Can You Claim Health Insurance from Multiple Policies ?

Do you have more than one health insurance policy? If yes, you definitely have an advantage.

Medical inflation is on the rise and coverage of one policy may not be enough for an individual or their family. 
Many people today have more than one health policy. Having multiple policies gives wider coverage and benefits, flexibility in filing the number of claims and can help you save money at the time of actual claims.

So If you’re among multiple health policyholders, let me tell you a great benefit of having multiple health policies. 

Your hospital can possibly be more than the sum insured. This means that your one policy won’t suffice the expenses incurred. In such a situation, your second policy will be of great help. 
You may have your own individual policy and a corporate policy provided by your employer. Or, you may have multiple individual policies. 

The Contribution Clause

Before 2013, the IRDAI had a contribution clause for the benefit of policyholders to use multiple policies for their claims. 
According to this, if the hospital bill amount was greater than the sum insured of one policy, then both insurers were liable to pay the expenses in the proportion of sum insured of policies. 
But now this clause is no more applicable. Now the policyholder can approach any insurer to claim against their hospital bill.

How does claiming from multiple insurers work?

Only when your bill amount is greater than the sum insured of one policy, you can claim from multiple policies. Else, you have to initiate the claim under a single policy. 
To raise a claim from health insurance companies, the structure can be of two types - cashless and reimbursement. 

1. Cashless: Under cashless claims, you get admitted in a network hospital to avail the cashless facility. Raise a cashless claim with one insurance company and get its settlement letter. Collect the rest of the documents and file the second claim for balance expenses as a reimbursement claim. 
   
   
2. Reimbursement: As per your preference and emergency, you may have to get treated in a hospital that’s not in your policy network. In such a case, you will have to first pay the entire bill yourself and then go for reimbursement. Submit all attested documents, final bills, discharge summary, lab reports, OPD papers, etc. to file the claim.
   Remember to inform the insurance company about hospitalization and treatment details at the time of admission itself to avoid claim rejection.

In both cases, you first raise the claim from the first health insurance company. Once it’s settled, collect all documents including claim settlement summary, hospital bills, consultation papers, lab reports and other relevant treatment specific documents to be sent to the second insurance company for claiming the remaining expenses. 

Thus, having more than one policy supports you financially and reduces your out of pocket when your medical expenses surpass the sum insured of one policy.