How To Make Health Insurance Claims With Multiple Policies?

• Written by Yashita Sinha

  Reviewed by Akhil Pillai

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With the rising healthcare costs in the country, having health insurance is not an option but a necessity. But in today’s fast-paced lifestyle, health has taken a backseat and in the daily hustle and bustle, unexpected health issues might arise.

In such an unpredictable scenario, having single health insurance might not always cover the full extent of medical expenses, especially during critical illnesses or accidents requiring prolonged hospital stays.

Having multiple health policies provides comprehensive coverage, protecting you from financial burdens. But how do you navigate the process of making claims across multiple policies? This blog covers everything you need to know.

Types Of Health Insurance Claims

Claiming health insurance from multiple policies includes two types of claims: cashless claims and reimbursement claims. Each is discussed below for better understanding.

Cashless Claims

These claims within a health insurance policy allow you to avail of cashless treatment in network hospitals listed under your policy. In cashless claims, your medical expenses and hospitalisation charges are directly settled between your insurer and the network hospital.

Process For Availing Cashless Claims

• If your claim falls within the sum insured of a single policy, pick a network hospital covered under this policy.
• Inform the primary insurer about your hospitalisation and provide them with complete details.
• Your primary insurer will now coordinate with the network hospital to coordinate with the network hospital, including evaluating the claim. If the claim gets settled, you will receive the claim settlement summary.
• Submit the claim settlement summary and the attested hospital bills to the second insurance company. This allows you to claim reimbursement for the remaining amount.
• Your second insurer evaluates the claim and settles the amount based on their policy terms and conditions. They’ll provide reimbursement for the expenses which won’t be covered by the primary insurer.

Reimbursement Claims

These types of claims demand you to pay the hospital bills firsthand and then receive compensation from the insurance company at a later stage.

Process For Availing Reimbursement Claims

In cases where you receive treatments at non-network hospitals, you are supposed to file for a reimbursement claim. Here are the steps involved in filing the claim;

• The first step involves paying the hospital bill out of your own pocket. Next, ensure that you collect all the necessary documents, such as lab reports, medicine bills, summaries, and other relevant medical records.
• Please complete the claim form provided by the insurance company and attach the required documents according to your insurer’s guidelines.
• At the final step, the insurance company evaluates your claim based on the submitted documents and decides the reimbursement amount per their policy terms.

How Many Policies Can You Buy?

There is no limit on the number of health insurance plans that can be purchased. People should, however, have their private health plan with sufficient top-up coverage in addition to what their insurer provides. One family member can convert an individual cover into a family floater plan to provide coverage for every family member.

So, in addition to the insurance given by the insurer, one should have their policy as supplemental insurance, as well as a top-up on their personal health insurance policy, to ensure that any medical expenses that exceed the policy's coverage limit are also covered.

Which Policy Can You Use First?

While making a claim, a person may opt to use either their private health insurance policy or the group coverage offered by their insurer. Yet it makes more sense to choose a company-provided insurance coverage before filing a claim.

Using insurer-provided insurance first might be a better idea because claiming an individual health plan might impact the cumulative bonus. The top-up plan will be relevant if you don't have employer health insurance and file a claim under an individual policy that exceeds the total sum insured. A top-up policy typically has a deductible equal to the base policy's sum insured. The deductible can, of course, also be paid out of pocket.

How To Claim Health Insurance From 2 Policies From The Same Insurance Company?

• Claiming health insurance from two policies from the same company involves carefully curated steps. Here’s a breakdown of these steps.
• Review the policy terms and conditions to better understand the expenses covered by the policy. This will help you ensure that the costs you wish to claim are included in the coverage.
• Collect all the relevant documents, including medical bills and receipts.
• File for the claim on the primary policy
• Upon the settlement of the claim, you’ll receive a claim settlement summary from the insurance company.
• File for the second policy claim along with this summary and relevant documents.

How To Claim Health Insurance From 2 Policies From Different Insurance Companies?

Claiming health insurance from two policies from different insurance companies is tedious. But following these simple steps can help in streamlining the process;

Inform Both The Insurers

The foremost thing to do when filing claims for two health insurance policies from different companies is to inform them individually. Give them all the necessary details regarding your claim.

Submit Claim Documents

Collect all the relevant medical documents- bills, reports, receipts and other supporting documents. Next, ensure you have copies of these documents for each insurer you’re approaching.

Choose Your Primary Insurer

Your primary insurer is the insurance company you approach first for the claim settlement process. One way to make it easy to choose your primary insurer is to compare the coverage options they provide. This helps you evaluate which would be better for your specific medical expenses.

Claim Filing

Following your primary insurer's standard claim filing process, submit the claim documents.

Note: Ensure that the information provided in the documents is accurate and complete.

Get The Settlement Statement

Once your primary insurer settles the claim, you receive the settlement statement, which details the amount reimbursed.

Approach the Secondary Insurer

Now that you have the settlement summary from your primary insurer, approach the secondary insurer. Submit the summary and other relevant documents to initiate the claim process with the second insurer.

Collaboration between both insurers

Once you have filed for both claims, your primary and secondary insurers will collaborate to settle the final. This might involve sharing details about the already reimbursed amount by the primary insurer.

Reimbursement and settlement

Once the coordination between both insurers is completed, the secondary insurer processes your claims as per the sum insured. In the end, you receive reimbursement for the remaining amount as per policy terms and conditions.

What is the Contribution Clause in Health Insurance?

Before 2013, insurance providers were required to contribute to the policy's medical costs in proportion to the amount they had insured. For instance, your total claim is worth 75,000 INR, and you have two health insurance policies, each costing 1 and 2 lakh INR. In this case, the policyholder will receive INR 25000 from the first insurer and INR 50000 from the second, with a 2 lakh sum insured. This is the insurance policy's contribution clause.

However, to simplify things for consumers and insurance providers, IRDAI abolished this provision in 2013. A policyholder may now seek any insurer for claim settlement under the new regulation. The policyholder can utilise one policy first and the second one later to settle their medical insurance claim if the claim amount exceeds the total sum insured.

Are All Claims Going To be Cashless?

Remember that one of the two policies is the only one that allows cashless claims. So, one might utilise the cashless feature of their preferred insurance policy and receive reimbursement for the remaining sum from a second insurer.

To avoid rejection or other issues, you should always notify your insurer about your reimbursement claim within 24 to 48 hours of your hospital stay. To guarantee clarity, you can also tell the insurance company about the cashless feature on the other insurance.

The pre-authorisation form for cashless claims is available at the insurance desk located in each network hospital. Your claim will be approved, and the insurer will sanction the treatment amount once you submit the completed form.

Also, if the hospital where a person had treatment is not one of the healthcare providers in the insurance company's network, the person cannot use the cashless service. Reimbursement is the only option in this situation.

What Should You Do If You Have Several Insurance Plans with a Single Insurance Provider?

The claim settlement process is greatly facilitated by having two health insurance plans from the same provider. This eliminates paperwork. To make a claim under two policies, you may need to adhere to different rules set forth by various insurance companies. Before purchasing two health policies from the same insurance provider, carefully study the policy terms and conditions to ensure clarity in the future. You can also ask the insurer for clarification before purchasing the policy.

>>Read More-5 Rules of Buying Health Insurance Plans

Summing It Up!

Investing in a medical policy covering your health treatment costs is important if you want to access the greatest healthcare resources during unanticipated medical emergencies quickly. The policyholder is free to invest in various health insurance policies and decide which one should be used when necessary.

The policyholder is allowed to submit claims to two insurers but must ensure that the total real costs of the treatment do not exceed the total amount submitted to both insurance companies. You can choose health insurance plans by Care Health Insurance which has a 95.2% health insurance claim settlement ratio and offers a seamless claim settlement process.

Disclaimer - The above information is for reference purposes only: Policy Assurance and Claims at the underwriter's discretion.