A second health insurance policy can prove useful when a hospital bill is significantly higher than the coverage available under the first policy. However, having two policies does not mean a policyholder can seek reimbursement for the same expenses twice.
The claims generally need to be coordinated between the two insurers, with the second policy potentially being used to meet the eligible portion of the bill that remains unpaid after the first claim is settled.
This issue recently came up in an Ask Mint query involving a senior citizen who underwent valve replacement surgery costing ₹30 lakh. The patient had a ₹10 lakh personal health insurance policy, while a separate corporate policy provided ₹20 lakh of cover for the son. The policyholder disclosed the existence of both policies to the insurers while filing the claims.
The complication arose because the personal insurer had been processing the claim for nearly two months, while the corporate insurer wanted the original documents that had already been submitted to the first insurer.
How to use the second policy
The important point for policyholders with multiple covers is that the second policy can be used to address the unpaid portion of an eligible claim, after accounting for what the first insurer has already settled.
In the case highlighted in the query, the personal policy would be processed first. Once that claim is settled, the policyholder can approach the corporate insurer for the eligible residual expenses, within the limits and conditions of the second policy.
The second insurer will need evidence of what the first insurer has already paid. A claim settlement letter from the first insurer is therefore important. It should establish the total amount claimed, the amount approved and the amount that remains unpaid.
An insurer-attested copy of the claim documents can also be submitted to the second insurer when the originals are being held by the first insurer.
What if the first insurer is delaying the claim?
A prolonged delay can hold up the second claim as well. The expert cited in the print article advises policyholders to pursue the first insurer for a faster resolution rather than allowing the matter to remain pending.
If routine follow-ups do not work, the policyholder can escalate the matter to a senior official, the Third Party Administrator (TPA), where applicable, or the insurer's internal claims team. The insurer's grievance-redressal officer can be approached if the issue remains unresolved.
The larger lesson is that multiple health policies can provide additional financial protection, but they do not create a right to duplicate reimbursement. Policyholders should disclose all relevant covers and maintain copies of their medical and claim documents so that a second claim can be processed smoothly.
(Source: Ask Mint Insurance; expert advice by Abhishek Bondia, co-founder of SecureNow, as published in the print article.)