Can Health Insurance Claim be combined from multiple insurance providers?

[immayurpanchal]

I recently received a call from an HDFC Insurance agent who informed me that if I have multiple insurance policies, I can claim all of them simultaneously. For example, I currently have insurance from two providers: 10 Lakh insurance from Navi and 7 Lakh insurance from ICICI.

Now, let's say I need to be hospitalized and the final bill amount is 12 Lakh. Does that mean I will get Rs. 12 lakh claim passed? 10 Lakh from Navi and the remaining 2 Lakh from ICICI? I am only referring to health insurance in this scenario.

 

[spreading_knowledge]

Hey Mayur,
Yes, that's correct. With health insurance, you can claim from multiple insurance policies (irrespective of whether it is retail, corporate, group plan or any other health policy).
Now taking your example, yes you can claim entire 10 lakhs from Navi and remaining 2 lakhs from ICICI. But please note, in case you wish to have a cashless claim, then only 10 lakhs will be settled on cashless basis and remaining 2 lakhs has to be paid by you. Now this 2 lakhs can be reimbursed from ICICI by submitting necessary documents.

 

[luciferocious]

I recently received a call from an HDFC Insurance agent who informed me that if I have multiple insurance policies, I can claim all of them simultaneously. For example, I currently have insurance from two providers: 10 Lakh insurance from Navi and 7 Lakh insurance from ICICI.

Now, let's say I need to be hospitalized and the final bill amount is 12 Lakh. Does that mean I will get Rs. 12 lakh claim passed? 10 Lakh from Navi and the remaining 2 Lakh from ICICI? I am only referring to health insurance in this scenario.

I AM NO EXPERT.

In the scenario you've described, where you have health insurance policies from two different providers (Navi and ICICI), and you incur a hospital bill of 12 Lakh, the process of claiming from both insurers typically follows a certain procedure. This procedure might differ based on the terms and conditions of your insurance policies and the regulations in your country. However, I can provide you with a general understanding:

1. Primary and Secondary Insurance: In many cases, when you have multiple health insurance policies, one of them is considered the primary insurer, while the other is the secondary insurer. The primary insurer is usually responsible for covering the majority of the expenses.
2. Coordination of Benefits: Insurance companies typically have a coordination of benefits clause. This clause determines how much each insurer will pay when you have coverage under more than one policy. The coordination of benefits process ensures that you don't receive more than the total cost of the medical services you received.
3. Claims Process: When you incur medical expenses, you would typically file a claim with your primary insurer first. Once they have processed the claim and paid their portion, you can then submit a claim to your secondary insurer for any remaining eligible expenses.
4. Policy Limits and Coverage: It's important to review the terms and conditions of each of your insurance policies to understand the extent of coverage, any deductibles, copayments, and limitations that may apply.

In your scenario:

• Navi provides coverage of up to 10 Lakh.
• ICICI provides coverage of up to 7 Lakh.
• Your hospital bill amounts to 12 Lakh.

In a typical scenario, Navi, as the primary insurer, would cover the majority of the expenses, up to their policy limit of 10 Lakh. Then, you may be able to submit the remaining balance (2 Lakh) to ICICI, your secondary insurer, for consideration according to their policy terms.
It's essential to reach out to both insurance companies, understand their coordination of benefits policies, and follow their claims procedures to ensure you receive the maximum coverage available to you under your policies. Consulting with a representative from each insurance company can help clarify the process and ensure that you're taking full advantage of your coverage.

 

[immayurpanchal]

I AM NO EXPERT.

In the scenario you've described, where you have health insurance policies from two different providers (Navi and ICICI), and you incur a hospital bill of 12 Lakh, the process of claiming from both insurers typically follows a certain procedure. This procedure might differ based on the terms and conditions of your insurance policies and the regulations in your country. However, I can provide you with a general understanding:

1. Primary and Secondary Insurance: In many cases, when you have multiple health insurance policies, one of them is considered the primary insurer, while the other is the secondary insurer. The primary insurer is usually responsible for covering the majority of the expenses.
2. Coordination of Benefits: Insurance companies typically have a coordination of benefits clause. This clause determines how much each insurer will pay when you have coverage under more than one policy. The coordination of benefits process ensures that you don't receive more than the total cost of the medical services you received.
3. Claims Process: When you incur medical expenses, you would typically file a claim with your primary insurer first. Once they have processed the claim and paid their portion, you can then submit a claim to your secondary insurer for any remaining eligible expenses.
4. Policy Limits and Coverage: It's important to review the terms and conditions of each of your insurance policies to understand the extent of coverage, any deductibles, copayments, and limitations that may apply.

In your scenario:

• Navi provides coverage of up to 10 Lakh.
• ICICI provides coverage of up to 7 Lakh.
• Your hospital bill amounts to 12 Lakh.

In a typical scenario, Navi, as the primary insurer, would cover the majority of the expenses, up to their policy limit of 10 Lakh. Then, you may be able to submit the remaining balance (2 Lakh) to ICICI, your secondary insurer, for consideration according to their policy terms.
It's essential to reach out to both insurance companies, understand their coordination of benefits policies, and follow their claims procedures to ensure you receive the maximum coverage available to you under your policies. Consulting with a representative from each insurance company can help clarify the process and ensure that you're taking full advantage of your coverage.

Thank you very much for taking time and helping out with such detailed answer. This is indeed really helpful.

 

[immayurpanchal]

Hey Mayur,
Yes, that's correct. With health insurance, you can claim from multiple insurance policies (irrespective of whether it is retail, corporate, group plan or any other health policy).
Now taking your example, yes you can claim entire 10 lakhs from Navi and remaining 2 lakhs from ICICI. But please note, in case you wish to have a cashless claim, then only 10 lakhs will be settled on cashless basis and remaining 2 lakhs has to be paid by you. Now this 2 lakhs can be reimbursed from ICICI by submitting necessary documents.

Thank you very much for providing additional information like which kind of insurance is, I can claim whether group, corporate. retail etc.