A lot of us often wonder if we can take multiple health insurance policies, how to settle claims for more than one health insurance policy etc. Well, here are some things you must know before opting for more than one mediclaim policy.
A lot of people have this doubt about taking multiple health insurance policies or in other words more than one mediclaim policy. These doubts are in terms of whether they can take two mediclaim policies or the rules regarding having more than one health insurance policy or how to claim when you have more than one policy going. Well let us clear the air and understand how it works when you have more than one health insurance policy for you.
Firstly; yes, you can have more than one health insurance policy. This can be for various reasons, either you have an existing policy provided by your employer, but you need to have one on your own because you may change jobs etc. or you already have an existing health insurance that has a lower sum assured and you want to increase your risk coverage. One more scenario where people opt for more than one mediclaim policy is to cover critical illnesses if your existing policy does not cover it. Whatever your need is, you can have multiple health insurance policies in India. However you need to be aware of certain rules and regulations and more importantly, how to make claims under two different mediclaim policies.
First and foremost remember, when you opt for a second health insurance policy, you must declare your existing policy details to the new insurance provider. This way you make them aware of your policy details and thus disclose all facts from your end. This should be done to avoid any disputes later. However if your previous policy is from your employer, then you need not declare it as it is part of a group health cover provided by your employer only till the time you are employed with them.
Now the claim part, there are two ways you make your claim, either you pay first and then claim a refund later known as reimbursement or you go for cashless claim if your policy has those provisions and you do not have to pay up to the limits specified in your policy terms.
Claiming under Reimbursement:
As per the new guidelines by IRDA you need to approach one insurer first, obtain a claims summary from them, and then make a claim on the other later. Let us understand how it is done.
Firstly you need to submit original bills from your hospital for making any claim under your health insurance policies. Before submitting the original bills to any one insurer, make sure to keep multiple copies of the bills and get them attested from the hospital. Once you submit the bills to your health insurance service provider, your claim is processed and you will be given a claim settlement summary.
Now take the claim settlement summary along with the attested copies of the bills and make the claim from the other insurer of the remaining amount.
Things to Note:
When you have multiple health insurance claims, chances are your claims will be settled in a proportionate manner. Let us understand by example.
You have an insurance of Rs. 2 Lac from Insurer A and Rs 1 Lac from B. Your medical bills are Rs. 1.50 Lac. Now if you want you can just make a claim from A for the entire amount. However, chances are that they may apply the ‘percentage contribution clause’ since you have multiple policies (remember you have to declare all your policies to every insurance provider) and not refund the entire amount.
In this case your claim settlement will be something like this:
Total Insurance = 3 Lac
[‘A’ provides 2 Lac; ‘B’ provides 1 Lac; thus the contribution ratio A to B is 2:1]
Claim Required = 1.5 Lac
So your claim of 1.5 Lac will be divided as per 2:1 between A and B
Thus: 1,00,000 contributed by A and 50,000 contributed by B. (simple mathematics ratio calculation), even if A can actually pay the full value as per the maximum sum assured.
Cashless claims:
In case you have a cashless provision in your policies, you will be able to make a cashless claim only on one of the health insurance policies and the balance that is not paid as per the ‘contribution clause’ above, will have to be claimed by you as reimbursement from the other insurer. Thus effectively you get your claim settled from both health insurance companies, but only one is used as cashless, while the other will have to be claimed as a re-imbursement by submitting the claim summary from the first provider and attested photocopies of bills.
Also Remember:
If one of your insurers, among the multiple health insurance policies is through your employer, make a claim there first as it is under Group Health Cover and group health claims are settled faster than individual covers. Also if you happen to have policies with various limits, like day-limits, co-pay, sub-limits etc. claim from the one that has lesser or no limits first and then go to the one that has higher limits. This way your claim settlement amount will be higher than if you go the other way round.
A general suggestion is that if you can take a large mediclaim instead of opting for multiple mediclaim policies as the paperwork and claim settlement process is simpler and less time consuming. However if you do have multiple policies try to limit them to 2 and not more. Hopefully this post would have cleared your doubts regarding multiple health insurance claims and policy details. You can post your views in the comments section below.
Hi Sir,
My Father was covered under Family floater of Oriental with sum assured of Rs 2 Lacs and recently i have purchased Group insurance of New India assurance covering (sum assured again Rs 2 Lacs) myself & my Parents in my company (where i have recently joined). My father undergone through hospitalisation for emergent Cardiac treatment and we used the cashless option of Oriental and we got reimbursement of 90 % of bill where the cardiac surgery was done. But before that he had been admitted in another hospital for less than 24 hours and then was shifted to big hospital as there was no facility of surgery in former one. We have got 90% of bill (183000 X 90% = 164000) in that big hospital. But the operation charges of Rs 32000 were taken separately from us which were not included in that bill and also we incurred considered substantial charges in former hospital where my father was there for less than 24 hours. So The scenario is like below :
Oriental – Sum assured was 2 Lacs, out of which 164000 exhausted.
New India assurance – Sum assured 2 Lacs, not being used till yet.
So can i claim for remaining amount from any of either policies ? Please advise
Is the remainder balance in Oriental (200000-164000=36000) can be used to claim remaining charges or in any later time during this financial year ?
Basically my query is, If a certain amount is used at a point of time, can balance amount be claimed in same year if we have original receipts and documents?
And just to let you know in above case i have not informed any of the Insurers that i have another policy and TPA of both the insurers is same i,e, MD India. So what would be the effect of same TPA again ? Would that be having some different scenarios?
Hi Gauri,
The coverage that you have mentioned of 90% reimbursement recd, must as per the policy of Oriental, and you can clarify as to why the charge of 32000 were not paid. For every policy there is a certain amount which the person has to bear, it depends from company to company and policy to policy. There are also policies which do cover all expenses as long as they are in the clauses of the policy – or the fine print as we say.
Now, whether you can claim the remaining amount during the year, well from your query I do understand that either companies do not have the information of the other policy. Technically you can claim the balance for any other medical treatment and you should be reimbursed according to the policy terms. But it can’t be for this same situation you mentioned. Also since the NIA policy remains unclaimed, I think the company too isn’t aware of the other policy. Generally in case of more than one insurer, the settlement is done by both on pro-rate basis.
During renewal there will a difference in the premium amount due to the claim arising in the current year from Oriental – generally it will be a bit higher.
I have renewed my medi claim policy with United India Insurance co.Ltd on 01.09.2015 for rs. 4 lakhs .
Now under a group medi claim policy initiated by our bank, i have taken a fresh policy for 4 lakhs on 30.10.2015 with the same insurance company.
Is it now possible to claim refund from the first policy premium for the unexpired period of ten months.
janarthanan
Hi Janarthan,
The mediclaim premiums are non-refundable and they also do not have any returns. So I am afraid you can simply discontinue the policy if you wish, but you will not get back what you have paid.
My father is having one of the personal mediclaim policy of mediassi where SI is 1 Lakh & Also he is covered under my sisters Insurance policy which is through her employer where also SI is 1 Lakh & it is also of mediassis. we have incurred medical Expenses of 2.5 Lakhs. Please guide me how the things will be working.
Hi Ankur,
You need to place a claim with both and they will be settling the claim pro-rata that is each of the companies would be paying in their contribution ratio which in this case is 1:1 since both are of equal amounts. Out of the 2.5 some amount will have to borne by you.
Dear Sir
I have a New India Assurance family floater medi claim policy of 5 lakhs covering me and my spouse. I get the 80 D benefit of it as well. Can I take another medi claim of 5 lakhs from the same/another company with my wife as principal insured and me as spouse, so that she gets 80 D benefit and both of us are covered by the 2nd policy as well, so we have a total health cover of 10 lakhs ? Which public/private company should I opt for as the second insurer ? Is LIC Jeevan Arogya a good alternative ?
Regards
Dr Syamal Modi
Hi Dr Syamal,
You can opt for the second policy, but you will have to declare your first policy to the new insurer. Also the total cover in your case will be of 10 lac, but at the time of claim both companies will pay out in ratio. For example, if your claim is 4 lac, then it won’t be the case where any one of them will pay the entire 4 lac amount. It will be pro-rated based on their ratio in this case it is 5 each so it is equal, so both will pay 2 lac each.
LIC is a good option, only thing is a times the premium is slightly on the higher side with a lot of LIC policies. If that is not a big issue, then LIC is a reliable option.
Dear Sir/Madam,
I have taken one cashless mediclaim policy from ICICIC Lombard Rs.3.00 Lacs, from National Insurance Rs. 2.00 lacs and my company group cashless medicalim policy Rs. 1.50 lacs from Oriental Insurance.
My question , in future if I need to admit in a hospital ,where above company’s cashless mediclaim accepted and my total medical cost has gone upto 8.00 lacs, how I can get the benefit of my cashless mediclaim . For information , I don’t claim any amount as on date and all the policies are more than 5 years old. Kindly, advice.
Pinaki Paul.
Hi Pinaki,
Firstly its great you never had to claim Mediclaim in last 5 years and hope your health stays good for a long time.
For your question; if you have declared your health insurance polices to the other provider when taking a policy then all 3 will contribute but to the ratio of their cover. Which will be 3:2:1 so even though ICICI can pay full 3 lac it won’t since you have additional cover. In case you haven’t informed ICICI about the other two covers then maybe your entire 3 lac will be settled by them but there will be some issues claiming from the other two. Same goes if you claim from National Insurance first and so on. So mainly all three will contribute up to their ratios.