Can You Claim Health Insurance from Two Companies?

Can You Claim Medical Insurance from Two Companies?

Yes, you can claim health insurance from two companies. The Insurance Regulatory and Development Authority of India (IRDAI) allows you to claim multiple health policies for the same treatment or health emergency. However, there are certain conditions and guidelines that you need to follow.

If you have more than one mediclaim policy, you must inform both insurers about the existence of the other policy. This is important to avoid any health insurance claim rejection or complications in the future.

What is the Contribution Clause in Health Insurance?

The Contribution Clause applies if you have multiple health insurance policies. As per this clause, the total health insurance claim amount is shared among insurers in proportion to their respective sum insured amount. This means that if you are covered by more than one policy, each insurer will contribute a portion of the claim based on their coverage amount.

However, in 2013, the IRDAI revised its rules and removed the Contribution Clause. Hence, you can choose to claim the entire amount from a single insurer without any contributions from other insurers, unless explicitly stated in the policy terms.

When Should You File a Health Insurance Claim with Two Companies?

You will need to file a health insurance claim with two companies if your hospital bills exceed the sum insured of one policy. As a result, you will need to claim the remaining amount from your second medical insurance policy. Similarly, in case your claim is denied by one insurance company, you can approach the second insurer to settle your claim.

However, it is important to inform both health insurance companies about your hospitalization and expected claim to avoid rejection due to late intimation.

How to Claim Health Insurance from Two Companies?

You may be aware of how to claim health insurance from one company, but not with multiple insurers. Follow the steps given below to claim two health insurance from two companies:

Step 1: Inform both insurance companies about your hospitalization. Provide them with the necessary details to ensure a smooth process.

Step 2: Decide which insurance company you want to file the claim with first. You can choose based on the sum insured, coverage, ease of claim settlement, etc. Moreover, you should prefer an insurer that offers cashless hospitalization facilities.

Step 3: File your cashless claim with the primary insurer by submitting the pre-authorization form with other required documents.

Step 4: Once the primary insurer approves your claim, obtain the treatment and collect all essential documents, including medical bills, payment receipts, test reports, etc., at the time of discharge.

Step 5: The primary insurer will pay the approved claim amount to the hospital and provide you with a settlement statement indicating the amount.

Step 6: Pay the remaining hospital bill and submit the first insurer's settlement statement, along with other required documents, to the second insurer to file a reimbursement claim for the remaining amount.

Step 7: The secondary insurer will verify your documents and process your claim based on the policy terms and conditions. They will reimburse you the claim amount.

Let's understand this better with the help of the following example:

Rahul has two health insurance policies, one from Insurer A with a ₹3 lakh sum insured and another from Insurer B with ₹2 lakh coverage amount. When he undergoes surgery costing ₹4 lakh, he uses both policies to cover the expense. First, he claims from Insurer A, which reimburses ₹3 lakh. He then submits the claim for the remaining ₹1 lakh to Insurer B by submitting Insurer A's settlement statement and other required documents, ensuring full coverage for his medical expenses.

Documents Required to File a Reimbursement Claim

The following documents are required to file a reimbursement claim:

• Health insurance claim form
• Hospital discharge summary
• Hospital bills and payment receipts
• Diagnostic test reports and imaging scans
• Doctor's prescription, suggesting hospitalization and treatment
• Pharmacy bills and payment receipts
• Claim settlement statement from the primary insurer
• Any other documents required by the insurer

Things to Keep in Mind While Claiming Health Insurance from Two Companies

Here are a few things you should keep in mind while claiming medical insurance from two companies:

• Analyze the Coverage – Before filing a claim with either insurer, understand the coverage offered by each health insurance policy to know what you are covered for.
• Claim One Policy for Lower Claim Amount – If your claim amount is less than the sum insured offered by the first policy, then you can claim medical expenses from 1st insurer only.
• Settle Claim with Primary Insurer First - A claim with the secondary insurer can only be made after the primary insurer has settled the initial claim.
• File Cashless Claims First – If you can avail cashless treatment under your mediclaim policy, then file a cashless claim with your primary insurer. Once you obtain the settlement statement from the primary insurer, file a reimbursement claim for the remaining bill amount with the secondary insurer.
• Pay Hospital Bill Before a Reimbursement Claim – Before filing a reimbursement claim with either insurer, pay the hospital bill in full. Submit the required documents to the primary insurer to get your claim settled. You can then claim the remaining amount from the secondary insurer after submitting the settlement statement from 1st insurer and the required documents.
• Cross-check Documents Before Submitting – Make sure all submitted documents are accurate and complete to avoid rejection of the claim.
• Keep in Touch – Communicate with both insurers promptly to address any issues or concerns and keep a record of all communications with the insurer.

How to Claim Health Insurance from Two Policies with the Same Insurer?

Buying two mediclaim polices from the same insurance company is convenient as the claim process will be less cumbersome and you will require less paperwork. However, both plans may have different coverage and terms & conditions. Therefore, before purchasing both plans, read the policy document carefully to understand what you are covered for and what are the terms and conditions.

The best possible way to avoid any claim rejections and ensure a smooth claim settlement process is to be transparent with your insurer and disclose existing plans and medical conditions beforehand.

Tips to Claim Health Insurance from Two Companies

Check out the tips below to file a health insurance claim from two insurance companies:

• Notify both insurance companies about your hospitalization and intent to claim as early as possible.
• Choose your primary insurer based on factors like sum insured, ease of settlement, and policy benefits.
• Keep original bills, prescriptions, medical reports, and hospital receipts, as they are essential for claim approval.
• Once your primary insurer processes the claim, collect the settlement statement from them to raise a claim with the secondary insurer.
• You can only claim up to the actual expenses incurred. Any attempt to claim more amount from the two insurers will be considered insurance fraud.
• Submit your claims within the specified time limit of each insurer to avoid rejections.