Can We Claim Health Insurance From Multiple Insurers?

Introduction

We all know various instances of medical illnesses or accidents that were followed by a string of expensive healthcare bills. The most recent instances might be linked back to the previous wave of COVID-19. People with co-morbidities suffered greatly in these situations since they had to stay in hospitals longer and pay higher medical expenses.

People without health insurance were seen searching for new plans, while those who already had coverage either bought new ones or increased the coverage of their existing policies through top-up or super top-up plans.

Many people who had various health insurance policies from the same or separate insurers were able to sufficiently protect themselves and their loved ones at the same time. Owning numerous health insurance policies is very common and can support you financially when necessary. 

These plans could combine your personal health insurance, the group health insurance programme offered by your company, and any other health insurance you may have. The intriguing aspect is that many policies from any of these categories may be used for a single claim.

Process of claiming two health insurance policies

When a medical emergency arises, the policyholder has flexibility in the number of claims due to access to two or more health insurance policies. While most people know how to submit a claim for health insurance, filing claims for two different policies can occasionally be challenging.

The policyholder may only claim under one policy if his medical insurance claim is smaller than the sum assured. The policyholder can make a claim using either the reimbursement claim or the cashless method if the amount claimed exceeds the total sum assured of a single policy.

Cashless claim

You receive cashless hospitalisation at the network hospital under the cashless claims. You file a claim with one insurance provider in this instance, and you receive the claim settlement summary. Once this is done, the second insurance provider should be contacted to settle the remaining amount as reimbursement using the claim settlement summary and attested hospital bills.

Reimbursement claim

Even while network hospitals make cashless claims simple, there may be times when you must receive care at a hospital that is not a part of the insurer’s network. You must use the reimbursement process to resolve the claim in this circumstance. The hospital bill must be paid first before you may request a reimbursement from the insurance provider. 

To be eligible for reimbursement, you must submit the claim form and attested copies of your discharge summary, lab results and other relevant documentation. The insurance provider will examine the claim and pay the appropriate sum.

Documents needed to make a reimbursement claim with one insurance company when claim is settled by another insurance company

Here is the list of attested documents that is required for a reimbursement claim:

• Discharge summary
• Bills and receipts
• Lab reports
• Claim form
• Prescriptions
• TPA settlement advise

How to claim health insurance benefits from two policies?

The process of claiming health insurance benefits from two policies is relatively simple. Here is a step-by-step guide on claiming health insurance from two insurance providers 

Step1

Submit reimbursement or cashless claims for the insurance policy with the higher sum insured.

Step 2

Get the settlement certificate from the first insurer who has paid the claim.

Step 3

To obtain the remaining sum, file a health insurance claim with the second insurer. Deliver the necessary paperwork and a settlement certificate. If everything checks up, the second insurance company will assess their contribution clause and approve your claim.

It is simple to file claims for health insurance from two different companies. Keep the insurance providers informed of any health insurance policies you may have from other insurers, but don’t neglect to do so.

Remember to disclose existing policies

The important thing to remember when filing a claim under two policies is that both insurers must be aware of the other policy. Due to a contribution clause in the majority of policies, it is typically required to complete proposal documents when purchasing health insurance in order to disclose any existing policies.

You might purchase different insurance policies from the same provider to centralise your insurance needs. To prevent claims from being rejected and to ensure a seamless claim procedure, it is also essential to be open with your insurer.

However, it is vital to understand the different benefits of each plan before buying a suitable health insurance plan.

Summary

Today, many of us are covered by two different health insurance plans. People purchase multiple health insurance plans in order to cover their various needs and keep the coverage from running out.

It’s essential to invest in a health insurance policy plan that will cover your medical treatment costs in the event of an unexpected medical emergency so you can quickly access the best healthcare services. The claim is payable by the second insurer subject to the policy terms and  conditions.