How To Make Health Insurance Claims With Multiple Policies?


How To Make Health Insurance Claims With Multiple Policies?

People are increasingly choosing more significant sum insured amounts due to the sudden increase in healthcare prices, medical expenses, and lifestyle changes that cause daily illnesses. The number of consumers purchasing several online health insurance policies from various insurance policy providers has increased.

The cost of your hospital stays and other related costs during healthcare emergencies are covered by the medical policy, which is an essential service. You might want broader coverage and claim leverage in light of rising healthcare costs to preserve your funds. It can be advantageous in some situations to have multiple health insurance plans.

The most frequent query that arises when there are numerous health and medical insurance plans, including one purchased personally online and another that the employer-provided, is: Can we claim health insurance from two companies?

Many health insurance plans guarantee you improved protection and are very helpful throughout pricey medical treatments. You can utilise your second health insurance plan to pay the remaining costs if your medical expenses exceed the sum insured provided by one policy. However, informing both insurance companies about your alternate health plan in advance would be best. Health insurance claim settlement may be challenging if the current health plans aren't disclosed.

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 employer 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 employer, 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 employer. Yet it makes more sense to choose a company-provided insurance coverage before filing a claim.

Using employer-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.

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.

How to Make Multiple Health Insurance Claims?

Be sure you have informed both insurance providers about the second policy if you have two medical insurance policies, first and foremost. You need to declare this when the second health plan is purchased. You can pick any insurance company to settle claims when you have several insurers. You can utilise the second health plan to cover any remaining costs if your medical expenses exceed the insured amount of one policy. Always use your company health insurance policy to resolve claims before using your individual policy.

For example, you are protected by a family health insurance policy with a sum insured of INR 4 lakh and INR 2 lakh, respectively, and a group health insurance policy. Let's say your medical expenses total INR 3,50,000. In this situation, you can pay the first INR 2 lakh with your group health plan and the remaining INR 1,50,000 with your family floater. The family floater will be useful to pay for hospital fees if anyone in your family becomes ill within the same fiscal year.

You must attach the hospital bills, get the claim settlement summary from the first insurance company, and then contact the second insurance company to pay your claim to make a claim from two insurance companies.

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.

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.

>> Click to Know - 5 Rules of Buying Health Insurance Plans

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

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