Jane Dotson
With the rising costs of medical treatment in India, it has become increasingly important to have a comprehensive health insurance plan. While a single health insurance policy may not be sufficient to cover all medical expenses, the Indian government has made it possible to hold multiple health insurance plans. This allows individuals to benefit from broader coverage and provides flexibility during medical emergencies. However, claiming health insurance from two companies can sometimes be a complex process, and it is important to understand the coverage provided by each policy to determine the best approach.
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What You'll Learn
Yes, you can claim two medical insurance policies in India
With the ever-rising medical expenses in India, owning a single health insurance policy may not be sufficient to cover all your medical costs. This is why the Insurance Regulatory and Development Authority of India (IRDAI) permits you to file health insurance claims with two different insurance companies for the same medical emergency or treatment.
The IRDAI has also implemented changes to facilitate the utilization of multiple health insurance plans. Previously, there was a 'Contribution Clause' in health insurance, requiring insurance companies to share medical expenses based on the proportion of their sum assured. Now, you can benefit from broader coverage and have the flexibility to seek medical treatment from different insurers.
However, if you intend to claim from two insurance companies, you must keep both the insurance companies informed about any existing health insurance policies that you may have from other companies. You must also follow the necessary IRDAI-determined guidelines and protocols under which you can claim health insurance from two companies.
How to claim from two insurance companies
The claim-filing process typically remains the same for all insurers. Here is a step-by-step guide on claiming health insurance benefits from two policies:
- Understand the coverage: Review the terms and conditions of both policies to ensure the expenses you want to claim are covered.
- Gather documents: Collect all necessary documents, such as medical bills and receipts, prescription for diagnostic tests, treatment advice, and visual records of imaging studies.
- File the primary claim: Submit a claim with your primary health insurance company following the standard procedure. If you are eligible for cashless hospitalisation at a network hospital, you should first raise the claim with them.
- Obtain a claim settlement summary: Once the claim is settled, get a claim settlement summary from the insurance company.
- Submit a claim to the second policy: Provide the claim settlement summary and required documents to the second policy for reimbursement of remaining eligible expenses.
- Track the claim: Stay in touch with both insurance companies and monitor the claim's progress.
Important things to keep in mind
- Your claim can be rejected if you file a claim for an ailment that isn't covered by your health insurance policy, if you fail to submit the necessary documents, or if you file a claim during the waiting period.
- If the claim amount is less than the sum assured of a single policy, you can only claim under one policy. In such cases, it is recommended to raise a claim with a single insurance provider to avoid losing the No Claim Bonus (NCB) from one of the policies.
- To prevent claims from being rejected and to ensure a seamless claim procedure, it is essential to be open with your insurer about any existing health insurance policies you may have.
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You must inform insurance companies of any existing policies
In India, it is legal to have more than one health insurance policy. The Insurance Regulatory and Development Authority of India (IRDAI) permits individuals to file health insurance claims with two different insurance companies for the same medical emergency or treatment. However, it is crucial to keep both insurance companies informed about any existing health insurance policies. This is to prevent claims from being rejected and to ensure a seamless claim procedure.
When a claim is denied by one insurer due to the exhaustion of the sum insured, policyholders can turn to another policy and ask for coverage for the same medical expense. This proactive risk management approach underscores the importance of comprehensive coverage and diligent policy management in health insurance. By spreading coverage across multiple insurers, policyholders can leverage the principle of risk pooling to their advantage.
To file a claim with two insurance companies, policyholders must first raise the claim with their primary health insurance company and obtain a claims settlement summary. They can then submit the hospitalisation bills to the second health insurance company to request reimbursement for the remaining amount. It is important to note that the total hospitalisation expenses should not exceed the maximum coverage provided by one or both insurance policies.
It is also essential to understand the different benefits of each plan before purchasing multiple health insurance policies. While having multiple insurance policies can be beneficial, it is important to opt for policies with smooth medical insurance claim procedures to avoid problems during the claim process.
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Claims can be cashless or reimbursement
In India, it is legal to have two or more health insurance plans. This can be beneficial as it gives you access to higher sums insured while comfortably covering your various medical costs. However, if you intend to file claims with two different insurance companies for the same medical emergency or treatment, there are a few things to keep in mind. Firstly, both insurance providers must be aware of the other policy and any existing health insurance policies you have. Secondly, you must follow the necessary guidelines and protocols determined by the IRDAI (Insurance Regulatory and Development Authority of India) for claiming health insurance from two companies.
When it comes to making a claim, there are two main options: cashless claims and reimbursement claims. With a cashless claim, the insurance provider settles the hospitalization bills directly with the hospital. This option typically requires hospitalization at a network hospital of the insurer, and you must notify the insurance company at least 48 hours before hospitalization. Cashless claims offer advantages such as no upfront payment, wider hospital access, a simplified and faster claim process, and reduced paperwork.
On the other hand, with a reimbursement claim, you would need to submit the claim form and attested copies of your discharge summary, lab results, and other relevant documentation. The insurance provider will then examine the claim and pay the appropriate sum. Reimbursement claims may take longer to process and require more paperwork, but they offer flexibility in choosing a hospital, including non-network hospitals under certain conditions.
If you have two insurance policies and the claim amount exceeds the sum assured of one policy, you can use the reimbursement or cashless method for the policy with the higher sum insured. Once you receive the settlement summary from the first insurer, you can contact the second insurer to settle the remaining amount using the reimbursement method and providing the necessary documentation.
It is important to carefully review the terms and conditions, coverage benefits, waiting periods, and exclusions of your health insurance policies before filing a claim to understand which option is best for your specific situation.
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Multiple policies can be a strategic hedge against claim rejections
In India, the rising costs of medical treatment and healthcare have made it imperative to purchase a comprehensive health insurance plan. While a health insurance policy can always come to your rescue during a medical emergency, it is not uncommon for claims to be rejected. Claims can be rejected for a variety of reasons, including filing a claim for an ailment that isn't covered by the policy, failing to submit the necessary documents, or filing a claim during the waiting period. To hedge against the risk of claim rejections, individuals may consider investing in multiple health insurance policies.
Multiple health insurance policies can serve as a strategic hedge, providing a safeguard against the financial impact of claim rejection by one insurer. This strategy diversifies risk exposure, ensuring that the insured individual or family is not left in a vulnerable position during an emergency. By spreading coverage across multiple insurers, policyholders can leverage the principle of risk pooling to their advantage. In the event that a claim is denied by one insurer due to the exhaustion of the sum insured, policyholders can turn to another policy to seek coverage for the same medical expense. This proactive risk management approach underscores the importance of comprehensive coverage and diligent policy management.
It is important to note that claiming health insurance from multiple companies can sometimes be a complex process. Policyholders must be well-informed about the coverage provided by each policy to determine the best approach. If the claim amount is less than the sum assured by a single policy, it is generally recommended to claim under only one policy to avoid losing the No Claim Bonus (NCB) from the other policy. However, if the claim amount exceeds the sum assured of a single policy, policyholders can utilise the benefits of multiple policies.
The process of claiming health insurance from two policies typically involves the following steps: understanding the coverage of each policy, gathering necessary documents such as medical bills and receipts, filing the primary claim with one policy, obtaining a claim settlement summary, and then submitting a claim to the second policy for reimbursement of remaining eligible expenses. It is crucial to keep both insurance companies informed about any existing health insurance policies to ensure compliance with IRDAI guidelines and protocols.
In conclusion, multiple health insurance policies can indeed be a strategic hedge against claim rejections. By investing in multiple policies, individuals can reduce the financial risk associated with denied claims and ensure that they have access to the necessary funds during medical emergencies. However, it is important to carefully evaluate and select policies from different insurers, understanding their coverage and benefits to optimise the utilisation of multiple health insurance plans effectively.
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Pros and cons of multiple health insurance plans
In today's complex healthcare landscape, managing medical expenses can be challenging. One strategy that many individuals explore is securing multiple health insurance policies. While the idea of having more than one health insurance plan may seem redundant, it can provide added financial security and coverage.
Pros of having multiple health insurance plans
- Broad coverage and reduced out-of-pocket costs: Multiple health insurance plans can provide broader coverage by filling in the gaps left by each individual plan. For example, if one plan excludes certain treatments or medications, the other may cover them.
- Financial security: With multiple health insurance plans, you can reduce the risk of a potential financial burden, which often comes with the rejection of claims during emergencies.
- Flexibility: Multiple health insurance plans give you the flexibility to seek medical treatment from different insurers.
- No claim bonus (NCB): If the claim amount is less than the sum assured of a single policy, it is recommended to raise a claim with a single insurance provider to avoid losing the No Claim Bonus (NCB) from one of the policies.
- High medical needs: Individuals with chronic illnesses or those who anticipate significant medical expenses may find that additional coverage offers necessary financial protection.
- Coordination of Benefits (COB): When you have multiple health plans, they can coordinate benefits through a process known as Coordination of Benefits (COB). This ensures that one plan pays first (the primary plan) while the second plan covers any remaining eligible costs. This system helps maximise your benefits and minimise out-of-pocket expenses.
Cons of having multiple health insurance plans
- Increased premiums: One of the main drawbacks of having multiple health insurance policies is the increased cost of premiums and possibly higher deductibles, which can lead to increased monthly costs that may outweigh the financial benefits gained from having additional coverage.
- Complex management: Managing multiple health insurance policies can be cumbersome and complex, involving more paperwork, potential delays in claims processing, and the need for a thorough understanding of which plan covers what services.
- Duplication of coverage: Sometimes, two health insurance plans may provide overlapping coverage for similar services, leading to unnecessary costs.
- Intricate claims process: Navigating the intricate claims process with multiple insurers can be time-consuming and confusing.
- Potential for reduced benefits: Even with multiple policies, there are limits on how much you can claim for medical expenses. Typically, insurers will not allow you to receive more than 100% reimbursement for any given medical bill across all policies combined. This means that even with multiple policies, you may still face out-of-pocket costs if all your expenses are not fully covered.
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Frequently asked questions
Yes, you can claim two medical insurance policies from the same company in India. To do so, you must first submit a claim with one of the policies, following the standard procedure. Once the claim is settled, obtain a claim settlement summary from the insurance company. Then, submit a claim to the second policy, providing the necessary documents and the settlement summary.
There are several benefits to having multiple health insurance policies in India. Firstly, it provides broader coverage and flexibility during medical emergencies. Secondly, it acts as a hedge against claim rejections, reducing the financial risk associated with denied claims. Additionally, it allows you to seek medical treatment from different insurers and better manage high hospitalization costs.
When claiming two medical insurance policies in India, it is important to keep the insurance companies informed about any existing health insurance policies you have from other companies. You must also follow the necessary guidelines and protocols determined by the Insurance Regulatory and Development Authority of India (IRDAI). Before filing a claim, ensure you understand the coverage benefits, terms, and conditions of each policy.
One potential challenge is that claiming from multiple insurance companies for the same hospitalization bill can be complex and time-consuming. Additionally, if the claim amount is less than the sum assured of a single policy, it is generally recommended to raise a claim with only one insurance provider to avoid losing the No Claim Bonus (NCB) from one of the policies.
