Given the rising healthcare costs in India, health insurance has become an integral part of our lives. In such a scenario, having multiple health insurance policies can offer added benefits, such as comprehensive coverage, higher sum insured, and better claim settlement options. Do keep in mind the health insurance claim settlement ratio and consider policies with features like cashless health insurance, making hospitalisation a hassle-free experience. This blog will guide you through the process of claiming health insurance from multiple insurers in India and help you understand why having several policies can be advantageous.
The Contribution Clause and its Relevance
The Insurance Regulatory and Development Authority of India (IRDAI) has made changes to the rules and regulations to make it easier for policyholders to take advantage of multiple health insurance plans.
Prior to 2013, the IRDAI had enforced a regulation that required insurance companies to share the total medical expenses in accordance with the sum assured by each company. This regulation, referred to as the “Contribution Clause” in health insurance, has now been removed, and policyholders can approach any of their insurers to settle their claims.
Process to Claim Health Insurance From Multiple Insurers
The process to claim health insurance from two policies or more is quite simple. To raise a claim from multiple health insurance plans, you need to raise it with the first insurance company towards medical treatment expenses. Next, you should acquire the claim settlement summary, authenticate the hospital bills and then approach the second insurance company to cover the remaining expenses.
It is essential to note that the process of claiming health insurance from multiple insurers gets structured on the cashless and reimbursement method for insurance coverage.
If your claim is less than the sum assured, you should initiate the claim under a single policy. In case the hospital bills exceed the sum assured of one policy, there are two ways to claim insurance. You can do it through
- cashless claims or
- reimbursement claims
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The Cashless Claims Method
The cashless claims process provides policyholders with cashless hospitalisation at a network hospital. To initiate a cashless claim, the policyholder must file a claim with one insurance company and receive a claim settlement summary. The policyholder must then provide the claim settlement summary and verified hospital bills to the second insurance company to settle the remaining amount as reimbursement.
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The Reimbursement Claims Method
On the other hand, under the reimbursement claims procedure, if you receive treatment at a hospital that is not part of the insurer’s network, you’ll have to settle the claim through the reimbursement method. To do this, you’ll need to pay the hospital bill first and then get a reimbursement from the insurance company. You must submit attested documents, such as the discharge summary, medicine bills, etc., along with the claim form to obtain reimbursement. The insurance provider will evaluate the claim and disburse the settlement accordingly.
When making a reimbursement claim for your medical expenses, you will need to provide the following documents:
- A discharge summary
- Bills and receipts for the treatment received
- Laboratory reports for any tests or procedures done
- Prescriptions for any medication prescribed
- X-ray films and slides, if applicable
- A claim form provided by the insurer
- The claim settlement summary if you are claiming from multiple insurers
Having these documents ready will help speed up the reimbursement process and ensure your claim gets processed without any delays.
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Multiple Health Insurance Plans Offered by a Single Insurer
You may have multiple health insurance plans from a single insurer but do remember the following factors.
- Purchasing multiple health insurance plans from the same insurer can be beneficial since it may result in easier claims processing and less paperwork.
- Read the terms and conditions of each plan to understand the specific requirements and conditions for making a claim.
- Transparency with your insurers is crucial to ensure that claims do not get rejected and the process is smooth.
Centralising your insurance requirements through purchasing multiple policies from the same insurer can be a smart move, but it’s essential to understand the unique benefits and limitations of each plan before deciding.
Conclusion
Having multiple health insurance policies can be beneficial, especially in the case of high medical expenses. It is vital to comprehend the terms and conditions of each policy before making a claim. Opting for cashless health insurance policies can simplify the claim process and reduce paperwork. In case the medical expenses exceed the sum assured of a single policy, you can use the reimbursement method to claim from multiple insurers. Providing complete and accurate documentation is essential to ensure a smooth and hassle-free claim settlement process. Before purchasing health insurance policies from multiple insurers, it is important to compare the health insurance claim settlement ratio and review the features and benefits of each policy.