People often tend to take different health policies for different benefits and these could indeed be beneficial while making a health insurance claim. Having multiple policies increases the coverage and can save a lot of money by utilizing the benefits under multiple policies. Choosing a policy is an important decision and you want the best medical care treatment that is available for several important illnesses. This creates a demand for having health insurance which covers you and your family fully all the times.
However, it is important to know that a claim more than the sum assured couldn't be raised, whether it is a single plan or multiple policies. There could be cases where the treatment cost would go up, and here the utilization of second health insurance to cover you comes into play.
Contribution Clause in a Health Insurance
To make it easier for the policyholders to take advantage of the multiple polices IRDAI made some changes in the rules and regulations. Before 2013, IRDAI made it mandatory that total medical expense had to be shared by insurance companies in the proportion of whatever sum was assured by them, this is known as the Contribution Clause'. This has been eradicated and now the policyholder can reach out to any of the insurers to settle the claim.
The process to Claim health Insurance from two or more policies
Multiple insurances are common as one could be provided by the employer and you can also decide buy health insurance online with desired add-ons. To raise a claim at multiple policies you need to first approach an insurer to settle the claim then take a summary of the claim settlement and approach the second insurer with hospital bills and the summary to settle the rest of the expenses. If a claim is less than the sum insured, the claim is initiated under one policy, if it is more then, the methods to be taken are:
Under the cashless claim, you get free treatment at a network hospital. In this process, you raise a claim with one insurance company and get the claim settlement summary. After this, the summary and hospital bills which you have paid must attest and submitted to the second insurer to settle the balance amount as reimbursement.
While the cashless claim is simple with the involvement of network hospitals, there are cases when you will have to get treatment at a non-network hospital. In this, the claim has to be settled with the reimbursement method. When all the hospital bills are paid you need to submit the attested documents such as Discharge Summary, lab reports, bills, prescriptions. The insurance company will review these documents and settle the claim.
People also opt for different plans from the same insurer which is convenient since it decreases the paperwork. However, it is important to read terms and conditions properly before getting a policy. You can always approach the second insurer with different insurers involved in case the first one rejects the claim.