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How to File Claims for Multiple Health Insurance Covers

By Chanel Rick - Oct 26,2022
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Here’s a short tale on the importance of proactive actions and quick thinking.

On an early rainy August morning, a couple was woken up by several calls made to their phones. Their groggy initial replies of confusion quickly turned into panic. Sneha Bhatia, their daughter, had met with an unfortunate accident during an early-morning jog. Once they arrived at the hospital, the nurse and other staff informed them about the severity of her condition.

“She requires immediate medical attention. We can settle the bill post-treatment. Meanwhile, contact your health insurance provider,” the doctor said. But how would they pay off such a hefty medical bill? Mr. and Mrs. Bhatia quickly called their family insurance provider and filled them in on the situation. After several moments of deliberation, the representative asked, “Does Sneha own a separate health insurance, too?”

Lo and behold she did! Her company-provided group insurance offered a substantial cover. And, just like that, two claims were made to save a life.

So, what was the problem? The family floater insurance owned by the family was insufficient for the complete treatment and hospitalisation. But, the company-provided health cover was able to chip in to fund the expenses.

That one question from the representative changed the course of the situation. Strangely enough, most people fail to realise that they can own more than one health insurance. It’s strongly advised to boost your health insurance with backups like another policy, add-on, or pocket insurance. It would prevent policyholders from facing ugly situations like insufficient or an exhausted sum insured.

Owning Multiple Health Insurance

There is no limit to the number of health insurance policies an individual can own. However, there are some rules that everyone must follow. While purchasing a policy, insurers will inquire whether you own any other health insurance aside from this. You must disclose this information because of the contribution clause. It’s essentially a mandatory declaration of owning another policy. The clause states that if a policyholder owns multiple health insurance, all insurers must share claims made in an equal ratio as per the sum assured. Moreover, it’s up to the discretion of the insurer on whom the claim is made to enforce the contribution clause.

Example:

Mr. X owns two health insurance policies. One has a sum insured of Rs. 2 lakhs (Insurer A), and the other is for Rs. 4 lakhs (Insurer B) If he claims Rs. 1 lakh, both the insurers will pay Rs. 33,333 and Rs. 66,666, respectively. Mr. X must submit all the requested original documents and collect a settlement certificate from the Insurer A. Then, he must claim the balance with Insurer B, with copies of the claim documents.

However, the health insurance regulatory body recently simplified the claim process. They took off the contribution clause to an extent. Earlier, policyholders needed to inform all their insurers regarding claims requiring them to contribute in the ratio of the sum assured. With the changed rules, it’s up to the policyholder to approach insurers.

So, if the claim amount breaches the sum insured of a policy, the policyholder can freely reach out to their other insurance providers. In such situations, the insurer could apply the contribution clause to settle the claim. Keep in mind that this clause does not apply to fixed covers or benefits, nor is it associated with the treatment expenses.

Common Multiple Claim Scenarios

To make it easier, we have compiled information based on different types of multiple claim scenarios. It will help you understand which suits your financial conditions best. Moreover, before purchasing a policy from multiple providers, learn the claim process for different situations.

Scenario #1: Cashless Claims

Most salaried individuals own at least two health insurance policies – employer-provided and personal health insurance. In cases that involve two or more independently purchased health insurance policies, you can approach either insurer for cashless claims at their network hospitals. As a policyholder, you must obtain the necessary claim settlement summary statement from the first insurer with the attested copies of hospital bills.

These documents must be provided to the second insurer and so on. Once the documents are received, the second claim is considered a reimbursement claim and will require pre-payment from you. Moreover, the insurer will reimburse the necessary dues or balance amount soon after.

Scenario #2: Non-Network Hospital Claims

Like any other non-network claim, the policyholder must pay for all the hospitalisation and treatment charges upfront. Then, they can begin the claim process with their respective health insurance providers to settle the bills via reimbursement. In this case, a claim form must be submitted along with the necessary documents, like lab reports, X-rays, etc.

If the total bill exceeds the sum insured, the remaining can be settled with the other insurer. However, ensure that you submit the attested copies of the claim settlement from the previous insurer.

In such situations, policyholders must maintain a folder with all the documents collected throughout the treatment and hospitalisation. Especially for claims made after treatment at non-network hospitals. The insurers will manually scrutinise all the receipts and paperwork to ensure they’re per the claim amount for reimbursement.

The advantages of owning multiple health insurance outweigh the cons. Moreover, it’s a smart move if your primary policy has an inadequate sum insured. So, weigh the options of owning multiple insurance policies. Once that’s done, head on over to Bajaj Markets! We offer a variety of health insurance policies for individuals, families, and more. 

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Bajaj Finserv Direct Limited ("BFDL") is primarily engaged in distribution of financial products and services through its digital platform (“Bajaj Finserv MARKETS”) and inter alia renders services of customer acquisition, providing preliminary credit support activities, fulfilment services and post-acquisition customer services to Banks, NBFCs, HFCs. BFDL is also a registered Corporate Agent (Composite) under valid IRDAI registration number: CA0551 valid till 10-Apr-2024 for solicitation and servicing of Insurance Products. Registered Office: Bajaj Auto Limited Complex, Mumbai – Pune Road, Akurdi, Pune – 411 035 CIN: U65923PN2014PLC150522