Procedure for Health Insurance Claim from Multiple Policies

Policyholders can have any number of health insurance plans. However, they cannot claim reimbursement for the same expense from multiple insurers. If one cover is not sufficient, the other cover can be used to cover the expenses.

Health Insurance is of utmost importance for every individual. A comprehensive health insurance policy ensures that the policyholder has an easy access to the best medical care and finest treatment, without being financially burdened. During a medical emergency, it’s important for the patient and his/her family to be free of any worries. Leading insurance companies in India provide health insurance policies which comprise of affordable plans, tailor-made to suit the policyholder’s rising healthcare costs. The most popular plans are individual health insurance, family health insurance, health insurance for senior citizens, and top-up health insurance cover.

Every health insurance policyholder must have the liberty to be able to decide and use more than one health insurance policy, as and when required. This is especially applicable in case of meeting steep hospitalisation expenses. Say, as a health insurance policyholder, you hold two health insurance policies, then you do have the right to claim either one policy or both. What needs to be kept in mind is that the actual hospitalisation expenses incurred cannot be more than the amount that you can claim from a policy or two policies.

The process of claiming two health insurance policies has been explained below -

For a Cashless Claim:

For cashless claims, you can use multiple health insurance policies in two ways. The first and most popular being the one where you , and procure the claims settlement summary. Once this is done, you need to get attested copies of the bills. You can now approach the second insurance company to request a reimbursement of the remaining amount. If you are lucky enough to get a clearly defined cost of treatment, you can duly fill both the authorisation forms. The hospital will send a form each to both the insurance companies. Depending on this, insurance companies will settle the bill accordingly, directly with the hospital.

Health Insurance Claims On Multiple Health Policies

For a Reimbursement Claim:

It is true that the cashless mode is prevalent these days, as it ensures the convenience of the hospital and insurance company settling the bills directly amongst themselves. Despite earning soaring popularity, there are some hospitals where the cashless facility is not accepted. In these cases, you need to pay the bill from your own pocket first, only to have it reimbursed by the insurance company later. You will be required to submit the original bills based on which the insurer will reimburse the medical expenses incurred by you. Please note that these bills will be kept by the insurer.

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To use Two Health Insurance Policies to Pay the Bill:

Say your hospital bill sums up to Rs. 3 lakhs, and you own two health insurance policies bought from two different companies. Let’s assume that the sum insured or health insurance cover in each of these policies is Rs.2 lakhs. As you wish to claim an amount of Rs. 3 lakhs, you need to make use of both the policies. This will again require you to submit all the original bills and documents to the first/more preferred insurer. You must clearly state the amount that you wish the aforementioned insurance company to pay. Once this insurer pays Rs. 2 lakhs, you will then have to obtain a claims settlement summary from the insurer and get photocopies of all the bills. You must these copies attested by the hospital and submit them (along with the claims settlement summary) to the second insurance company. Only then will the second insurer pay the remaining amount.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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