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ashish wrote: i would also want to know if religare
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Laxminarayan wrote: Hi Sir, my parents are aged 73
and 63. Both have ... [More]

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Introduction: Holding more than one health insurance policy Ravi Nagrani wrote: Also I would be more happy if
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Lot of people these days hold more than one health insurance policy. For those wondering why and Upgrading your Health Insurance Coverage (7)
how an individual can have multiple health insurance policies, here are some scenarios: Vinita Kapoor wrote: I have a 6 Lac Family Floater
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a)      Health insurance cover from employer (you may be covered under a group health insurance
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policy by your own employer and / or spouse’s employer and / or father’s employer and / or mother’s
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b)     Over and above the health insurance cover from the employer (as seen in point (a) above) you
may have bought a personal health insurance cover (individual or family floater) because you did
not want to depend on your employer’s health insurance cover solely.

c)      You may have bought a health insurance policy some 10 years back and now feel the cover
amount is less as health insurance costs have gone up significantly in the last few years and hence Health Insurance for Senior Citizens0
you bought one more health insurance policy to enhance your or your family’s health insurance CommentsRating: 4 / 1
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d)      You may be covered under the group health insurance policy of your bank (provided to account
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holders as a benefit) or some state / central government scheme or some other association / club
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/ group etc.
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e)      You may have bought a separate critical illness policy or added an critical illness rider to one of Premium Back Cover0 CommentsRating: 5 / 1
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f)       You may have bought a ‘hospital cash’ policy that pays a fixed amount on the happening of a
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specified event. This policy may have been bought to cover some expenses that may or may not be
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covered by a hospitalisation indemnity policy.
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Now that we have seen the scenarios under which an individual may hold more than one health 1
insurance policy, the next two questions that come to mind are: Health Insurance Policy for Senior Citizen - Should I
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a)      If there is a claim, can the claim be made from multiple health insurance companies? yet

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b)      If yes, then what is the process?
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Can a claim be made with multiple health insurance companies?
Religare Health Insurance's new product – “Care” :
How good is it? (55)
As per IRDA (Health Insurance) Regulations, 2013, the answer to the above question is yes.
ashish wrote: i would also want to know if religare
has critical... [More]
Let us try and understand this with the help of some scenarios
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Scenario 1: When the claim amount is less than the sum assured of the policy against which a claim Insurance in India! (61)
is made Laxminarayan wrote: Hi Sir, my parents are aged 73
and 63. Both have ... [More]
Example: Ajay has the following 2 health insurance policies Religare Health Insurance's new product – “Care” :
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Policy A from health insurer A for a sum assured of Rs. 2 lakhs Ravi Nagrani wrote: Also I would be more happy if
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Policy B from health insurer B for a sum assured of Rs. 1 lakh
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The claim is of Rs. 60,000 Vinita Kapoor wrote: I have a 6 Lac Family Floater
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In this scenario, Ajay can make a claim from health insurer A or health insurer B. 10 Smart things to compare before you buy Health
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So if Ajay decides to lodge his claim with health insurer A, since the claim amount of Rs. 60,000 is less SHIV C ARORA wrote: I want to buy a policy for
than the sum assured of Rs. 2 lakhs, the entire amount will be settled by health insurer A. Similarly if myself,age 46 ,sum assu... [More]
Ajay decides to lodge his claim with health insurer B, since the claim amount of Rs. 60,000 is less than Email Id :
the sum assured of Rs. 1 lakhs, the entire amount will be settled by health insurer B.
Submit
Scenario 2: When the claim amount is more than the sum assured of the policy against which a claim
is made

Example: Vijay has the following 2 health insurance policies

Policy A from health insurer A for a sum assured of Rs. 3 lakhs

Policy B from health insurer B for a sum assured of Rs. 1 lakh

The claim is of Rs. 3.6 lakhs

In this scenario, the contribution clause will be applied by the health insurers. Vijay can lodge the first Category
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claim with health insurer A or health insurer B. Select Category

So let us assume that Vijay decides to lodge his first claim with health insurer A. In this case health
insurer A will pay its proportionate share of the claim. Vijay’s total health insurance cover from the two
health insurers is Rs. 4 lakhs (distributed in the share 3:1 or 75%:25%). So health insurer A will pay
75% of the claim amount (i.e. Rs. 2.7 lakhs). After that, health insurer B will then pay its proportionate
share of the claim i.e. 25% or Rs. 90,000. So the total payout received by Vijay from the two health
insurers will be Rs. 2,70,000 + Rs. 90,000 = Rs. 3,60,000 (which is the total claim amount).

Please note if there are more than two health insurers from whom the claim is to be made, then the
same process will apply as above.

Also you cannot profit by claiming the entire amount multiple times from multiple health insurers. Even
if there are multiple policies involved, you cannot get paid more than the actual hospitalisation amount.
0
So as you can see, IRDA has made the process simpler and policyholder friendly. Now that we
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understand that a claim can be made with multiple health insurers, now let us address the next
question: the process of making a claim with multiple health insurers.

What is the process of making a claim with multiple health insurance companies?

In the event of a claim, if there is more than one health insurance policy involved (let us assume there
is health insurer A and health insurer B involved in this case), you need to take the following steps:

If there are more than 2 health insurers involved in a claim, then the same process needs to be
repeated as mentioned above. Every subsequent claim can be made only after the previous claim is
settled.

Policies with defined benefits

Hospital cash and critical illness policies are defined benefit policies. These policies pay a lumpsum
amount on the happening of a specified event and the policy terminates. The amount paid under such
policies is fixed in nature and is not related to the actual cost of treatment. In case the insured holds
two such policies and the specified event has occurred, then the insured can make a claim with both
the insurance companies for the specified amount (no contribution clause will be applied here).

Some points to consider

a)      Always declare all your existing policies in force when applying for a new policy (not applicable
for health insurance policy from employer). If the details of existing policies are not declared, then at
the time of claim, the insurance company may reject the claim on grounds of misrepresentation.

b)      When more than one health insurance policy is available for making a claim, preference should be
given to your employer’s policy (or other group policy) first. This is because in case of such policies
the claim processing is faster as compared to individual policies. Also in group policies there are
fewer restrictions (like waiting periods may be lower or may not be there, pre-existing diseases
may be covered) as compared to individual / family floater policies. If the entire claim can be
settled from the employer’s policy itself, it will not affect the no-claim bonus (NCB) on your
individual policy at the time of renewal.

c)      If you don’t have an employer / group policy and have two of your own health insurance policies,
then claim from the older policy should be made first. This is because in case of the older policy,
 the waiting periods for some diseases / treatment procedures may have been over.

Conclusion

It is ideal to have a single health insurance policy with a high sum assured amount so that you don’t
have to go through the hassle of making multiple claims with multiple health insurers. It helps in
avoiding excessive documentation and in avoiding running around to multiple health insurers and at
the same time it saves on time and effort. The flip side to having a single policy is it may affect your no
claim bonus (NCB) adversely in the event of a claim. While having a single health insurance policy with
a higher sum assured is an ideal thing, we understand that practically this may not be a feasible
solution for lot of us. To conclude, we sincerely hope that we have helped you to some extent in
understanding how a claim can be made when more than one health insurance policy is involved.

The article has been written by Gopal Gidwani who is the owner of personal finance website
www.bachatkhata.com

Additional reading
0 Extract of IRDA (Health Insurance) Regulations, 2013
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Multiple policies

i. If two or more policies are taken by an insured during a period from one or more insurers, the
contribution clause shall not be applicable where the cover / benefit offered:

1. is fixed in nature;

2. does not have any relation to the treatment costs;

ii. In case of multiple policies which provide fixed benefits, on the occurrence of the insured event in
accordance with the terms and conditions of the policies, the insurer shall make the claim payments
independent of payments received under other similar policies.

iii. If two or more policies are taken by an insured during a period from one or more insurers to
indemnify treatment costs, the insurer shall not apply the contribution clause, but the policyholder
shall have the right to require a settlement of his claim in terms of any of his policies

1. In all such cases the insurer who has issued the chosen policy shall be obliged to settle the claim
without insisting on the contribution clause as long as the claim is within the limits of and according to
the terms of the chosen policy

2. If the amount to be claimed exceeds the sum insured under a single policy after considering the
deductibles or co-pay, the policyholder shall have the right to choose insurers by whom the claim to be
settled. In such cases, the insurer may settle the claim with contribution clause.

3. Except in benefit policies, in cases where an insured has policies from more than one insurer to
cover the same risk on indemnity basis, the insured shall only be indemnified the hopsitalisation costs
in accordance with terms and conditions of the policy.

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Abhay Taneja
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2 years ago
Good to know this info.
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Smita Shetty
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2 years ago
Very
Share good article

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