Claiming under Multiple Health Insurance Policies

While filling up the health insurance proposal form, you might have noticed that the insurers always ask about your other policy details also. Ever wonder why?

Till the latest Health Insurance regulations were introduced in 2013, your other medical insurance policies had significance at the time of claims. Multiple insurance policies meant that contribution would apply in case of a claim. The contribution clause means that for the same claim, if there is more than one policy, then all the policies will contribute in equal proportion to the sum insured. To make it simpler, let us take an example. I own two health policies, policy A for Rs 1lakh and policy B for Rs 2lakh each and I have a hospitalisation bill of Rs 50,000. In this scenario the insurers will pay me Rs 16,666 from policy A and Rs 33,333 from policy B, respectively.  This process was not very customer friendly, as you had to inform both the insurance companies and submit documents to both the insurers.

Thanks to the changes in the health regulations, claiming medical insurance even if you have more than 1 policy has become easier. As a policy holder you have been empowered to choose the insurer with whom you would like to claim. If the amount of claim is less than or equal to the amount insured then the policy holder can claim the entire insurance from a single insurer. To take the above example of Rs. 50000 as the claim amount, I can claim this amount from Policy A or Policy B which rests with two different companies. Since the claim amount is less than the Sum Insured in both my policies, which ever insurer I approach will have to settle my claim fully.

However, if my claim amount is Rs 250000, then any single insurer cannot settle the claim, hence the contribution clause will have to be applied. My policy A will pay Rs 83333 and policy B will pay Rs 166667. In such a case both the insurers will have to be informed and the policy holder will have to choose the insurer with whom he is going to claim first. Once the first claim has been approved and paid then the claim has to be submitted with the second insurance company. Original documents will have to be submitted to the first insurer and attested copies of the documents will have to be taken from them to be submitted to the second insurer.