Can You Claim Health Insurance from Two Companies?

With the rising costs of healthcare, medical expenses, and lifestyle changes leading to an increase in illnesses, more individuals are opting for higher insured amounts. As a result, many are purchasing multiple health insurance policies—both personal online health insurance and employer-provided plans.

A common question arises: Can you claim health insurance from two companies?

The answer is yes—policyholders can claim health or medical insurance from multiple companies. However, there are certain conditions and procedures that must be followed when making a claim.

Key Considerations When Claiming from Multiple Insurers

1. Disclosure of Policies Policyholders must disclose details of any existing health insurance policies when filling out the proposal form for a new policy.
2. Timely Notification It is advisable to notify both insurance companies about any anticipated hospitalization claims to avoid complications due to late notifications.

Understanding the ‘Contribution Clause’ in Health Insurance

Previously, under the ‘Contribution Clause,’ when a policyholder had multiple health insurance policies, insurers would share the obligation of paying the claim in proportion to their sum assured. However, in 2013, the Insurance Regulatory and Development Authority of India (IRDAI) amended the rules, eliminating this clause.

Now, policyholders can claim the full amount from one insurer without requiring contribution from the others—unless specified in the policy.

How to Claim Health Insurance from Two Companies

Claiming from multiple insurers provides flexibility during medical emergencies but requires careful execution. Here’s a step-by-step guide:

1. Evaluate Coverage

Before filing a claim, understand the coverage offered by each policy to determine the best approach.

2. If the Claim is Less Than the Sum Assured

If the claim amount is lower than the sum assured under a single policy, the policyholder can file a claim with just one insurer.

3. Cashless Claims

• If the policyholder is admitted to a network hospital, they should first initiate the cashless claim with the primary insurer.
• Once the primary insurer settles the claim, the policyholder should obtain the claim settlement summary.
• This summary, along with hospitalization bills, can then be submitted to the second insurer for reimbursement of any remaining amount.

4. Reimbursement Claims

• If the hospital is not part of the network hospitals of either insurer, the policyholder must pay the bills upfront.
• The policyholder can then seek reimbursement from one insurer.
• After receiving the first claim settlement, they can submit the settlement letter and additional documents to the second insurer for further reimbursement.

5. Required Documentation for Reimbursement Claims

To ensure a smooth claims process, the following documents must be submitted:

• Discharge Summary – Details of diagnosis, treatment, and follow-up care.
• Bills and Receipts – Proof of all incurred expenses, including hospital charges and medications.
• Lab Reports – Medical test results related to the treatment.
• Prescriptions – List of medications prescribed, including dosage and duration.
• X-ray Films and Reports – Imaging studies used for diagnosis.
• Claim Form – Completed and signed claim form required by the insurer.
• Claim Settlement Summary – Document outlining how the claim was settled by the first insurer.

Mitigating Claim Rejection Risks

Having multiple health insurance policies acts as a safeguard against claim denials. If one insurer rejects a claim due to the exhaustion of the sum insured, the policyholder can approach the second insurer for coverage. This diversification helps mitigate financial risks and ensures uninterrupted access to medical care.

Final Thoughts

To ensure access to the best healthcare services without financial burden, investing in a health insurance policy is essential. Policyholders can hold multiple policies and decide which to use based on their needs. Understanding the claim process for multiple insurers can help individuals navigate medical expenses effectively, ensuring they receive the maximum possible benefit from their policies.