It is fairly common for people to receive health insurance coverage through their workplace. However, some people also choose to maintain a separate personal policy purchased independently for additional financial protection.
Corporate health insurance policies often come with limitations such as coverage caps, restrictions on certain treatments, and the risk of losing the policy when you switch jobs, making a separate personal policy an important financial safeguard, as per multiple experts.
When the hospital bill arises, people may wonder if both policies can be used for the same treatment. Here’s what experts say about such an arrangement, and the process that needs to be followed.
Can you claim from two health policies for the same treatment?
A person can claim under both a corporate and an individual health insurance policy during the same hospitalisation, Siddharth Singhal, Head of Health Insurance at Policybazaar, said.
“If the claim amount exceeds the sum insured under a single policy, one can claim the balance amount from the other policy,” he added.
However, he cautioned that if a policyholder has more than one health insurance policy, they must inform both insurers about the existence of the other policy. “This is important to avoid any health insurance claim rejection or complications in the future. Non-disclosure of a parallel policy is one of the most common reasons claims get rejected,” Singhal said.
When asked whether informing the first insurer about the existence of a second policy at the time of filing the claim could affect the settlement, Singhal said that it would not have any impact on the claim.
Additionally, Vineet Gupta, Head of Product Development at ManipalCigna Health Insurance, noted that while such an arrangement is permitted, the total reimbursement across both policies cannot exceed the actual hospitalisation expenses incurred.
He also added that the same medical expense cannot be claimed twice under different policies.
How does it work?
For example: If a person’s total hospitalisation bill is ₹8 lakh, and they have ₹5 lakh coverage under a corporate health policy, along with another ₹5 lakh under a personal policy, the corporate policy can first be used to settle ₹5 lakh through cashless mode or reimbursement, and the remaining ₹3 lakh can then be claimed from the individual retail policy, Gupta explained.
The policyholder must submit all original bills and documents to the first insurer and share certified copies along with the settlement summary from the first insurer when filing the second claim.
Gupta also advised policyholders to first exhaust the corporate group health insurance cover, as it is employer-funded and ceases upon separation from the organisation.
“Many individual (retail) policies offer renewal benefits such as no‑claim bonuses or premium discounts for claim-free policy years. Accordingly, utilising the corporate policy first, followed by the individual policy, is typically a more prudent approach,” he told Mint.
Can insurers reject the second claim? What are common reasons?
Experts said that there are certain circumstances under which the second claim may be rejected or partially settled. Some of the most common reasons are:
— Non-disclosure: Not informing the second insurer about the existence of the first policy and the prior claim.
— Duplicacy: Trying to claim the same expenses twice from both insurers. The total reimbursement can never exceed actual costs incurred.
— Missing documentation: The second insurance company will review their contribution clause and approve your insurance claim only if all the information checks out. Insufficient documents, missing settlement certificate from the first insurer, or absence of attested original bills can lead to rejection.
— Late intimation: Not informing either insurer in time at the point of hospitalisation.
— Policy exclusions: The second policy may have different exclusions or sub-limits, such as room rent caps, that can result in partial or full rejection of the balance claim.
Gupta further noted that having both a corporate group health insurance policy and an individual retail health insurance plan is a “prudent approach” to managing healthcare costs in today’s environment of rising medical inflation.
“While the corporate cover offers immediate, employer-funded protection, it is inherently temporary and tied to one’s employment. An individual retail policy, on the other hand, provides long-term continuity, portability, and the flexibility to enhance coverage based on personal and family health needs over time,” he said.
