Is it possible to claim with Multiple Health Insurance policies ?

POSTED BY Yogesh K ON February 28, 2012 11:58 am COMMENTS (8)

I have follwoing 3 questions

1. Person A has two Health Insurance policies. One is company group policy and the other one is individual policy (not floater) and both from different companies. In this case how the claim should be processed in case of hospitalization. Is it mandatory to file claim with both the insurers on the basis of ratio of respective sum assured in each policy?

2. Person B has taken two Health Insurance policies. One is family floater policy and the other one is individual policy and both from different companies. In this case how the claim should be processed in case of hospitalization.

3. For any claim one needs to submit original documents (like discharge certificate, hospital bill). So if the claim is made for one company then for claiming other company what is the procedure in the absence of original documents?

8 replies on this article “Is it possible to claim with Multiple Health Insurance policies ?”

  1. SANTOSH KUMAR says:

    Hello,

    Its really a tricky question to answer. Here the underlying thread is ” Whats written in the policy document”. Because if the policy provider has quoted that Double claim is permissible, then only you have a way out. Otherwise it would be wise to first claim from the Company Group Insurance and then touch the individual one, if needed. The reason for the same is quite simple. The next renewal premium revolves around your previous claim in many cases.

  2. Dear TheZionView, Here the case is a bit different. Here the person is not having 2 individual policies from 2 different insurers in individual capacity. 1 is provided under a group cover from the employer where as another policy is an individual one. The group cover may cease to exist either due to change in co. policy or simply due to change of job. In any case, the split ‘ll not be possible.

    Also in this case, there is no need to quote the group cover to individual cover insurer.

    That’s why I asked to file claim only with employer insurer.

    Thanks

    Ashal

  3. Yogesh K says:

    Thanks for all responses. I have the same query as asked by “TheZionView”. Lets both the policies have limit of 3 lakhs each and hospitalization expenses are 2 lakhs. Then Is it mandatory to file claim with both the insurers for 1 lakh each ? Or I can file claim for 2 lakhs with only one insurer ?

  4. Dear Ram, make it a habit to file your claim with your employer insurer only. Please do not file your claim with personal insurer unless amount is so big that employer’s insurance sum assured is falling short.

    Thanks

    Ashal

    1. TheZionView says:

      @ashal
      I thought it is mandatory to claim from both parties and usually settle based on their ratio of the share. For example if i have 4L from A and 1L from B and if my expense is 1L .

      Then claim ratio will be 80:20 ie 80K from A and 20K from B. Please explain if this is not the case.

  5. rmohan80@gmail.com says:

    Yes you can claim multiple policies.

    Let’s look at an example; you have a cover of 2 lacs in policy A and 1 lac in policy B. However your total expenses comes to 2.5 lacs.

    You have the following options:

    1) Claim 2 lac from policy A and 0.5 lac from policy B
    2) Claim 1 lac from Policy B and 1.5 lac from policy A

    It is totally upto you how you claim them. Let’s take the scenario 1. You’ve claimed 2 lac from Policy A and have submitted all bills to insurance company. They’re supposed to provide you a letter that shows how much total discharge is and this you can send to Company B.

    I’m not sure exactly how the entire procedure works, but this is what the TTK folks at my office said when I raised similar question on how we can use multiple policies

    Thanks,

    Ram

  6. BanyanFA says:

    Yogesh,

    Your total claims from all medical insurances can not exceed more than your medical bills.

    Regards
    BFA

  7. Typically when you take Health insurance companies insist declaring existing covers.

    So when you have 2 policies the insurers will insist on paying pro-rata based on the total coverage.

    In any case the combined sum of payment received may not exceed the total expenses incurred because the cost of illness is limited to the actual expense. [Unlike term insurance where Human life has not definite value so all term plans taken by a person will pay in full]

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