You can claim multiple health insurance policies; however, you cannot file the same claim from two different insurance providers. It would be construed as being health insurance fraud. You can file a claim on the other plan ONLY if one health insurance plan has been exhausted. Hence, purchasing multiple health insurance policies is a prudent decision.
Buying health insurance is no more a privilege reserved for a select few. Ever-rising risks to people’s health and the rising incidence has increased the penetration of insurance in India.
Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024. The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
What Is A Contribution Clause In A Health Insurance Policy
The Contribution Clause in health insurance is associated with the contribution of various health insurers towards your health insurance claims. Before 2013, the Insurance Regulatory Development Authority of India (IRDAI) rules stated that different insurance companies had to bear the medical expenses of a particular policyholder in proportion to the sum insured in health insurance for each policy.
For instance, if you had two health insurance policies of, say, Rs. 10 Lakhs and Rs. 20 Lakhs each from insurer A and B, respectively, then your health insurance claims would be settled by them in the proportion of 1:2. If you filed a claim for Rs. 3 Lakhs, then A would pay Rs. 1 Lakhs whilst B would pay Rs. 2 Lakhs. However, this clause does not exist anymore. Now you can approach any of your health insurance providers for a health insurance claim without the contribution Clause being in the picture.
Therefore, if you have two health insurance policies of say, Rs. 5 Lakhs and Rs. 15 Lakhs and wish to file a health insurance claim of Rs. 4 Lakhs owing to the treatment cost of a surgery covered under both the plans, then you can file said claim with either (but not both) of the insurers.
How To Claim Health Insurance Benefits From Two Policies Or More?
It is easy to purchase more than one health insurance policy. However, with regard to claiming their benefits, it is natural to wonder: 'how to claim multiple health insurance policies?'. You must inform the health insurance providers you wish to file a claim with as soon as you get a medical treatment and/or get hospitalised.
Subsequently, you need to file a health insurance claim with one of your multiple health insurers. Once they have settled the claim and issued the summary of the claim settlement, you can approach the second insurer (only if the sum insured of the first policy was insufficient to cover your medical expenses).
For instance, if you incur medical expenses to the tune of Rs. 8 Lakhs and have two health insurance policies with sum insured of Rs. 5 Lakhs and Rs. 4 Lakhs, respectively, you must firstly file a health insurance claim with one of the insurers. Once you have received the claim settlement documents, you can file the claim for the remaining amount of the policy with the second insurer. You can file either a cashless claim or a reimbursement claim.
Cashless Claim
You must inform your health insurers before getting treatment at a network hospital (in case of planned treatment) or after getting treatment (in case of emergencies). Then you must file a cashless claim with one of the insurers. If the sum insured under one of the policies does not suffice, then you must file a subsequent reimbursement claim with the second insurer. If required, you can reach out to a third insurer as well (if you have more than two health insurance policies).
Reimbursement Claim
To file a reimbursement claim, you must inform your health insurer/s at the earliest before or after getting treatment at a non-network hospital. Then, you must submit the duly filled claim form along with the required supporting documents to the first insurer. If there is a gap between your actual medical expenses and the claim settlement amount, then you can repeat the process of claim settlement with a second insurer.
If you have purchased two health insurance plans with different coverages from the same insurer, you can file the second claim on the second plan.
What Are The Documents To File A Reimbursement Claim
Here are the documents that you must submit with your reimbursement claim.
Hospital admission and discharge summary
The bills and receipts for your treatment, including hospitalisation
Your prescriptions relevant to the treatment for which the claim is being filed
Copies of laboratory reports, X-rays, etc.
The claim settlement summary received from the first health insurance provider (in case you are filling a reimbursement claim with a second or third health insurer).
Important Points To Keep In Mind Whilst Claiming Multiple Health Insurance Policies
In addition to having an answer to, “Can I claim insurance from 2 different companies?”, you must keep certain important points in mind whilst filing such claims.
It may take 30 to 45 days for each of your health insurance claims to be settled. The claim filed with the first insurer can be a cashless claim and the insurer will settle it after accounting for the applicable deductions and sub-limits under the policy. Then, you can proceed with the filing of the second claim.
The second insurer will have a similar claim settlement process as the first, and will deduct the claim amount of the first claim to arrive at your second claim settlement.
If you have Group or Corporate Health Insurance as well as Individual Health Insurance, then you must firstly file a claim on the former. Employer Health Insurance Policies are generally simpler and have an easy claims process.
Retain the copies of all your hospital bills, payment receipts, diagnostic reports, doctor's prescriptions, etc. These documents serve as important supporting documents whilst filing a health insurance claim.
The Final Takeaway
Although the health insurance claims processes for most insurance providers have been simplified and made customer-friendly, filing multiple claims for the same treatment can be complex and confusing. It can be difficult to wait for the reimbursement of health insurance claims from multiple health insurance providers.
Therefore, it is advisable to opt for a single health insurance plan, one that has a high sum insured. At any point, should you feel that the coverage of the plan is insufficient, you can opt for a Top-Up Health Insurance Plan to enhance your overall health insurance coverage.
Frequently Asked Questions About Claiming Multiple Health Insurance Policies
Can I file a claim on my health insurance policy multiple times in a single year?
Yes, you can file multiple health insurance claims on one policy in a single year. However, your claims will be entertained only as long as their amounts do not exceed the sum insured mentioned in your health insurance policy.
Is it legally permissible to have multiple health insurance policies?
Yes, you can purchase multiple health insurance policies. However, it is prudent to opt for one plan and have a high sum insured. This approach can spare you the hassle of filing multiple health insurance claims for the same medical treatment.
Can we claim multiple health insurance policies?
Yes, you can claim from multiple health insurance policies. However, the sum insured under your first policy must be exhausted for you to be able to claim from a second or third policy for the same medical treatment.
