Can You Claim Health Insurance from Two Different Companies?

Health Insurance provides financial protection that will safeguard you from medical costs that may come up unexpectedly. 

Generally, individuals buy a single health insurance policy, but due to rising medical expenses, some might also consider buying another policy from a different insurer. 

Now the question arises: Can you claim health insurance from two different companies? We have good news for you - yes, you can! But there are certain terms and conditions. 

All your questions surrounding this topic will be discussed in this article, so keep reading! 

What is the ‘Contribution Clause’ in Health Insurance?

If you want to claim health insurance from two different health insurance companies, it's important for you to understand the ‘Contribution Clause’ first. 

This law is made in accordance with the Insurance Regulatory and Development Authority of India ( IRDAI) guidelines. 

According to this, if you have taken two or more policies from one or more insurers to cover the treatment costs, the Contribution Clause will not be applied initially. This means you are free to choose any one of the policies for claim settlement.

The insurer you choose has to pay the claim without asking other insurers to contribute as long as the claim is within the policy's limits and terms. 

However, if the claims exceed policy limits, the insurers can use the Contribution Clause to share the payment proportionately. 

For this, let’s look at the following example: suppose Sunaina has two health insurance coverage taken from two different companies - of INR 5 Lakh from Company A and INR 10 Lakh from Company B. If in case she raises a claim for 9 Lakh, this claim will be given to her from both companies in a ratio of 1:2. This ratio will be decided by the insurance companies after mutual agreement.

Is it Possible to Claim Health Insurance from Two Companies?

Absolutely, yes! Having health insurance policies from two different companies has a lot of advantages, such as more coverage, greater flexibility, and better protection against unforeseen medical conditions. 

But there are some terms and conditions which you must understand! To make you understand better, we’ll take two different situations. 

Mr Singh bought a health insurance policy from ABC insurance company (primary insurer) that offers coverage up to 10 lakh. After a couple of months, he bought another plan from XYZ insurance company (secondary insurer) with coverage up to 20 lakh. 

Due to a health issue, he was admitted to the hospital, where his medical bill was 15 lakh. 

Instance 1: Because Mr Singh's medical bill was ₹15 lakh, which exceeds the ₹10 lakh coverage limit of his policy with the primary insurer, so they will cover ₹10 lakh. For the rest of ₹5 lakh, he can reach out to XYZ insurance company and get the amount settled. 

If Mr Singh's medical bill was ₹10 lakh

Instance 2: ABC Insurance company would cover the entire ₹10 lakh, as it is within their policy limit. Plus, he can't reach out to XYZ insurance company as it will be considered fraud because one cannot claim more money than they need for their medical expenses at that particular moment. 

Important: Remember that you cannot hide any information from the primary insurer when you are deciding to buy a policy from another company.  

How To Claim Health Insurance From Multiple Insurers?

Below’s a step-by-step guide explaining how you can claim health insurance from multiple companies hassle-free:

• Inform All Insurers:

Let both insurance companies know about your hospital stay or medical treatment as soon as possible. This helps keep everything clear and straightforward.

• Submit Initial Claim:

Choose the primary insurer to handle the first claim. Send all the required documents, like the claim form, medical bills, and hospital discharge summary. Wait for them to process the claim! 

• Obtain Settlement Summary:

After the first insurer pays, ask them for a settlement summary. This shows how much they paid and how much is left to be claimed.

• Submit the Remaining Claim to the Secondary Insurer:

Give the second insurer the settlement summary, the original claim documents, and a copy of the claim form. Do the basic formalities according to their terms, and the remaining amount will be settled according to policy coverage. 

The insurance companies provide policyholders with two different options for claim settlement. Both have their own perks and different timelines for claim processing. Read on to find out! 

Cashless Claims

You can opt for cashless claims if you are being treated at the insurance company’s one of the network hospitals. 

Here, the insurer coordinates with the network hospital to cover the medical bills based on the coverage mentioned in your policy. This way, you don’t have to worry about reimbursement procedures, and there is no need to make any cash payments. 

According to the IRDAI “three-hour time limit” guideline, the insurer is bound to settle the claim in three hours, given all the paperwork and certain conditions are met by the policyholder.

Reimbursement Claims

If you are at a hospital that is not a part of the insurance company's network, you cannot avail of the cashless claims. In this situation, you will have to utilise the option of reimbursement claims, where the hospital bill will be covered by you at first and later reimbursed by your insurer. 

Generally, reimbursement claims are settled within 7 to 15 days and a maximum of 30 days. 

How To Claim Multiple Health Insurance From The Same Company?

Claiming multiple health insurance from the same company is much easier than two different companies. Here’s how to do it. 

Pro Tip: Check the details of each health insurance plan you have. Understand what each one covers.

• The first step is pretty obvious. Contact your insurance company and let them know you have multiple policies with them. 
• Collect all necessary documents like the claim form, medical bills, discharge summary, and any other required papers. Submit one set of documents for all your policies since they are with the same insurer. This makes the process easier.
• Clearly list all the policy numbers so that the insurer knows you have multiple policies. 
• The claim will be settled according to specific policy terms and offered coverage. 

Advantages of Multiple Health Insurance Policies

Having more than one health insurance policy can be really helpful. Read on to know why! 

• Claim-Settlement Flexibility: With multiple health insurance policies, you can decide which insurer to claim from first based on the best terms. Plus, it also helps you get the maximum reimbursement for your medical expenses.
• Higher Coverage: Combining coverage from multiple policies allows you to have a higher total coverage amount, which can be very useful for expensive treatments or surgeries. In short, large medical bills will be covered without worrying about a single policy's limits.
• Less Out-of-Pocket Costs: Your one health insurance policy might not cover the medical cost that you require. But with another policy by your side, those gaps can be filled, and all parts of your medical bill will be covered. 
• Better Risk Management: If one policy lapses or is discontinued, you still have other policies providing you coverage. At the same time, if one insurer makes an issue with claim settlement, you’ll still have other policies in place.
• Access to More Hospitals: Multiple health insurance policies give you access to a broader network of hospitals and healthcare providers.

Frequently Asked Questions (FAQs)

Ques 1. Can I claim health insurance from two different companies for the same medical expenses?

Ans. Yes, you can claim from multiple insurance companies if you have more than one policy. However, you cannot claim more than the total amount of your medical expenses. Each insurer will pay up to their policy limit.

Ques 2. Can I have two insurance policies?

Ans. Yes, you can have multiple insurance policies in the same company and different companies at the same time. 

Ques 3. Is there a limit to the number of health insurance claims I made?

Ans. No, there is generally no limit to the number of health insurance claims you make. But it's worth remembering that coverage will only be provided according to policy terms. 

Ques 4. Are there any disadvantages to having multiple policies in different companies?

Ans. There are no major disadvantages of having multiple policies in different companies other than the fact that you will have to pay multiple premiums. 

Ques 5. Is there any risk of claiming from multiple insurers?

Ans. No, if you accurately report your expenses and follow the claims process correctly, there is no risk. Make sure you do not claim more than your actual costs, and keep all documentation clear. Any fraudulent activity might lead to legal consequences. 

Ques 6. Can I claim the full amount from both insurance companies?

Ans. No, you cannot claim more than your actual medical expenses. Each insurer will only cover their share up to their policy limit.