How to Use Multiple Policies for a Single Health Insurance Claim

Health Insurance Claim: In today’s world of soaring medical costs, having a single health insurance policy may not always be sufficient to cover all your healthcare needs. To bridge the gap, some individuals may choose to purchase multiple health insurance policies or top-up plans from different insurers.

If you have multiple health insurance policies, read on to understand how you can make the most of them at the time of claim.

By leveraging these policies strategically, you can ensure a higher sum insured and safeguard yourself against unexpected medical expenses. In this article, we will explore the benefits and considerations of using multiple health insurance policies, shedding light on the terms and conditions involved in the process.

Leveraging multiple policies 

Having two or more indemnity policies provides policyholders with the flexibility to choose the policy under which they want to make a claim.

An indemnity policy is a type of health insurance policy that provides coverage for medical expenses incurred by the policyholder. Under an indemnity policy, the insured individual is reimbursed for the actual expenses they have paid towards their medical treatment. The policyholder retains the freedom to choose healthcare providers and facilities, and the insurer reimburses them for the covered expenses based on the terms and conditions of the policy.

If the claim amount exceeds the sum insured of the first policy, the remaining balance can be claimed under the second policy. It is important to disclose all existing policies while purchasing health insurance, as non-disclosure can lead to claim rejection, violating the insurance contract.

Contributing factors and Health Insurance claim settlement

Insurance companies often include a contribution clause in their policies. This means that if an insured individual holds multiple policies, all policies will contribute proportionally to the sum insured when a claim is made. For instance, if you have two policies with sum insured amounts of ₹3 lakhs and ₹4 lakh respectively, and you make a claim of ₹2 lakh, you can choose either policy for the claim. However, if the total claim value reaches ₹7 lakh, insurers may settle the claim based on the proportionate sum insured.

Navigating multiple health insurance policies effectively

To make the most of your multiple health insurance policies, there are several factors to keep in mind. First, assess the total claim amount and the available sum insured across all policies. Pay attention to any deductibles or co-payment clauses, where a percentage or fixed amount must be borne by the policyholder.

Tip: While buying a retail or individual health insurance policy, try and opt for policies without co-payment or deductible to minimise out-of-pocket expenses.

Co-pay and deductible are two terms commonly used in health insurance policies to describe the cost-sharing arrangement between the policyholder and the insurance company. While they both require the insured individual to contribute towards their healthcare expenses, there are important differences between the two.

Co-pay: A co-pay, also known as a co-payment, is a fixed amount that the insured person is required to pay out of pocket for specific healthcare services. It is a predetermined cost that the policyholder must pay each time they receive a covered service.

Deductible: A deductible refers to the initial amount that the insured individual must pay for covered medical expenses before the insurance company starts reimbursing or covering the costs. It is an annual amount that the policyholder must meet before their insurance benefits kick in.

It is advisable to prioritise the policy with the least waiting period and pre-existing exclusions. If you have an employer-offered policy and an individual policy, choosing the employer-offered policy first is recommended, as it often leads to faster and simpler claim settlement. Additionally, selecting the group policy ensures the retention of your no-claim bonus on the individual policy.

Understanding cashless Health Insurance claims and reimbursement

When you have two policies with a cashless facility, the hospital may provide this option on only one policy and request you to pay the remaining amount for reimbursement from the other insurer. Note that not all policies offer cashless claims. In such cases, you can either opt for the policy with cashless claims or proceed with reimbursement claims. Make sure to obtain the claim summary and certified hospital bills from the first insurer and submit them to the second insurer for reimbursement.

Choosing the Right Approach

While there is no set limit to the number of health insurance policies you can purchase, it is recommended to stick to a maximum of two policies with a sufficient sum insured. This typically includes a base policy and a top-up policy, in addition to any coverage provided by your employer. Maintaining a manageable number of policies ensures clarity and ease during claim settlement, minimizing any potential confusion.

In a nutshell

In the face of rising healthcare costs, utilising multiple health insurance policies can be a prudent approach to safeguarding your financial well-being. By carefully understanding the terms and conditions of each policy, prioritising coverage options, and leveraging cashless claims or reimbursement as per the policies’ provisions, you can maximise your health insurance benefits.

Remember to disclose all existing policies to insurers and maintain proper documentation throughout the process. With the right strategy in place, you can navigate the complex world of health insurance and ensure comprehensive coverage during times of medical need.