How to File for a Claim When You Own Multiple Mediclaim Policies

There are people who hold more than one health insurance policy with the intention of getting a higher insurance coverage or improving their chances of getting a claim approved. Other incidental reason which makes people own multiple health policies is their employment status. For instance, if both husband and wife are working, their respective employer may offer a family coverage which should also lead to dual coverage for family members.

While you are holding multiple policies, it is vital to understand that the claims procedure will be a bit different than it is when you hold a single policy. While filing for a claim for hospitalization in case of multiple mediclaim policies, it is advisable that you inform the Third Party Administrator (TPA) about all the health insurance policies that you own. The claims procedure would depend on what sort of combination of medical insurance policies you own. Discussed below are three different combinations:

1. Combination of two personal reimbursement policies

In case both health insurance policies are bought personally by you, it is important to inform the TPA, because most policies have a contribution clause which allows insurers to share the hospitalization cost in proportion to the coverage they offer. Like if the hospitalization cost is Rs 2 lakhs and you have two policies allowing coverage of Rs 2 lakhs and Rs 3 lakhs respectively, in that case the hospitalization cost of Rs 2 lakhs would be shared in the proportion of 2:3.

Apart from cost sharing, the other aspect that you would need to take care of is getting duplicate copies of the hospitalization documents (treatment summary, bill, discharge slips) that are required to claim health insurance. You would have to either give duplicate copies of the original document or attested photocopies of the original documents. The hospital would obviously be fussy about giving you duplicate copies and hence you may have to get them attested.

2. Combination of a group insurance plan and personal reimbursement plan

If you own a combination of a group insurance policy and a health insurance policy that you boughton your own, in that case, it is preferred that you file the claim from your group policy. This is because while you file a claim from your group health insurance policy, there is no loading premium that would be levied on your policy when you renew it next year. Besides, group insurance policies are more liberal in the sense that they allow coverage of pre-existing disease from the first year, while a personal reimbursement health plan has a waiting period of 3 to 4 years.

3. Combination of a personal reimbursement plan and a fixed-benefit plan

Fixed benefit plan is supposed to pay you a fixed amount if you are hospitalized with a certain condition while an indemnity plan would reimburse the actual costs incurred. If you have both the plans, you can opt for a claim from both these plans.