- Date : 04/10/2022
- Read: 4 mins
Mediclaim process in case of multiple health policies
There could be scenarios where you may have two or more active health insurance policies covering your medical bills. The most common such scenario is an existing personal health cover in addition to an employer-provided health insurance plan. Then there is the option of buying more than one health policy from the same insurer, for added benefits. The IRDAI allows a policyholder to claim for a medical event from more than one policy. Taking this into consideration, you may deem it appropriate to buy an additional health policy to expand your sum assured even further.
However, you cannot claim the same hospital bill from two policies simultaneously. Here are a few things to keep in mind if you plan to raise multiple health insurance claims against the same medical expense.
Claiming Health insurance Through Multiple Policies
Prioritise Office Health Plan - If you have health insurance coverage provided by the office, you should exercise it first, over any other policy that you have personally. Claiming through office health insurance is easier for the employee as there would be a coordinator or agency in between, liaising the claim process. Doing so will protect the sum assured under your personal policy or family floater. Besides, you may lose out on your no-claim bonus, if any, if you claim through your personal or family plan instead of the office plan.
Cashless Claim – To claim cashless hospitalisation, you must get admitted to a hospital empanelled in its network by your insurer. By the time you are discharged, your insurer shares the claim settlement summary with you. If your hospital bill exceeds the claim settlement, you can submit the summary along with attested hospital bills to the second insurance company for a reimbursement claim on the excess amount paid.
Reimbursement Claim – If you get admitted to a non-network hospital or didn’t get the opportunity to apply for cashless hospitalisation, you can claim a reimbursement from the insurance company(s). After you get discharged from the hospital and receive all the documents, you can fill out the reimbursement claim form and submit it along with the documents to the insurance company. Once your mediclaim is settled and you receive the settlement summary, you can share the same along with attested hospital bills and other required documents to the second insurer.
In a reimbursement claim, you typically need to furnish the following documents to the first insurance company,
The duly filled claim form, hospital discharge summary, medicine and lab bills, lab and diagnostic reports, prescription etc. While claiming from the second insurer, the claim settlement summary must be added to attested copies of relevant/required documents.
Claim Sequentially – You cannot claim from multiple insurers simultaneously. Claims in both cashless and reimbursement mode must be made sequentially. Thus, even in cashless claims, the second claim will inevitably be a reimbursement claim. This is explained in the example below.
Your hospitalisation bill amounted to Rs 9 lakhs. You have a sum assured of Rs 6 lakhs with your first chosen insurer. In cashless insurance claims, you get a claim settlement of Rs 6 lakhs. You pay the remaining Rs 3 lakhs out of your pocket. Then you will have to fill out the reimbursement claim form for Rs 3 lakhs with your second insurer. The form will be accompanied by the above-mentioned documents.
Disallowances – The terms and conditions of every policy differ, and disallowance is one such condition. If a portion of the medical expense is disallowed by one insurer, the policyholder can claim the same with the next insurer. This is applicable even if the sum assured with the first insurer is not exhausted. For example,
Let’s assume that your sum assured with Insurer A is Rs 5 lakhs. You had a claim of Rs 3 lakh, out of which Rs 2 lakhs were settled while Rs 1 lakh was disallowed. You can claim the disallowed Rs 1 lakh from your second insurer, although you have the residual Rs 3 lakh sum assured intact with the first insurer.
To sum up,
Multiple health insurance policies is not an unusual practice. Although there are no restrictions, financial advisors would recommend you to limit it to two. Always inform your insurance company about the existence of other active health insurance plans. It is wise to have a family floater or personal policy, even if your current employer provides a health cover of its own.