Understanding Multiple Health Insurance Policies: A Comprehensive Guide

With rising medical inflation and the escalating costs of hospitalization, having a reliable health insurance plan has become essential. A well-structured health insurance policy ensures access to quality healthcare without bearing the brunt of significant medical expenses.

However, in some situations, a single health insurance policy may not be sufficient. Factors such as chronic illness within the family or an inadequate sum insured for all members in a joint family might necessitate additional coverage. In such cases, many individuals opt for multiple health insurance policies. While this approach offers financial security, filing claims under multiple policies can be a more complex process than under a single policy. Below is an overview of how to navigate claims when holding multiple health insurance policies.

Filing a Claim Across Multiple Health Insurance Policies

When you have multiple health insurance policies, two key scenarios may arise:

1. The Claim Amount Exceeds the Sum Insured Under a Single Policy

In cases where hospitalization and medical expenses surpass the sum insured of one policy, you will need to file claims under both policies, ensuring each contributes proportionally.

• Primary and Secondary Policy Designation: Ideally, you should designate one policy as the primary insurer and another as the secondary. You should first file a claim under the primary policy for the maximum permissible amount. The remaining balance should then be claimed under the secondary policy.
• Example: If your total medical expenses amount to ₹5 lakhs, but your primary health insurance policy covers only ₹4 lakhs while the secondary policy covers ₹3 lakhs, you can claim ₹3 lakhs from the primary policy and the remaining ₹2 lakhs from the secondary policy.

2. The Claim Amount is Less Than the Sum Insured

If your claim amount is within the sum insured of any single policy, you can file a claim under either policy. In this case, a contribution clause does not apply, and you have the flexibility to choose the policy that best suits your needs.

Key Considerations When Purchasing Multiple Health Insurance Policies

1. Informing Insurers About Existing Policies:
   • When purchasing additional health insurance, you must disclose any existing policies. Failing to inform insurers about prior policies can be considered a breach of contract and may lead to claim denial if another policy is discovered during the claim process.
2. Using a Health Insurance Premium Calculator:
   • Managing premiums across multiple policies can be challenging. A health insurance premium calculator can help estimate your total premium based on factors such as age, gender, smoking habits, policy duration, and sum insured.
3. Choosing the Right Policies and Insurers:
   • Ensure that each policy and its respective insurance provider offer the following:
     • Comprehensive coverage and add-ons
     • A high claim settlement ratio
     • Efficient customer service
     • 24/7 claim assistance
     • A broad network of hospitals for cashless treatment

Should You Opt for Multiple Health Insurance Policies?

Paying premiums for multiple health insurance policies can be a financial commitment, making it essential to carefully assess your needs before opting for additional coverage. The key reasons to consider multiple policies include:

• Inadequate Sum Insured: If your existing policy does not provide sufficient coverage, a secondary policy may help bridge the gap. Some insurers have underwriting limitations, restricting the sum insured, especially for older applicants.
• Coverage Limitations: If your current plan does not offer coverage for specific diseases or medical conditions, opting for another policy from a different insurer might be beneficial.
• Family Coverage vs. Individual Needs: While a family floater plan may cover multiple members, certain individual health concerns may necessitate additional individual coverage.
• Expert Consultation: Seeking advice from a financial expert can help ensure that your choice of multiple policies aligns with your financial and medical needs.

Conclusion

Multiple health insurance policies can provide enhanced financial security, ensuring comprehensive medical coverage for you and your family. However, they should be chosen strategically, keeping in mind affordability, coverage benefits, and the claim filing process. By understanding how to manage claims and ensuring compliance with insurer guidelines, you can effectively maximize the benefits of multiple health insurance policies while minimizing financial burdens.