What Happens When You Have Two Health Insurance Policies?

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Imagine you have a family floater plan provided by your employer that covers your spouse, children, and parents. In addition, you’ve purchased a separate senior citizen health plan with a higher sum insured for your elderly parents from a different insurer.


So, how do these two policies work together in a medical emergency, and what should you keep in mind while making a claim? Here’s a closer look at the details.


What Should You Know When You Have Two Health Insurance Policies?


Having two health insurance policies is very common in India. People do this to remain financially protected when medical conditions arise.


When you have two health insurance policies, one is often an individual health plan, while the other may be a group health insurance policy provided by your employer. In some cases, one may have other disease-specific health insurance in addition to these.


An important point to note is that multiple policies from these categories can be utilised for a single claim.


How to Claim Health Insurance Benefits From Two Policies?


While most individuals are familiar with the standard claim process, managing claims across multiple policies can sometimes become challenging. If the treatment cost is within the sum insured of a single policy, the policyholder can choose that policy and settle the entire claim under it.


However, if medical expenses exceed the coverage limit of one plan, the remaining amount can be claimed from the second policy. In such cases, the policyholder can choose either a cashless facility or reimbursement. It mostly depends on the insurer's terms and the hospital network.


Here is a step-by-step guide you can follow:


Step 1: Submit cashless or reimbursement claims for the policy that has the higher coverage.


Step 2: After the claim settlement, obtain the certificate from the first insurer.


Step 3: File another claim with the second insurer for the remaining sum. Submit all the necessary papers along with the first settlement certificate.


Step 4: The second insurer verifies your claim and evaluates its contribution under the contribution clause. If everything aligns with the clause, they approve your claim.


What Documents are Required for a Reimbursement Claim with Another Insurance Company?



  1. All medical bills and receipts



  1. Treatment records



  1. Screening test reports



  1. Reimbursement claim form with all necessary details



  1. Prescriptions



  1. Discharge summary from the healthcare facility



  1. TPA settlement advice


What to Inform Your Insurers?


When filing a claim under two health insurance policies, it is important to inform both insurers about each other. Most policies come with a contribution clause. It means insurers may share the claim amount. This is why you should declare any existing policies while filling out the proposal form at the time of purchase.


Some individuals choose to buy multiple policies from the same insurer to streamline the claim process. It helps prevent claim rejections and ensures a smooth, hassle-free claim process.


Final Words


Many Indians hold multiple health insurance policies. However, maintaining transparency with your insurer is essential. At the same time, it is equally important to understand the benefits and coverage offered by each policy before choosing the right health insurance plan.