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Can we claim health insurance from two insurance companies?

Learn if you can raise health insurance claim with multiple insurers. Read on to gain insights about the process, challenges & complexities of the same.

  • 25 Jun 2024
  • 3 min read
  • 2104 views

Purchasing health insurance means safeguarding yourself against several contingencies. It is like a layer of protection for yourself and your family. But can another layer of protection be added to health insurance plans? Yes, there is! Health insurance from multiple insurers can enhance coverage and offer greater peace of mind.

Here is a point of caution- you need to know the terms and conditions of your plan very well before you can make a claim from multiple insurers. Also, can we claim health insurance from two companies? This question intrigues many.

So, let us look into this query:

What is the health insurance contribution clause

The Insurance Regulatory and Development Authority of India (IRDAI) made rule changes to make things easier for both insurers and policyholders. Before 2013, the health insurance contribution clause required insurance companies to distribute the total medical expenses among them proportionally based on the sum insured by each insurer. It ensured that insurers shared the burden of covering medical costs according to their policy limits.

However, this regulation underwent a significant change, and as of now, policyholders are no longer bound by the Contribution Clause. They now have the freedom to approach any of their insurers to settle their claims.

How to claim health insurance from two or more policies?

Those struggling with the question — Can I claim medical expenses from two insurance companies? Here is the answer:

If the amount the policyholder claims is below the sum insured, he/she is restricted to making a claim under just one policy. However, if the claim amount exceeds the sum insured by a single policy, the policyholder has two options: Cashless Claims and Reimbursement Claims.

  • Cashless claims: In this case, the insured individual does not have to pay anything to hospitals empanelled in the insurer's network. It involves filing a claim with one insurance company. You must obtain a claim settlement summary. Now, you need to submit this summary along with authenticated hospital bills to the second insurance company. They will then reimburse the remaining balance amount.
  • Reimbursement claims: This works when the hospital where one is admitted is not empanelled under the insurance company's network. Initially, you're responsible for covering the hospital bill upfront before seeking reimbursement from the insurance company. Alongside the claim form, you must provide validated documents like the discharge summary, lab reports, and medication invoices to facilitate reimbursement. After assessing the claim, the insurance company will settle the amount accordingly. If you are making a claim from more than one insurer, you must submit a claim settlement summary to the other insurance provider. Remember that both insurers must be notified of all your policies; otherwise, your claim may be rejected.

Conclusion

Having health insurance plans from multiple insurers always helps; if one insurance provider rejects your claim, you have others to rely upon. However, this comes with its own set of challenges and complexities. So, analyse your plans well and know which insurer to approach well in advance if you are stuck with a medical emergency.

In latest news, the General Insurance Council of India, after consultations with general and health insurance companies, has launched Cashless Everywhere initiative. Under this initiative, a policyholder can get treated at any hospital of his/her choice, and they can avail cashless facility, even if the hospital is not part of their insurer's network list. Ask your insurer about this initiative to learn more details and use it at the right time.

Also read:

Disclaimer: The information provided in this blog is for educational and informational purposes only. It may contain outdated data and information regarding the Insurance industry and products. It is advised to verify the currency and relevance of the data and information before taking any major steps. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.

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