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Got multiple health insurance policies? Here’s how to make claims from both

If you have one insurance policy provided by your employer and another as a personal cover, it’s best to use the office-provided cover first. That’s the easier of the two to claim reimbursements from.

September 08, 2022 / 09:13 AM IST

At times, hospital bills can be scarily high. Often, your insurance may not be enough to cover the entire bill. And then, if you do not have another policy, you need to pay the difference yourself.

If you do have multiple health policies, you can make claims from more than one policy.

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While you still cannot claim more than the sum assured, it helps if you have the option of combining two policies to get as much of the claim settled as possible.

That said, the process of making claims from multiple policies can be a bit complicated. So, it’s best to have a basic understanding now rather than begin reading up only when you need to use these policies.

How to claim from multiple insurers

Assume you have two health plans: one from your employer (office-provided) of Rs 4 lakh and the other a standalone family floater of Rs 5 lakh that you bought for yourself.

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It’s always advisable to not depend entirely on your employer for health insurance. You don’t know if you might be out of a job temporarily and end up being hospitalised during that exact period.

Now, if you get hospitalised and the bill comes to Rs 7.5 lakh, how do you go about making the claims?

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Here’s how you should go about claiming your health insurance:

·         First, exhaust your employer coverage of Rs 4 lakh. Employer group health policies are the easiest ones to get claims settled and don’t have waiting periods.

·         You have now partly cleared the bill. You still need Rs 3.5 lakh more to clear the full Rs 7.5 lakh bill.

·         Here comes the important part. Chances are that the hospital will not allow you to use cashless mode more than once to settle one hospital bill. So, you may have to first clear the remaining Rs 3.5 lakh from your pocket and then claim reimbursement of the amount from your personal health insurance.

·         To get the rest of the expenses (Rs 3.5 lakh) reimbursed from the second insurer, you will need to submit all the relevant documents, proof of payment, etc. Not just of what you spent from your pocket but also the proof of partial claim settlement from the first insurer.

Raising both claims, proportionately

You might be wondering if you can just raise claims with the two insurers simultaneously for proportionate amounts, so as to avoid putting in your own money.

The answer is you can’t.

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You need to make a claim first with one insurer and if the total claim exceeds the sum assured, then seek reimbursement of the balance from the second one.

And if, for some reason, you must get treated in a non-network hospital, then you will have to clear the entire bill on your own first and then get reimbursed by both insurers. In such a case, it is always advisable to clear one part of your hospital bill from one insurer, get payment and proof of the amount cleared and then go to the second insurer to get the pending bills cleared.

Despite insurance policies, have an emergency corpus in place

It is for this reason that it’s advisable to have an emergency fund in place.

You may need to go to a non-network hospital in emergencies. If you have a financial cushion in place, at least you can afford to pay the bills first and then run around for reimbursements. For older people, it is extremely important to have a medical contingency fund in place, in addition to health insurance.

How much insurance do I need?

Make sure you have a family health insurance cover of at least Rs 15-20 lakh. This should be in addition to any corporate health insurance coverage that you already have.

If buying a large cover is not feasible, then purchase a smaller base plan and enhance it with a super top-up policy. For instance, you can buy a Rs 5 lakh base cover and then a top-up policy of, say, Rs 20 lakh.

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While purchasing the second health insurance policy, make sure you disclose this fact to them that that you already hold a health insurance from another insurance company. Do not hide anything. You don’t want your claims rejected in future as you didn’t disclose important information.

If you do have to make a claim, first go for your corporate (office-provided) cover. It’s easier. Also, if the bill is less than the sum assured, you can continue the NCB (No-Claim Benefits) that are applicable on your personal insurance.

If you don’t have a corporate cover but have two personal covers, then you can combine these two as well.

But since your claim settlement will depend on the room-rent limit, be sure to apply for the claim from the policy that has an appropriately high room rent limit. This is an extremely important aspect that most people miss and regret later.

You also need to consider co-payment clauses, if any, in the policy before deciding which ones to use for claims.

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While you as a policyholder have the right to buy multiple health insurance policies and can also choose which policy you want to use first to make a claim, it is important to understand the nuances involved and use the policies effectively, as discussed above.
Dev Ashish is a SEBI Registered Investment Advisor (RIA) and Founder, StableInvestor
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