Using two health insurance policies for one hospital bill? Are you aware of these claim rejection traps?

Policyholders may claim from both employer-provided and individual health insurance for one hospitalisation. But if you overlook certain terms, it can lead to a rejection. Check details.

Many individuals receive health insurance coverage from their employers, while some also buy a separate individual health insurance policy to supplement their corporate cover and provide additional financial protection.

A policyholder is allowed to claim under both corporate and individual health insurance policies during the same hospitalisation if the expenses exceed the coverage available under one policy.

Most importantly, the total reimbursement from both policies cannot exceed the actual hospitalisation expenses incurred. Policyholders also cannot claim the same medical expense twice under different policies.

If you fail to follow the prescribe claim process or overlook policy conditions, it could delay claim settlement or even worse, lead to a claim rejection, leaving you to bear the expenses out of your own pocket.

When can an insurer reject the second claim?

Though Insurance Regulatory and Development Authority of India (IRDAI) allows people to buy multiple health insurance policies, there are certain circumstances under which the second claim may be rejected or partially settled.

Some of the most common reasons include:

• Non-disclosure: Not informing the second insurer about the existence of the first policy and the prior claim is the primary cause of rejection.
• Duplication: Trying to claim the same expenses twice from both insurers can lead to a rejection as the total reimbursement can never exceed actual costs incurred by a person.
• Missing documentation: The second insurer may reject the claim if documents such as the first insurer’s settlement letter, attested bills or other required records are missing or incomplete.