Can Multiple Health Insurance Cover Be Used For Single Claims?

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Has your employer provided you with health insurance? Do you think that your employer-provided health coverage is enough and you don’t need a standalone health insurance policy? If yes, then you need to stay updated.

It is always better to have a standalone health insurance policy, as employer-provided health coverage may not be enough if you get hospitalized due to a critical illness. What if you changed your job and the new employer didn’t offer you the same health benefits? You might have to shell out lakhs out of your own pocket to meet the hospitalization expenses.

What you should do in such a case

Here, an individual health insurance plan plays a crucial role. This cover ensures that you are comprehensively covered even in the worst scenario, such as when you’re out of job or when your employer-provided policy is turns out to be insufficient. Well, there is nothing to get dishearten. The good thing is that you to leverage the coverage offered by the second plan, especially when the previous policy is exhausted.

Imagine you have two health insurance plans – basic protection plans that compensate for hospitalisation – one with a sum assured of Rs. 2 Lakh and the other with a sum assured of Rs. 1 Lakh. If your hospitalization bill is of Rs. 2.5 Lakh, then you can claim the coverage offered by the plan with higher sum assured, i.e. of Rs. 2 Lakh and make use of the other plan to pay out the remaining amount of Rs. 50,000.

Also, you must not forget that the condition of contribution doesn’t apply to the health insurance.

What is the condition of contribution?

Let’s see what it is:

The condition of contribution is an exercise that states if you’ve two policies covering the same risk(s), then both the policies are required to pay the claim. However, in case of health insurance, if you’ve two policies, insurance companies cannot insist that you make use of both the policies to pay the claim. You can pick the policy of your choice and if the coverage amount is not enough, then you can claim the remaining amount from the other policy.

How can you use two health insurance policies for a single claim?

While using two policies to pay for the same claim, generally only one policy is used in the cashless form.

For instance, if you are required to pay Rs. 2 Lakh for your knee replacement surgery and you have your employer-provided health coverage of Rs. 1 Lakh only, then you can choose to pay the remaining amount from your standalone health plan.

When you get hospitalized, you will need to send your required documents to one insurance provider for cashless approval. Once the insurance company approves your claim, the hospital will ask you to pay off the remaining Rs. 1 Lakh, which you’ll have to pay from your own pocket. Once you get discharged, a settlement letter will be sent to the insurance provider by the hospital indicating the total expenses. You’ll require the settlement letter – ask the insurance provider or the hospital – to contact the second insurance company.

Your settlement letter will contain all the necessary information, such as the amount of money you paid, the treatment undertaken, date of admission and the details of your policy.

Generally, the settlement letter is sufficient to approach your second insurer to get the reimbursement of the remaining bill amount, which you paid from your own pocket. You can also obtain documents from cashless insurance provider, which indicate the amount of money it has paid in order to avoid any payment-related hassle.

Nevertheless, if you have two health insurance policies taken from the same insurance company, then it is comparatively easy to process the cashless payment when you file a claim.

Now that you have a fair idea of how the coverage offered by multiple health insurance policies can be used for a single claim, let’s take a glimpse of the benefits of multiple health insurance plans:

  • Hedge against the rejection of claims
  • Diversify across various insurance providers
  • Smaller coverage
  • Lower premiums
  • Critical Illness Plan and Personal Health Policy

Over to you!

It is certainly a great idea to have a comprehensive health insurance policy. However, it is even better to have multiple health insurance plans. This not only provides enhanced coverage but also widens your financial backup, in case of medical emergencies, job change or loss of your job etc. It is up to you how wisely you act upon this!