How to claim health insurance from multiple insurance companies?

How to claim health insurance from multiple health insurance companiesHow to claim health insurance from multiple insurance companies?


While an individual might have group medical insurance from their company, for several reasons, individuals would take individual health insurance policies. However in case of any claim, it is not that simple to approach multiple insurance companies. You should understand the steps which are involved in claiming health insurance from multiple insurance companies. In this article, I would elaborate on step-by-step process on how to claim health insurance from multiple insurance companies.

Also Read: Top and Best Health Insurance Policies in India in 2015

Why individuals would take multiple health insurance companies?


An individual would have group medical insurance plan from their company, however they would take additional individual health insurance plan for various reasons like:

  • Company provided health insurance is not adequate in term of sum assured, as cost of treatment is increasing day by day.
  • Individual health insurance plans are taken to cover specific diseases like Cancer, Diabetes, Critical Illness coverage etc.
  • Reduce dependency from one health insurance company so that in case of any claim rejection, other policy would be handy.
  • In case of any job change or loss of job, such additional individual health insurance plan would be useful in case of any claim.

In case of claim, which health insurance to be claimed first?


In case of any claim, if you have multiple health insurance plans, you should adopt the following strategy:

  • Claim through group medical health insurance plan first. Since this is company provided health insurance plan, as an individual you need not pay any extra premiums in future due to claims in current year. In case you are claiming individual health insurance plan, your premiums could increase in future as there could not be no-claim bonus due to claims in current year.
  • In case you have new health insurance plan and also old insurance plan, coverage for specific diseases may not be possible through new insurance plan. In such case you should go for old health insurance plan as waiting period could have been over in that.
  • In case of multiple health insurance plans, Contribution clause comes in to play. Contribution clause is based on sum assured from a single company over the total sum assured from all insurance companies where you have taken health insurance plans.

E.g. You have taken Rs 1 Lakh health insurance from A Insurance company and Rs 3 Lakhs health insurance from B Insurance company. In case of any claim, the expenses would be borne by A insurance company and B insurance company in the same proportion. In such case, for A Insurance company the cost of expenses would be Rs 1 Lakh over total Rs 4 Lakhs i.e. 25%. Similary for B insurance company, it would be 75% (Rs 3 Lakhs over total of Rs 4 Lakhs).

  • In case the claim covers the sum assured from all companies, individuals have choice to claim from any one company.

E.g. in above case, if insurance claim is less than Rs 1 Lakh, it is immaterial if you want to claim from A Insurance company or B insurance company. However in case of expenses more than Rs 1 Lakh, you cannot claim from A Insurance company alone as sum assured is only Rs 1 Lakh. In such case, you can claim through multiple health insurance plans.

Also Read: Should you consider health insurance plans offered by Bank?

How to claim health insurance from multiple insurance companies?


You can follow these steps while claiming health insurance in case you have multiple health insurance plans.

  • In case of any hospitalization / treatment / pre-hospitalization, inform all insurers and Third Party Administrators (TPAs) where you have taken health insurance plans.
  • At hospital, fill application form with all policy details including insurance companies, policy nos etc.,
  • If you claim through one insurance company and claim amount exceeds for one insurance company, they would follow-up with other insurance companies listed by you in application for their contribution. You need not follow-up with other insurance companies.
  • If you have old and new health insurance policies, you should claim through old insurance policy as new one may not cover pre-existing diseases. You should indicate old policy details as primary one to claim.
  • If you are claiming from multiple health insurance companies, they would need original bills and supporting medical documents. They may approach you in case primary insurance company is not willing to share them. You can get duplicate copies from hospital itself. If you have difficulty, you can ask for attested copies of the bills and medical reports. These can be submitted to other insurance companies.

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Suresh
How to claim health insurance from multiple insurance companies

4 comments

  • Amit

    Very nice and informative article. Thank you so much for sharing.

  • Shubh

    Thank you for this article. It replies many of my queries.

    I shall appreciate, if you can advise, how should we claim, if both the health insurance policies (Company provided group plan for family and Individual family floater plan) are from the same insurance company.

  • DB DESAI

    Please verify whether the condition on contribution clause is still applicable or not. I remember having read some time back that it has been removed and the policyholders have been given freedom to claim from any company of their choice.

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