Health insurance is a necessity in today's times and nothing can be more useful than it in times of an illness or accident. Many people even have two health insurance policies; one of them is their own individual policy and the other is a group health insurance policy provided by their employers. In view of the rising inflation in the medical field, you can even decide to take out two insurance policies for yourself. In such cases, you may wonder if it’s possible to file a claim in two insurance companies simultaneously. If you are also looking for the answer to this question then the answer is both yes and no. IIn this article, we will also talk about the different conditions associated with claiming from two companies.

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  1. The process to make claims from multiple insurers
  2. Documents needed to make reimbursement claims

While you can have multiple health insurance policies at the same time, you cannot make multiple claims across different companies for the same health expense or bill. That is, the maximum amount you can get from all the insurance companies together is the same as the amount you have spent. If your medical bill is more than the sum insured of one insurance policy, then only you can claim the balance amount from another company.

In the year 2013, the Insurance Regulatory and Development Authority of India (IRDAI) made necessary changes in the rules. Before these amendments in the rules, every health insurance plan had a contribution clause. At the time of claim, each insurance company used to contribute an amount in equal proportion to the sum insured. The amendment in the rules made the claim process easier. Now, if the claim sum is less than the insured, then the contribution clause is not applicable. However, if the claim amount is more than the sum insured, then this contribution clause is applicable. You can also decide for yourself which insurance company you want to claim first from. 

(Read more: Policyholder's Responsibilities during Claim Settlement)

Cashless claim

In the case of a cashless claim, you file a claim with a company and the company settles the bill directly with the hospital. If the claim amount is more than your sum insured, then you can claim the remaining amount from another company. For this, you first have to pay the remaining amount yourself at the hospital. Then you will have to take a claim settlement summary from the first company. You will also need to take attested copies of all the bills. After this, you will have to claim a reimbursement from the other company for the remaining amount.

Reimbursement claim

A cashless claim is more convenient for the insured, as the insurance company settles the bill with the hospital itself. Despite this, it is not necessary that you would be getting treatment in a network hospital of the insurance company. In such cases, you have to first pay the hospital bill yourself and then claim reimbursement with your health insurance company. For reimbursement, you need to submit the claim application form to the insurance company along with all the original bills and hospital documents (these will be retained by the insurance company).

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If you have a health insurance policy from more than one company and you are getting treatment in a non-network hospital, then you have to inform all the insurance companies about your hospitalization. After this, you can decide for yourself which insurance company you want to claim from first. Some important documents required for reimbursement claim are as follows:

  • Hospital, doctor and medicine bills and receipts
  • Discharge form
  • Diagnostic test
  • Doctor's prescription
  • X-ray film and slides, if any

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If you want to claim health insurance, then our advice would be to claim under the group insurance policy from your company as their claim process is faster. One important thing you should also remember is that you should take as many attested copies of all the above-mentioned documents as you want to claim from the insurance companies. The first company where you make a claim will provide you with a claim settlement summary. You will put this copy along with the other document for the other insurance company, so they can transfer the outstanding amount of your claim to you.

Every time you file a claim, it is not necessary for the company to pass it. Sometimes, the health insurance company even rejects the claim. If you have not mentioned your pre-existing health insurance policy while taking another insurance policy, then the company can refuse to pay the claim. Apart from this, if the claim amount is more than the amount of the contribution clause, you can still be denied the claim.

(Read more: Hospital Cash Policy in Health Insurance)

There is no doubt that the inflation-related to health facilities is increasing continuously. That is why it has become very important to have a large sum insured in your health insurance policy. To avoid any kind of problem, instead of taking multiple policies with a lower sum insured, our advice is to take a large sum insured in one policy.

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