How Many Times Can You File a Health Insurance Claim in India?

If you have a health insurance policy, you need to file an insurance claim to get your insurer to pay for your medical expenses. The best part is that you can file multiple claims during your policy term, provided your sum insured has not exhausted. The only way you can raise claims despite sum insured exhaustion is through the restoration benefit.

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      The cost of hospitalization has risen so much that in certain cases the sum insured might get exhausted in the initial two or three claims only. In such a scenario, a restoration benefit or refill of sum insured is provided by health insurance companies once in a year.

      When the limit of coverage amount gets exhausted or the limit of sum insured is used up during the policy period, the insurer recovers the cost of medical treatments by refilling the basic coverage amount either once in a year or as per the limits specified in the policy wordings. The idea is to ensure that the insured gets paid for the undergoing treatment and can live with the peace of mind.

      Here is a scenario to help you understand better

      Neerav purchased a mediclaim policy for family with sum insured amount of Rs 5 lakh with restoration benefit. When Neerav underwent bypass surgery he filed the first claim and the treatment costed him around Rs 3.5 lakh. A few months later a health insurance claim of Rs 1.5 Lakh was filed due to some other medical emergency. His policy sum insured got exhausted during the second claim and his insurer provided him with automatic restoration of the base sum insured. Neerav can avail claim benefit of up to Rs 5 lakh again during that year because of restoration benefit.

      Later, in the same year, Neerav had some health repercussions due to the previous open heart surgery. Although his policy was of Rs 5 lakh still the health insurance claim won’t be settled. The restoration benefit feature, does not apply to the same course of medical treatment. Unfortunately, Neerav’s health insurance claim process will not be initiated for the treatment he has undergone earlier, and he will have to pay the hospitalization expenses himself. Therefore, it is imperative to know the policy terms and features of the health insurance policy that you are purchasing.

      Therefore, you should opt for an adequate coverage amount and check the limit for restoration benefit when buying health insurance in India. Mostly, all private health insurance companies in India provide restoration benefit but you should still check with your health insurance company about the restoration benefit. With refill benefit your sum insured amount gets doubled and helps you meet all the medical expenses.

      If you have some more doubts then you can check-out the answers to some of the questions that you might have regarding health insurance claim process.

      After how many days can you file claim for your health insurance policy?

      This will totally depend on your health insurance provider. There might be a waiting period before you can file a claim and also on some specific illnesses. And once this waiting period is over, you can lodge a claim up to the sum insured limit during the policy term.

      Can you file medical insurance claim with two insurers at the same time?

      No, it is not possible to file health claim with two insurance companies simultaneously. You will have to file a claim with the first insurance company and if that is not enough then you can claim for reimbursement from your other insurance policy. It is usually done with top-up mediclaim policies that offer coverage over and above the deductibles in the existing health plan. Make sure that you maintain transparency and disclose all the essential details to avoid claim rejection from either of the insurance providers.

      Is it possible to purchase multiple health plans for the same person?

      Yes, you can purchase multiple health insurance policies on the same person. This will offer wide coverage and availability of different benefits from each of the insurance providers. Having access to two or more health insurance plans can be beneficial, especially during claims.

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30-minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881. Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. As per the Insurance guidelines, you are allowed to cancel the policy with-in 15 days from the date of Issuance of policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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