How to Claim from Two Insurance Companies: Health Insurance

Claim from Two Insurance
Claim from Two Insurance 

Health insurance is the cornerstone of financial security in times of emergency. Not only does it cover hospital bills and associated costs during an emergency, but having multiple policies can protect your savings and give you flexibility when claiming benefits. Having multiple health insurance policies may be beneficial in times of financial stress or emergency.

 

Multiple insurance policies can offer better coverage and be invaluable during costly medical procedures. If your bills exceed what is insured under one policy, your second plan can cover any remaining costs. Be sure to inform both companies about your health plan; otherwise it may become difficult to settle a health claim if neither party knows about it.

Contribution Clause in Health Insurance

Before 2013, the insurance companies were required to pay a portion of the costs for medical treatment of the policy holder according to the amount they insured.So If two policies of health insurance cover an insured value in the range of INR 1 lakh, and another in the amount of INR 2 lakhs and both policies have amounts of INR 75,000 each, then each policyholder will receive INR 25000 in the one as well as INR 50000 with the other, with the sum insured of 2 lakh which is called an insurance contribution.

 

In 2013, IRDAI abolished this rule to make life simpler for both policyholders and insurance companies alike. Now, policyholders may approach any insurer regarding claim settlement. If their claim amount exceeds the insured sum, they may use one policy to settle their issue.

Tips for Claiming Health Insurance From Multiple Insurers

First, inform both of your insurers if you have more than one health policy. Doing this is necessary when taking out the second plan. Claims can be made from any insurer, even multiple ones; use the secondary policy to pay any remaining amount if medical expenses exceed what was insured under one policy. When settling claims, always start with personal coverage first and then switch over to group coverage if available.

 

Group health insurance or family coverage for up to 1 lakh INR or two lakhs may cover your hospital bills if they total INR 1,50,000. In this instance, your group health plan would pay the first 1 lakh and then use your family floater account for the remaining balance of INR 50,000. Furthermore, this same family floater can also be used if any members of your household become ill during that financial year.

How to Claim from Two Insurance Companies: Health Insurance

First, obtain the claim settlement summary from your first insurance company. Attest the hospital bills then contact the second insurer to arrange any remaining expenses.

Health Insurance Claim Settlement Process - Multiple Policies

Policyholders have two choices when it comes to health insurance claim settlement: cashless or reimbursement claim settlement. You can settle the claim with any policy if the amount claimed exceeds what was insured; if one policy doesn't cover all your hospital expenses, then a second one can be used to make up any difference.

 

Two ways to resolve a health insurance claim:

1.Cashless Claims:

In order to receive your cashless claim, you must select a network hospital. Furthermore, inform your insurance company ahead of time about the medical procedure by filling out a preauthorization form at the insurance desk. Afterward, file a claim with each insurer to obtain the settlement summary. To claim any remaining amounts due from each insurance company, submit both documents along with attested hospital bills; if all is in order, they will review and settle your case.

 

2. Request for reimbursement:

 

If you decide to use an outside network facility for your procedure, you have to pay for hospital charges from your own pocket to receive reimbursement from your insurance.To process your reimbursement claim, send the completed claim form and certain attested documents such as your discharge summary and medical bills directly to the insurer; these will then be reviewed by them and settled accordingly.

Reimbursement Claims Need Documentation

In order for reimbursement claims to be settled, policyholders must provide the following documents:

 

·        Completed Claim Form

·        Discharge Summary

·        Diagnostic or Lab Reports

·        Receipts and bills for medicines purchased.

·        Prescriptions

·        Treatment papers

·        If possible, X-ray slides and films.

Claim Settlement Summary (to the second insurer)

 A copy of your health card.

Canceled Cheque KYC-PAN Card and Hospital Registration Card

A doctor's certificate with diagnosis Radiology, pathology, and other reports that confirm the diagnosis.

 

 A letter from the attending physician outlining the patient's condition.

What Should You Do if You Have Different Insurance Plans From the Same Insurance Company?

Two health insurance policies from the same company can simplify paperwork and expedite claim settlement. Different insurers might have distinct guidelines you must follow to claim from multiple policies, so make sure you read through their policy terms and conditions thoroughly beforehand. Doing this will prevent any confusion later on; any questions can be clarified with your insurer before finalizing the purchase.

 

1. Can I have more than one health insurance policy for coverage?

 

Yes, you are allowed to have multiple policies of health insurance to get greater protection. However, if you use all of your insured sum from one policy in a given policy period, the second one can be used for new claims.

2. I have employer-sponsored insurance. Do I have to maintain it?

Yes, you must purchase a separate health insurance policy. Any group or employer-sponsored plans you have will only remain valid while you are employed by the company; after that, any coverage purchased becomes invalid. Furthermore, there is usually a waiting period before claiming on your policy; if an unexpected medical expense arises during that time, then large outlays of cash may have to be taken from your pocketbook.

3. What is the waiting period to obtain health insurance?

Most policies come with either a one month or thirty day waiting period, which may differ between insurers. During this time, insurance companies won't accept claims. There is typically between 9 and 4 years for coverage for maternity benefits; preexisting conditions could mean policyholders need to wait between 9 months and 4 years before using their policy for medical bills covered under their policy; no waiting period exists for accidental injuries.

 

4. How Many Claims Per Year Can I Make for Health Insurance?

 

You are allowed to make as many claims as you wish within your policy period, provided the amount insured under your plan allows it. After the amount has been exhausted, there are no more claims that can be filed within the policy time. In addition, some insurers specify a maximum number of claims policyholders may make per policy period; make sure you understand these conditions before you make a purchase.

5. Is there a deadline for submitting a claim for reimbursement from health insurance?

Generally speaking, policies require policyholders to submit their reimbursement claim within 15-30 days after discharge from the hospital. Some insurers will accept claims up to three months old.

 

6. When Should You Claim on Two Health Insurance Policies?

 

You have two policies of health insurance to choose from if your hospital bills exceed what is insured by the first one. For example, if the total of both policies is INR 2 Lakhs and INR 3 Lakhs respectively, then you can make a claim on the second policy to cover any discrepancy. However, remember to utilize both policies simultaneously!

Conclusion

It is wise to have two HELPFUL INSURANCE policies on hand, as healthcare costs are rising steadily. This is especially pertinent for those with inadequate health plans. In order to avoid issues during settlement of a claim for health insurance coverage, make sure both companies know about each other's policy details.