Having access to multiple health insurance policies can be a benefit when making health insurance claims. It increases the coverage, flexibility in the number of claims, and can save a lot of money by utilising multiple benefits. While choosing health insurance, you want the best healthcare facilities and treatment for several important illnesses. It is critical you have a robust health insurance plan to cover your family from any unforeseen hospitalizations.

How to Claim Health Insurance From Multiple Insurers - Acko

You also need to know that you cannot claim more than the sum assured, be it through a single or through multiple plans. However, there are situations when the expenses incurred for the treatment are more than the sum assured. Here is when you can use the second health insurance to pay for the remaining. Read on to learn about how to claim health insurance from multiple insurers.

What is the ‘Contribution Clause’ in Health Insurance?

To make it easier for policyholders to take advantage of multiple health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) has made changes to the rules and regulations. Prior to 2013, the IRDAI made it mandatory that the total medical expenses had to be shared by the insurance companies in proportion to the sum assured by them. This is known as ‘Contribution Clause’ in health insurance. However, this has been eradicated and now the policyholder can approach any one of the insurers to settle the claim. But how to claim from two or more insurance companies? Read on to find out.

How to Claim Health Insurance From Multiple Insurers?

With multiple health insurance plans, one from your employer and the second is your personal health insurance policy, you may ask the question “Can I file a claim with two insurance companies?” The answer is yes. To raise a claim from multiple health insurance plans, you need to raise it with the first insurance company towards the expenses of medical treatment. Then, you need to obtain the summary of the claim settlement, attest the hospital bills and approach the second insurance company to settle the rest of the expenses.

Process to Claim Health Insurance From Two or More Policies:

The health insurance claim process from multiple insurance companies is structured on the basis of a cashless and reimbursement method for insurance coverage. If your claim is less than the sum assured, then you initiate the claim under a single policy. However, if the hospital expenses are more than the sum assured of a single policy, then you can claim under the below two methods:

1. Cashless Claims

Under the cashless claims, you get cashless hospitalisation at the network hospital. In this case, you raise a claim with one insurance company and obtain the claim settlement summary. Once this is completed, the claim settlement summary and attested hospital bills should be submitted to the second insurance company to settle the balance amount in the form of reimbursement.

2. Reimbursement Claims

While cashless claims are hassle-free through network hospitals, there may be situations when you may have to avail treatment at hospitals which are not part of the network of the insurer. In this situation, you will have to settle the claim through the reimbursement method. You need to pay the hospital bill first and then get a reimbursement from the insurance company. Along with the claim form, you need to submit attested documents such as discharge summary, lab reports, medicine bills, etc to get a reimbursement. The insurance company will review the claim and settle the amount accordingly.

Documents Needed to Make Reimbursement Claims

Below is the list of documents required while registering a reimbursement claim:

  • Discharge summary
  • Bills and receipts
  • Lap reports
  • Prescriptions
  • X-ray films and slides, if any.
  • Claim form
  • Claim settlement summary (in case of claim from multiple insurers)

Also, read: COVID-19 Health Insurance: Corona Kavach and Rakshak

Different Health Insurance Plans From the Same Insurance Company:

Having different health insurance plans from the same insurer is convenient since claims are a lot easier and paperwork might be lesser. However, there may be different terms and conditions to raise a claim. It is essential that you read the terms and conditions before you choose to buy a health insurance plan. You can always approach the second insurer in case the first insurer rejects the claim. There are several online health insurance plans that you can review before you opt for the right plan.

It is also imperative you be transparent to your insurer to ensure claims are not rejected and to experience a smooth claim process. You can buy different types of insurance policies from the same insurer to centralise your insurance requirements; however, it is also important to understand the different benefits of each plan before purchasing a suitable health insurance plan.

Frequently Asked Questions:

Below are some of the common questions about health insurance claims with insurance companies:

Can I have two or more health insurance policies?

Yes, you can have more than one health insurance policy. A wide coverage offers you the option to avail hospital treatment from different health insurance plans. It gives you extended support in case you may have to avail medical treatment more than once during the policy period. Also, if you have reached the limit of claims during the policy period, you can raise claims from the second policy, offering you wide coverage.

Can I have both employer insurance and a separate personal health insurance policy?

It is advisable to cover yourself and your family with wider coverage. This can be in the form of multiple health insurance plans. While the employer insurance is valid until you are employed with that organisation, it ceases to exist once you have left the employer. In situations when you are not covered by employer insurance, the personal health insurance policy comes to your rescue, especially if you have lost your job and the employer insurance is not valid.

Is it advisable to claim from different insurance companies for the same hospitalisation bill?

If the claim amount is less than the sum assured, then it is advisable to raise a claim from one insurance company. This way you can avoid losing the No Claim Bonus (NCB) from one of the insurance policies. The claim process is a lot easier when you initiate it with a single insurance provider. However, if the medical expenses are more than the sum assured of the first insurance policy, then you claim the balance from the second insurance provider.

How many times can I claim health insurance in a year?

You can raise several claims during the policy period; however, this can be up to the sum assured. Once the sum assured limit is reached, the insurer will not honour any more claims from the policyholder. However, some insurers may cap the number of claims during the period. You need to read the terms and conditions on the number of claims before you purchase the policy.

After how many days can I claim health insurance?

It depends upon your insurance provider. There may be waiting periods for certain critical illnesses and also a waiting period before you can raise a claim as soon as you buy a new health insurance plan. Once the waiting period is over, you can raise claims up to the sum assured during the policy period.

What is the time limit to submit a reimbursement claim for health insurance?

Generally, the time limit is 15 to 30 days. You need to read the terms and conditions of your health insurance policy to know the time limit to submit reimbursement for medical expenses. Post the time limit, insurers do not honour claims and may lead to rejections.

What is the right time to make claims on two health insurance policies?

If your hospitalisation bill exceeds the sum assured of one policy, you can make claims on two health insurance policies. It is advisable to use the policy judiciously to take advantage of the benefits. Small claims are not practical and it is advisable to avoid such claims.

What document is required while raising a reimbursement for the balance amount from the second insurance company?

You need to procure the claim settlement summary from the first insurance company. This document should be submitted along with attested bills, receipt, lab report and other diagnostic reports to get a reimbursement for the balance amount.

Can I raise a claim with two companies at the same time?

No, you cannot raise the same claim with two different insurers. You need to claim with the first insurance company and if your medical expenses are more than the sum assured, then you can opt for reimbursement for the balance amount from the second insurance company. Ensure you are transparent and disclose all details to avoid rejection of claims by either of the insurance companies.

Can I purchase multiple health insurance policies on the same person?

Yes, you can purchase multiple health insurance policies on the same person. This will offer wide coverage and availability of different benefits from each of the insurance providers. Having access to two or more health insurance plans can be beneficial, especially during claims.

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