Health Insurance Claim from Multiple Policies

When it comes to claiming from multiple insurance companies, the process can be simplified with a few key steps. 

1. Inform all the insurers: As a policyholder with multiple health insurance policies, it is important to inform all the insurance companies involved about your intention to make a claim. Notify each insurer individually and provide them with the necessary details regarding your claim. 
2. Submit claim documents: Gather all the required documents related to your medical expenses, such as bills, receipts, medical reports, and any other supporting documents. Make sure you have copies of these documents for each insurer you plan to approach. 
3. Choose the primary insurer: Decide which insurance company you want to approach first to settle your claim. This is typically referred to as the primary insurer. You can choose the insurer with whom you have a longer-standing relationship or the one that offers better coverage for your specific medical expenses. 

1. File the claim: Submit the claim documents to the chosen primary insurer following their standard claim filing process. Ensure that you provide accurate and complete information to avoid any delays or complications. 
2. Obtain the settlement statement: Once the primary insurer has processed your claim and provided you with a settlement statement, which details the amount they have reimbursed, you can proceed to the next step. 
3. Approach the secondary insurer(s): With the settlement statement in hand, approach the other insurance company or companies involved in your coverage. Submit the settlement statement along with the necessary claim documents to initiate the claim process with each secondary insurer. 
4. Coordination between insurers: The primary insurer and the secondary insurer(s) may communicate and coordinate directly to determine the final settlement. This may involve sharing information about the expenses already reimbursed by the primary insurer to ensure that there is no duplication or overpayment. 
5. Reimbursement and settlement: Once the coordination is complete, the secondary insurer(s) will process your claim based on their share of the sum assured. You will receive reimbursement for the remaining eligible expenses as per their policy terms and conditions. 

It's important to note that each insurance company may have its own specific requirements and processes for coordinating claims, so it's advisable to review the policy documents and reach out to the insurers for any additional guidance or clarifications. 

How to Claim Health Insurance from 2 Policies From the Same Insurance Company?  

You can also claim health insurance from two policies from the same company. Here is a step-by-step guide on claiming health insurance benefits from two policies from the same insurance company: 

1. Understand the coverage: Review the terms and conditions of both policies to ensure the expenses you want to claim are covered. 
2. Gather documents: Collect all necessary documents, such as medical bills and receipts. 

1. File the primary claim: Submit a claim with one of the policies following the standard procedure. 
2. Obtain claim settlement summary: Once the claim is settled, get a claim settlement summary from the insurance company. 
3. Submit a claim to the second policy: Provide the claim settlement summary and required documents to the second policy for reimbursement of remaining eligible expenses. 
4. Track the claim: Stay in touch with both insurance companies and monitor the claim's progress. 
5. Review the reimbursement: Verify the reimbursement amount from the second policy aligns with the policy coverage. 

1. Seek clarification if needed: Contact the insurance company's customer service for any questions or concerns. 

By following these steps, you can effectively claim health insurance benefits from two policies of the same insurance company. 

Advantages of Having Different Health Insurance Plans from the Same Insurer: 

1. Convenience: Managing multiple health insurance plans from the same insurer makes the claims process more convenient and reduces paperwork. 
2. Access to Multiple Policies: By having different plans, you can benefit from a wider coverage range and potentially higher sum assured. 

1. Second Insurer Option: If the first insurer rejects a claim, you have the option to approach the second insurer for coverage, providing an additional layer of security. 
2. Centralized Insurance Requirements: Purchasing different types of insurance policies from the same insurer allows you to centralize your insurance needs, simplifying administration and communication. 

Disadvantages of Having Different Health Insurance Plans from the Same Insurer: 

1. Varied Terms and Conditions: Each plan may have different terms and conditions for raising a claim, requiring careful review and understanding to ensure compliance. 
2. Complex Claim Process: Dealing with multiple plans can sometimes result in a more complex claim process, as you need to navigate different terms and potentially coordinate with multiple insurers. 

1. Potential Duplication of Coverage: It's important to ensure that the benefits of each plan do not overlap or duplicate, as this can lead to confusion and may not provide any additional advantage. 
2. Need for Transparency: To prevent claim rejections, transparency with the insurer is crucial. Accurate and complete disclosure of the information is necessary to avoid potential issues during the claim process. 
3. Understanding Plan Benefits: It is important to thoroughly understand the benefits and limitations of each plan before purchasing to ensure they align with your specific healthcare needs and preferences. 

Types of Health Insurance Claims

When claiming health insurance from two or more policies, the process typically involves two methods: cashless claims and reimbursement claims. Here is a detailed breakdown of each method: 

Cashless Claims:  

1. Select a network hospital: If your claim falls within the sum assured of a single policy, choose a network hospital associated with one of your insurance companies. This allows you to avail cashless hospitalization.  
2. Inform the primary insurer: Notify the primary insurance company about your hospitalization and provide them with the necessary details. Fill out the cashless claim request form provided by the insurer.  
3. Authorization process: The primary insurer will coordinate with the network hospital for the pre-authorization process. They will assess the claim and, if approved, provide a cashless claim settlement summary.  
4. Settlement summary and bills: Once you receive the settlement summary from the primary insurer, submit it along with the attested hospital bills to the second insurance company. This is done to claim reimbursement for the remaining balance. 

1. Reimbursement settlement: The second insurance company will review the claim and settle the balance amount based on their policy terms and conditions. They will reimburse you for the eligible expenses not covered by the primary insurer. 

Reimbursement Claims:  

1. Non-network hospital treatment: In situations where you receive treatment at a hospital that is not part of the network of any of your insurers, you will need to go through the reimbursement method. 
2. Paying hospital bills: Initially, you are required to settle the hospital bill out of your own pocket. Ensure you collect all the necessary documents such as discharge summaries, lab reports, medicine bills, and any other relevant medical records during your hospital stay. 
3. Claim submission: Fill out the claim form provided by the insurance company and attach the required documents. These include the attested hospital bills, medical reports, and any other supporting documentation as per the insurer's guidelines. 

1. Claim review and settlement: The insurance company will evaluate your claim based on the submitted documents and determine the reimbursement amount according to their policy terms. Once the claim is reviewed and approved, the insurer will reimburse you for the eligible expenses incurred. 

Documents Required

When filing a reimbursement claim for health insurance, it is important to gather the necessary documents to support your claim. Here is a list of documents commonly required during the reimbursement claim process: 

1. Discharge Summary: This document provides details about your hospital stay, treatment received, and the period of hospitalization. It is usually issued by the hospital or treating physician. 
2. Claim Form: Fill out the claim form provided by the insurance company accurately and completely. This form collects essential information such as personal details, policy information, details of hospitalization, and the claimed amount.  

1. Bills and Receipts: Include all original bills and receipts related to hospital expenses, such as room charges, doctor's fees, nursing charges, operation theatre charges, medication costs, diagnostic tests, and any other relevant expenses. Make sure these bills are itemized and contain the necessary details. 
2. Prescriptions: Provide copies of the prescriptions given by the treating doctors for medications and treatments. These prescriptions should clearly mention the prescribed medicines and their dosages.  
3. Lab Reports: Include all relevant laboratory test reports, such as blood tests, pathology reports, and other diagnostic reports. These reports should be issued by accredited laboratories or hospitals where the tests were conducted. 
4. X-rays and scans: If you underwent any X-rays, MRIs, CT scans, or other imaging tests, include the original films or slides along with their reports. These provide evidence of the diagnostic procedures and their outcomes. 
5. Claim Settlement Summary (if applicable): In the case of claims from multiple insurers, include the claim settlement summary provided by the primary insurer. This summary outlines the amount reimbursed by the primary insurer and serves as supporting documentation for the secondary insurer(s) to determine the remaining eligible expenses. 

Remember to keep copies of all the submitted documents for your records. Additionally, it is recommended to check with your insurance provider regarding any specific documents they require for the reimbursement claim.

Each insurance company may have slightly different requirements or additional documentation based on their policies and claim procedures. 

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.