How to claim health insurance benefit from multiple policies
If you have multiple policies remember to disclose the information at the time of filling up the proposal form otherwise your claim can get rejected
With the rise in healthcare costs amid Covid-19, people have been looking to increase their sum insured. While some increase the sum insured of their existing policies others may opt for a separate plan offering wider coverage. If you have multiple health insurance policies, you can use multiple policies for a single claim, as per the insurance regulator.
If you plan to have multiple policies, be sure to disclose the information at the time of filling up the proposal form. It is important as both the insurers need to be informed about the other policy otherwise your claim may get rejected on the grounds of non-disclosure of facts.
Contribution Clause
The Insurance Regulatory and Development Authority of India (Irdai) changed the regulations relating to the claim process of multiple policies in 2013. Before 2013, each insurer had to settle the claim amount in the ratio of sum insured. The regulations are easier and much simpler.
There are two parts to the existing rules. First, if the claim amount is less than the sum assured, then you can claim the entire amount from an insurer of your choice. If the claim amount exceeds the sum assured, then the contribution clause will be applicable, where each insurer has to settle the claim in the ratio of the sum insured.
According to S K Sethi, Director Ria Insurance Brokers “One can claim the full amount, subject to the sum assured Limit, from one company. Supposing one policy has no room rent capping and the other one has capping, then it is suggested to go in for the policy which has no capping .”
Cashless claims
In case of cashless claims, settle the claim with the first insurance company and obtain all requisite documents for filing the claim. You can either split the bill or on discharge can take the attested copies of all the bills, as you will be needing them while applying for reimbursement of the balance amount.
Sethi explained, supposing Policy 1 has SI of Rs 2 lakh and Policy 2 has SI of Rs 3 lakh. As there is no capping in Policy 1, therefore one should go in for Policy 1 and there is no need to inform the Policy 2 insurer. When it becomes clear that the bill is going to be more than Rs 2 lakhs then it will be better to inform Insurer 2.
Assuming the bill is Rs 2.70 lakhs then the procedural issues come up. One option is to get the bill issued for Rs 2 lakhs from Insurer1. For the balance amount of Rs 70,000, one can get a bill issued which will be original and this can be given to Insurer 2. In case the bill is for Rs 2.70 lakhs then get the photocopy attested by the hospital itself so that Insurer 2 takes it as original and passes the claim.
Reimbursement claims
Here you apply for claim settlement after being discharged from the hospital. You are required to submit all the original bills to the first insurer. Once the claim is paid, you have to obtain a claim settlement summary along with photocopies of all the hospital bills. You need to submit these documents to the second insurance company for the reimbursement of the remaining amount.
Having multiple policies can increase paperwork making it cumbersome for the claim settlement process. It is always easy and simple to claim from one policy for a quicker and speedy settlement. However, if there is no choice don’t forget to maintain all attested photocopies in one place in order to avoid any hassles at the later stage.