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Claim under Two medical insurance policies

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09 Sep, 2020 by  Tosit

Sir, I have a query related to medical insurance.

If a person is covered under medical insurance under two different policies.

In first policy as primary policy holder and in other as spouse of policy holder.

 

The sum insured is 5 lakhs and 9 lakhs in both the policies respectively.

 

How does the policy claim is settled in this scenario..?

For instance if expenses comes out to be 12 lakhs.

Then can both the SI be clubbed and full claim will be settled by respective insurers..?

Thank you

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09 Sep, 2020

Thank you, Tosit for using the forum :)


1) Yes. If you are covered under a family floater under two health insurance policies, you can always claim from the

available sum insured in both the policies.

2) The process for cashless requires to inform the hospital about both the policies, as soon as you know that the cover required will be more than the sum insured in one of your policies.

3) In case of reimbursement or one of the claim in reimbursement - the process will be longer. You need one of the insurers to settle the claim first - the second insurer may then ask for the attested copies of all the documents, and claim settlement statement to process the claim.


Hope this helps.


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09 Sep, 2020
Tosit
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12 Sep, 2020

Hey Tosit, to add to what Mahavir mentioned, the key thing to consider is that are the policy specifications. The limits in policy A with 5 lakh cover and policy B with 9 lakh cover may be very different. Therefore, based on my experience one thing I can tell you is that claim recovery can be very different based on the sequence in which you apply claim. So the claim payout when you claim in A and then in B may yield a recovery more than if you were to claim in B first and then in A.


Two policy claims are never a simple calculation of claim 12 lakhs from 5+9 = 14 lakhs sum insured. No, never!

If your example is actually a real claim, and you need some advice on how to recover maximum, do reply back with more details. Happy to help you recover maximum.

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