Health insurance is a necessity for many people in India. Many people have to pay for health insurance, either through their employer or as an individual. This article will guide you through the process of claiming health insurance from multiple health insurance policies.
When you have more than one type of health insurance, it can be difficult to keep track of what's covered and what's not. This guide will walk you through how to claim your benefits from all of your policies and make sure that you're not paying more than necessary. We'll cover how to figure out which plan is best for you, how to file a claim, and how to make sure that your claims are processed correctly by the right company.
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Importance of Having Multiple Health Insurance Policies
Multiple health insurance policies are a good option for people who want to save money on their monthly premiums. However, there are some things that you should know before you buy one. Here is an essential fact about multiple health insurance policies that you should know about:
Mr. Jon working in an MNC has purchased Health insurance from ABC insurance company along with his family for a family floater sum insured of Rs.4 Lacs. But with the rising medical operational costs, he felt that this sum insured would not be enough and opted for a family health protection plan for a floater sum insured of Rs.8 Lacs from XYZ insurance company. He has taken adequate coverage and also informed the insurance companies regarding the other health insurance policy.
One bad day, while driving in his car he met with an accident and was immediately rushed to a nearby hospital where he underwent major surgery. The final bill at the time of discharge was around Rs.9 Lacs, he applied with both the insurance companies for claim settlement expecting that each insurance company would settle Rs.9 Lacs and he would end up getting Rs.9 Lacs profit from the whole scene. But little did he know that there would be a concept of indemnity and contribution in the insurance industry where the claim would be paid based on actual or up to the sum insured.
Concept of Indemnity in Insurance:
The concept of Indemnity in insurance is that the insurance company promises to compensate the loss faced by the insured in return for a particular premium amount.
The insurance company guarantees to replace the insured in the same position as he/she was just before the occurrence of loss.In short, the insured cannot be profited by insurance.
For example, in the above case, Mr. Jon has taken two insurance policies with a sum insured of Rs.4 Lacs and Rs.8 Lacs and the final hospital bill was around Rs.9 Lacs. In this scenario even though he had paid a premium for both the policies, he cannot claim more than the expenditure i.e. hospital bill. Both the insurance companies together will settle Rs.9 Lacs only according to the principle of indemnity.
Concept of Contribution in Insurance:
The concept of contribution is a corollary of the principle of indemnity and states that the claim amount will be contributed to the insured in proportionate to the premium paid / Sum insured selected. The insurance companies promise to settle the claim of the insured and replace him/her in the same position just before the occurrence of the loss.
In the above scenario, Mr. Jon has taken an insurance policy from 2 companies with a Sum insured of Rs.4 Lacs (ABC Health insurance) & Rs.8 Lacs (XYZ health insurance), and the final claim amount arrived at Rs. 9 Lacs. The insurers will pay Rs. 3 Lacs (ABC -4 Lacs S.I) and Rs. 6 Lacs (XYZ- 8Lacs S.I), respectively.
The claim amount is divided among the two insurance companies in proportionate to the premium paid and the sum insured taken. In this way, the insured will be settled with the overall claim amount from both insurance companies as per the principle of contribution.
There would be many reasons for buying multiple health insurance policies such as Employer health insurance coverage might not be adequate for the entire family, a separate health insurance policy for parents, and many other reasons.
However as per the new health insurance rules regarding multiple insurers, if the claim amount is less than the sum insured of the insurer you are claiming then the contribution clause would not be applicable. Only if your claim amount is more than the sum insured by the insurer you are claiming the contribution clause will be applicable.
What is the process to Claim Health Insurance from Multiple Policies?
There are two types of health insurance claim settlement processes that a patient can go through.
Cashless Claim Settlement Method
When you get medical treatment at a network hospital with your health insurance, then you can attain a cashless claim. As per the Cashless Claim Settlement Procedure, you need not pay anything to the hospital for the treatment and medical services. The insurer directly pays the hospital subject to the amount of the claim. You will need to pay only in case of co-payments or a sub-limit clause that you have chosen during the plan purchase.
How to Make a Claim:
- Find the network hospitals
- Intimate the insurer
- Complete the documentation process
- Claim settlement
- Pay the bills.
Reimbursement Claim Settlement Method
If you get treatment at a hospital outside the network of the insurer, you set foot in a Reimbursement Claim Settlement Procedure. As per this process, you have to pay for the treatment at the hospital and get it reimbursed later on from the insurance provider subject to the amount of the claim. The insurer is liable to pay the entire amount of the claim after considering all the voluntary or compulsory sub-limits, deductibles, etc. opted by you at the time of purchasing the policyholder.
How to Make a Claim:
- Intimate the insurer
- Complete the documentation process
- Payment of bills
- Claim settlement
Documents Required for Health Insurance Claim Settlement
Here are the following documents you need to have for the successful claim settlement of health insurance:
- Original investigation reports
- Pharmacy bills along with the prescription
- Final hospital discharge summary
- FIR or post-mortem report if happened
- Original bills, receipts, and discharge report
- Original hospital bills and a valid photo ID proof
- Treating doctor's report, and original consultation notes
- Nature of operation performed and surgeon's bill and receipt
- Indoor case papers and duly-filled claim form
- Test reports along with attending doctor’s or surgeon’s report.
Step By Step Process to make a Claim on Multiple Policies
| Step 1: |
Intimate your two health insurance companies at the time of hospitalization |
| Step2: |
Fill out the claim form of the first health insurance company |
| Step3: |
Submit all the required documents and hospital bills |
| Step 4: |
The first insurance company received all original documents and have settled the claims |
| Step 5: |
After the first company settles the claim amount. Get the claim summary then move to the next company |
| Step 6: |
Fill out the claim form of the second health insurance company |
| Step 7: |
Submit all the required documents and a letter explaining which company you have claimed and claim summary and hospital bills, etc. The second insurance company received all the documents and has settled the remaining claim amount. |
| Step 8: |
After all the process you can receive your claim amount within a few weeks |
Conclusion
Having two health insurance policies can be beneficial in a variety of ways. It can provide you with more coverage, a wider range of providers, and better rates. If you have a high deductible, it might be cheaper to have two policies instead of one. Another benefit is that you are more likely to have a better coverage plan with two policies.
However, it is important to understand each policy in detail to know all the terms and conditions, inclusions, exclusions, claim settlement process, etc. This increases awareness about different health insurance policies so that you can claim your health insurance policies easily.
Related FAQs
Can I Buy Two Health Insurance Policies?
Yes, it is possible to buy two health insurance policies, but you need to be careful. You may be subject to the “dual coverage” rule if you have two health insurance policies. This rule may limit the amount of benefits that are paid for by each policy. Here are some things to consider before buying a second health insurance policy:
- Is it cheaper than my current plan
- Is it a better coverage than my current plan
- Do I need an extra policy
Can I Use Two Different Health Insurance Policies in India?
We can use two different health insurance policies in India. But there are some conditions to be fulfilled based on the type of policies and where you brought the plans.
Can I Buy Two Health Insurance Policies for One Person in India?
Yes, a person can have more than one health insurance policy in India. But they might only allow you to buy two different plans from the same provider.
What are the Benefits of Two Health Insurance Policies?
There are many benefits of having two health insurance plans.
- First and foremost, the most common reason for having two different health insurance plans is that it provides you with more financial protection in the event something goes wrong and you need medical care.
- Second, if you have a plan at work and another one on your own, then you can save money by only paying premiums for one policy.
- Thirdly, some people choose to have a plan on their own because they want more flexibility or they want to be able to choose their doctors and hospitals.
Which Reasons Can My Claim Get Rejected?
Your claim can get rejected due to
- Treatment within the waiting period
- Expired insurance policies
- Fraudulent claims
- Standard exclusions.
How long does it take for an insurance company to settle the claim?
The time it takes for an insurance company to settle the claim can vary depending on several factors. It can take anywhere from a couple of days to a month or so for the company to settle claims.