How Do We Claim Health Insurance From Two Companies?

It is not a compulsion to have just one insurance policy, you can have multiple health insurance plans as well for covering your medical expenses. One such example is when you receive a group health coverage from your employer. It might not always be sufficient for you as it isn’t custom-made. Along with that policy, you can still keep your old insurance plan that you have or purchase a new individual plan for the coverage you desire. Another reason can be that, you’ve had your children covered under one policy and want to purchase another policy only to cover your parents.

What is the procedure to make multiple claims?

Certain changes were made to the regulations by the Insurance Regulatory and Development Authority (IRDA) in the year 2013. Earlier, the contribution clause was included in all health insurance plans. While filing an insurance claim, each insurer must contribute a certain amount that is equal to the ratio of the sum assured.

However, the modifications have made the entire procedure much easier. Now if the claim amount is lesser than the actual sum assured, they won’t apply the contribution clause. But, for claims that exceed the sum assured, the clause will be applicable. At last, it is completely your decision to make, on which company you choose to make your claim with.

The two types of claims that can be made are:

  • Cashless claims

Cashless health insurance claims can be availed at network hospitals. You can find this list of hospitals on the website of your general insurance provider. Herein, you need not pay for the incurred expenses form your own pocket as your insurance company does so upon you submitting the required documents to process the claim.

  • Reimbursement claims

Under cashless claims, the insurance companies settle the hospital bills directly with your insurer. However, there are hospitals, which no not fall under the list of network hospitals that your insurance provider is affiliated with, that do not follow this procedure. These companies would want you to first pay the amount yourself and then you can follow the health insurance claim process. You must submit all the original documents retained by the insurer, as well as the claim application form.Your insurer will compensate for the expenses of the medical procedures once you’ve made the payment and completed the health insurance claim process correctly.

Essential documents required for reimbursement claims

On making claims under multiple health insurance policies, you should intimate various companies at the time of hospitalization. Later, you can select the company, where you want to make the first claim. However, you will need to attach certain documents to be attached with the claims form.

  • Prescriptions
  • Diagnostic tests
  • Bills and receipts of the treatment
  • Films and slides, if any
  • Forms of discharge

You must obtain more than one attested copy of the documents mentioned above from the hospital. A claim settlement summary will be provided by the first company that you must submit to the next insurer for filing the claim for the balance amount.

Remember, there are chances of your insurance claim to get denied. The reason might be that you did not notify your insurer about your existing policy when you bought it. There is also a chance that your claim exceeds the contribution clause amount.

Lastly stating that it is crucial to have adequate health insurance coverage to cope with the increasing medical expenses. It is good to obtain a higher coverage under a single plan, rather than buying small sum assured under several policies.