Having access to multiple health insurance policies can be a benefit when making health insurance claims from multiple insurers. It increases the coverage, flexibility in the number of claims, and can save a lot of money by utilising multiple benefits. While choosing health insurance, you want the best healthcare facilities and treatment for several important illnesses. It is critical you have a robust health insurance plan to cover your family from any unforeseen hospitalizations.
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How to Claim Health Insurance From Multiple Insurers
You need to know that you cannot claim more than the sum assured, be it through a single or through multiple plans. However, there are situations when the expenses incurred for the treatment are more than the sum insured. Here is when you can use the second health insurance to pay for the remaining amount. This will act as a financial backup in case of major medical events.
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To make it easier for policyholders to take advantage of multiple health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) has made changes to the rules and regulations. Prior to 2013, the IRDAI made it mandatory that the total medical expenses had to be shared by the insurance companies in proportion to the sum assured by them. This is known as ‘Contribution Clause’ in health insurance. However, this has been eradicated and now the policyholder can approach any one of the insurers to settle the claim. But how to claim from two or more insurance companies? Read on to find out.
With multiple health insurance plans, one is employer health insurance and the second is your personal health insurance policy, you may ask the question “Can I file a claim with two insurance companies?” The answer is yes. To raise a claim from multiple health insurance plans, you need to raise it with the first insurance company towards the expenses of medical treatment. Then, you need to obtain the summary of the claim settlement, attest the hospital bills and approach the second insurance company to settle the rest of the expenses.
The health insurance claim process from multiple insurance companies is structured on the basis of a cashless and reimbursement method for insurance coverage. If your claim is less than the sum assured, then you initiate the claim under a single policy. However, if the hospital expenses are more than the sum assured of a single policy, then you can claim under the below two methods:
Below is the list of documents required while registering a reimbursement claim:
A document provided by the hospital that outlines the treatment received, including details of the diagnosis, procedures performed, and follow-up care.
Official documentation of all expenses incurred during treatment, including hospital charges, medication, and other medical services.
Detailed results of medical tests and investigations conducted during your treatment, such as blood tests, urine tests, etc.
A list of medications prescribed by your doctor, including dosage and duration, to treat your condition.
The official form provided by the insurance company that you need to fill out to initiate the claim process.
A document that details how the claim amount has been distributed between multiple insurance companies when multiple policies are used.
Having different health insurance plans from the same insurer is convenient since claims are a lot easier and paperwork might be lesser. However, there may be different terms and conditions to raise a claim. It is essential that you read the terms and conditions before you choose to buy a health insurance plan. You can always approach the second insurer in case the first insurer rejects the claim. There are several online health insurance plans that you can review before you opt for the right plan.
It is also imperative you be transparent to your insurer to ensure claims are not rejected and to experience a smooth claim process. You can buy different types of insurance policies from the same insurer to centralise your insurance requirements; however, it is also important to understand the different benefits of each plan before purchasing a suitable health insurance plan.
Also, read: Health insurance for family
Below are some of the common questions about health insurance claims with insurance companies:
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Reviewed by Rupinderjit Singh 
Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.
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