policy vary.

Contribution Clause

A few years ago, there was a contribution clause imposed by the Insurance and Regulatory Development Authority of India (IRDAI). As per this clause, any individual holding many health insurance policies will need to claim the amount in the proportion of the sum insured by both insurers. But, some time ago, this clause was withdrawn. Now, the insured has the freedom to claim the amount from either of the insurance companies. In no way, it is compulsory for the insured to take a claim from each policy unless the amount claimed exceeds the sum insured of one policy. For example, Anil has two policies with the sum insured of Rs. 3,00,000 and Rs. 2,00,000. He has a claim of Rs. 4,00,000. He can claim Rs. 3,00,000 from the first and the balance from the second policy.

Choice of Policy

If you hold more than one health insurance policy, you can choose the insurer. The choice becomes simpler if you have one group insurance policy and one individual policy. In this case, you must choose the group policy. If needed, take the balance amount from the second policy. Under a group policy, the amount claimed will not affect the premium you pay for the next year. In case, the entire amount is settled by the group policy; you can avail the benefit of the No Claim Bonus (NCB) in your policy. In case both policies you have are individual plans, you can choose any one.

Partial Payment

If the insurer does not pay the entire claimed amount and does not approve a part of it, you have the right to claim the balance amount from the other insurer. Last year, the IRDAI had clarified for individuals with many health insurance policies. The amount disallowed by one insurance company can be availed at the second insurance company, even if you have not exhausted the entire sum insured.

The Claim Process

For settling any claim, the insurance company always requires the original discharge summary and hospital bills. The documentation can become an issue. Thus, you need to take claims from both insurance companies.

In this case, you need to submit the original documents to the first insurance company and keep the self-attested copy of all the documents with you. After the first insurance company settles the claim, you need to ask for original papers and submit these along with self-attested documents.
In case the first insurance claim you file is a cashless one, the second will need to be a reimbursement one. When settling the claim, both insurers will consider the sub-limits and the deductibles and arrive at the claim amount. The first one will pay the figure they arrive at and the second one will deduct the amount paid by the first company and pay the rest.
Transparency and disclosure are essential aspects if you hold more than one insurance policy. It’s okay to have many health insurance policies for financial protection at the time of medical emergencies. Having the complete understanding of both policies is essential for a smooth claim settlement process.

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