These days, being able to afford healthcare is becoming increasingly difficult. To reduce the financial concentration on them, some opt for multiple health insurance policies for an increased cover.
However, when you are faced with a huge medical bill and you want to claim it from two insurers, you need to probably understand how to claim multiple health insurance policies. If managed with care, multiple health insurance policies would work to your favor to get the maximum reimbursement against your medical bills.
Why Do People Buy Multiple Health Insurance Policies?
It is not an unheard-of thing to have two or more health insurance policies. People often buy personal health insurance that will cover any gaps left by the group insurance provided by their employers. Some will choose family floater plans atop any individual policies. Others might even go for top-ups or super top-up plans for extra security.
Whatever may be the cause, the real difficulty sets in when you need to claim under two health insurance policies. Let us understand how to work with split claims efficiently and smartly.
How to Claim from Multiple Health Insurance Policies
There are no contingencies by which the IRDAI permits an insured to hold more than one policy and claim from these.
When hospital bills exceed the sum insured under one contract of health insurance, one can claim for health insurance split between the policies, whereby the benefit of maximum claim is given subject to the principle of no profit from insurance (Indemnity).
Here’s how it typically works:
- Decide the Primary and Secondary Policy:
You need to make clear which one is the primary insurer, that is the first in line to settle the claim, and which one is secondary. Usually, the one with the larger coverage or an older policy is made the primary insurer. - Claim from the Primary Insurer First:
Send the hospital bills to the primary insurer. They will pay the claim up to the insured amount. After that, get a claim settlement summary and all relevant documents from them. - Claim the Balance from the Secondary Insurer:
With the documents and claim settlement summary from the primary insurer, they should be submitted to your secondary insurer, so the remaining amount can be claimed.
These steps will form the core of understanding and effectively executing primary/secondary health insurance claims.
Documents Required for Splitting Health Insurance Claims
To ensure smooth claim settlement for multiple health insurance policies, you’ll need:
- Original bills and discharge summary
- Final hospital bill
- Investigation reports
- Claim settlement summary from the primary insurer
- Duly filled claim form for the secondary insurer
- KYC documents
Always keep copies of everything you submit and follow up proactively with your insurance providers.
Important Tips for Smooth Claim Settlement
- Always keep both insurers well informed about the hospitalization.
- Maintain transparency with both parties.
- Do not make claims more than the actual expenses incurred, which is frowned upon in insurance practices and could even lead to rejection.
- If you are convinced about an action, give yourself the full time to read the fine print in every policy that deals with matters such as sub limits, co-pay clauses, and exclusions.
Conclusion
A two- or multi-health insurance policy claim need not be a messy scenario. Being fully aware of the procedure, armed with the right documents and with strategic planning, ensures you are claiming for a big loss split between different insurers and minimizing your financial burden. Whether it is an emergency or an elective procedure, knowing the procedures for claiming on multiple health insurance policies helps you make an informed choice.
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Frequently Asked Questions
1. What is a primary and secondary health insurance policy?
The primary policy is the first insurer you claim from; the secondary policy covers the remaining amount after the primary insurer’s settlement.
2. Will claiming from multiple insurers affect future premiums?
Not directly, but frequent claims may impact your No Claim Bonus or future underwriting decisions by insurers.
3. Can I get cashless treatment with multiple health insurance policies?
Yes, if the hospital is in the network of both insurers. Otherwise, you may need to opt for reimbursement.
4. Is there a time limit to file claims under multiple policies?
Yes, each insurer has a claim submission deadline (usually 30–90 days from discharge). Check your policy documents.
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