With more and more people having multiple policies in their name, the process of filing a claim and getting policy proceeds is a bit confusing for most of them. However, we will try to help you understand it in simple terms and explain you the steps needed to be taken while filing your claims of health insurance from multiple insurers.
First of all, if you have multiple policies, including those from your employers and separate individual policies and joint policies you bought for additional coverage of risk, then you have to necessarily update all the concerned insurance companies about the same. Not doing so can result in rejection of your claims.
Now, let’s take an example to understand the process further. Say you have two different health insurance policies:
Rs. 3 lakhs sum assured by company A
Rs. 2 lakhs sum assured by company B
Claim Amount: Rs. 2.25 lakhs
If you go to company A for the claims, it would have to settle the entire amount as the claim amount is less than the sum assured.
If you go to company B for claims, then contribution clause kicks in. In simple words, contribution clause says that the health insurance companies will contribute the cover amount in the ratio of their sum assured. So in this case, since company B’s assured amount is less than the claim amount, it will pay according to its ratio, which is Rs. 1,48,500 (as per 66% of their share) and would advise you to go to company A to claim rest of the amount.
In a scenario where the claim amount is Rs. 5 lakhs, then you can go to either of the companies and contribution clause will apply as the amount is more than the assured amount with either of the companies.
Whom to Approach First?
It is advisable to firstly apply for a claim using the health insurance policy provided by your employer. The primary reason being the claim process is faster and it will not affect your premiums, no matter how many claims you file.
If you have two separate health insurance policies and none from the employer, in that case always go first to the company that has some limits and conditions marked in your policy. That may reduce your refunds from company A, but you can always claim the balance amount from company B that doesn’t have any limits. This way you can maximize your claim amount.
What is the Process to be followed for Claiming Health Insurance?
- Inform all the insurance companies at the time of hospitalization.
- Decide which company you want to first file the claim and fill up the required form.
- Attach the bills and other required documents with the form in Original.
- Ask for attested photocopies of the same documents and bills from the hospital to be submitted to your other health insurance companies.
- The first insurance company will issue a letter informing that they have the original documents and they have settled the claims.
- After getting a claim from the first company, move to the next one and repeat the process of filling up the form with attested copies of required documents.
- Additionally you have to enclose a claim summary and covering letter informing the 2nd company that you have received an X amount of claim from 1st company.
- Once you receive a claim from 2nd company and still some balance remains, approach the 3rd company repeating the same process as done with 1st and 2nd company.
The ideal situation to avoid the complication of the claim process is to have one big insurance cover with one insurance provider, which will make life much easier as you won’t have to handle lots of documentation, extended waiting periods and other unforeseen issues. If not possible, try and have a maximum of two insurance covers for an easy handling of claims.
Health insurance policies are to help you, not to create more difficulties and hassles in your life. Make a wise decision and keep things simple.