Can We Claim Health Insurance from Two Companies?

Due to an increase in healthcare costs and lifestyle changes, there is a significant increase in policyholders opting for higher coverage amounts. Hence, more people are buying multiple online health insurance policies from different insurance companies.

With multiple health and medical insurance policies, one that is bought personally and the other that is given by the employer, the most common question arises: Can we claim health insurance from two companies? The answer is yes. One can claim health insurance or medical insurance from two or more companies.

Continue reading the guide below to learn about health insurance claims from two companies.

Understanding the 'Contribution Clause' in Health Insurance

The 'Contribution Clause' refers to the requirement that, when a policyholder has multiple health insurance policies, the insurance companies would share responsibility for paying the claim in proportion to their respective sum assured. However, the Insurance Regulatory and Development Authority of India (IRDAI) revised the rules.

The 'Contribution Clause' was removed, allowing policyholders to approach any one insurer for settling the claim. If you have health insurance from multiple insurers, you can now claim the entire amount from one insurer, and the other one will not be required to contribute unless stipulated in the policy.

How Can We Claim Health Insurance from Two Companies?

Health insurance claims from two companies provide policyholders with flexibility during medical emergencies, but it can sometimes be a complex process. Below are the ways to claim health insurance from two companies:

Step 1: Inform the insurance company about the hospitalisation and provide them with the necessary details.

Step 2: Choose the company you want to file the claim with.

Step 3: File the cashless claim with the primary insurer by submitting the required documents such as a pre-authorisation form.

Step 4: After the primary insurer approves the claim, collect all necessary documents, such as medical bills and test reports, after discharge.

Step 5: The primary insurer will settle the approved claim with the hospital and give you the settlement statement.

Step 6: Submit the first insurer’s statement along with the required documents to the second insurer to file a reimbursement claim for the remaining amount.

Step 7: The second insurer will verify the claim and process it based on the terms and conditions of the policy.

For example,

Payal has 2 health insurance policies from two insurers, one from insurer A of amount ₹5 lakh and the other from insurer B of amount ₹4 lakh. When she undergoes treatment costing ₹7 lakh, she uses both her policies to cover her expenses. First, she claims from insurer A, who gives her full coverage.

She then raises a claim for the remaining amount with insurer B by providing all the necessary documents and submitting insurer A’s claim settlement statement. Insurer B settles the claim after verifying the documents.

Also Read: How to Claim Medical Insurance: Reimbursement vs. Cashless Claims

Documents Required for Reimbursement Claims

When registering a reimbursement claim, the following documents are essential to process your request:

1. Discharge Summary

A document issued by the hospital detailing the treatment received, including the diagnosis, procedures performed, and follow-up care instructions.

2. Bills and Receipts

Official records of all expenses incurred during treatment, including hospital charges, medications, and additional medical services.

3. Lab Reports

Detailed results of medical tests and investigations conducted as part of your treatment, such as blood and urine tests.

4. Prescriptions

A list of medications prescribed by your doctor, including dosage and duration of treatment.

5. X-ray Films and Slides

Visual records of imaging studies, such as X-rays, MRIs, or CT scans, that were used to diagnose and treat your condition.

6. Claim Form

The official form from the insurance company that needs to be filled out to initiate the claim process.

7. Claim Settlement Summary

A document that explains how the claim amount is distributed between multiple insurance companies, especially when more than one policy is involved.

Hedge Against Rejection of Claims

Hedging against claim rejections in health insurance is a strategic plan with which a policyholder can reduce financial risk; it is usually associated with denied claims. Below are the following ways to hedge against rejection of claims:

Reduces Risk

Hedging against claim rejection in health insurance can act as a strategic plan to reduce the financial risk related to claim denials.

Robust Safety

Having more than one health insurance policy can provide a strong backup if one insurer rejects the claim.

Focus on Policy Evaluation

Every insurance company has different terms and conditions for a specific policy. Hence, it is important to select a policy after reading the terms and conditions.

Seek Professional Advice

Policyholders can consult a professional insurance advisor who can help them maximise their coverage strategies and minimise the risk of claim rejections.

Also Read: 5 Possible Health Insurance Claim Rejection Scenarios

Health Insurance Plans from the Same Insurer

Choosing different health insurance plans from the same insurer can be convenient, as it often means less paperwork and streamlined claims. However, each plan may have different terms and conditions. Before purchasing, carefully read through these terms to ensure you are aware of what is covered.

 If one insurer rejects a claim, you can approach another insurer if you have multiple policies with the same or different companies. Being transparent with your insurer can help avoid claim rejections and ensure a smoother claims process. It is also important to understand each plan's benefits and coverage to choose the one that best fits your needs.

Final Thoughts

In unforeseen medical emergencies, investing in a health insurance policy that covers medical treatment expenses helps you access the best healthcare facilities on time. The policyholder can invest in multiple health insurance plans and choose which policy to use.

The policyholder can file health insurance claims with two companies but must ensure the treatment costs do not exceed the total amount claimed from both companies.

Frequently Asked Questions (FAQ’s)

1. After how many days can the policyholder claim the health insurance?

In a standard indemnity health insurance, there is an initial waiting period of 30 days from inception before the insured can claim under the policy. The waiting periods also apply based on the nature of the claim.

2. In a year, how many times can a policyholder claim his health insurance?

Multiple times until the sum insured amount is exhausted. However, certain policies may have conditions on the number of claims that can be made in a year.

3. What happens if someone claims health insurance twice?

If someone claims health insurance twice, the insurer will pay the claim amount until the sum insured is exhausted.

4. Does the policyholder need to disclose the previous policy while buying a new one?

Yes, according to the IRDAI rules, one should disclose the existing policy to the new insurer to ensure a smooth claim settlement.

*Standard T&C apply

**Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

***Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to change. Please consult an expert before making any related decisions.