How to Make a Claim from Multiple Health Insurance Policies?

It’s not uncommon for individuals to have more than one insurance policy. A person may have an insurance policy of their own and then when they join a company, their employer may provide another one. In this way, they end up with two separate insurance policies. In fact, some people get new insurance policies just to get additional advantages.

Multiple-Health-Insurance-Policies

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At any rate, having multiple insurance policies indeed has its benefits. However, the question is- how to make benefit claims?

Contribution Clause

First and foremost, you need to understand the importance of declaring your existing insurance coverage to a new insurance provider before signing the papers and dealing with the formalities. However, if the premium of your current insurance policy is being paid by your employer then there is no need of intimate the same to the new insurance provider.

When an individual has multiple insurance policies then the “contribution clause” comes into effect. Originally, as per the clause, an individual was required to inform all the insurance companies they have taken insurance cover from about the different policies so that the insurance claim settlements can be divided among them all to reduce their financial liabilities.

The contribution clause exists today as well. However, according to the new regulations, it’s only applicable when your insurance claim amount is less than the sum assured of the insurer where you are claiming the benefits. Let’s take a look at the following examples to understand it better:

Let’s say the claim amount is Rs. 2 lakhs, and with company A the sum assured is Rs. 3 lakhs and with company B it’s Rs. 1 lakhs.

Case 1:  If you go to company A, it will settle your full claim (since Rs. 2 lakhs is covered under 3 lakhs sum assured)

Case 2: If you go to company B, they will pay Rs. 50,000 (25% of their share) and ask you to settle the remaining amount with the company A.

Follow these steps to settle your insurance claim with two insurers:

  • Inform all insurers at the time of hospitalization
  • Pick whichever insurer you want to go with first and fill their claim form with hospital bills and documents
  • After they have settled their portion of the claim, get a claim settlement summary from them and file another claim with the second insurer
  • Submit the claim settlement summary from the first insurer with the claim form

The second insurer will settle the remaining amount