Can you combine two health plans in a single claim? Yes–here's how

Mint

15-05-2025

"If you're a salaried employee, chances are you have a corporate health insurance plan from your employer. You may also have a personal health policy. In the event of a high-value hospitalisation, can you combine both to maximise coverage?
The answer is yes. All it takes is a few key steps.
You must first settle the claim with one insurer. Get a claims settlement letter from the first insurer and submit the same to the second insurer along with bills. The documents include copies of bills already settled by the insurer and original bills of unsettled amount, hospital receipts and KYC documents.
If both insurers are involved, you can use the first policy for a cashless claim up to its sum insured. Any amount not covered can be paid out of pocket and later claimed for reimbursement from the second insurer.
If the cashless claim is denied by both insurers, you can still go for reimbursement. But the second insurer will only process it after the first one settles the claim.
"You may be asked to submit attested copies of bills settled by the first insurer. You can request your first insurer to directly send them to the second insurer," said Bhaskar Nerurkar, head - health administration team, Bajaj Allianz General Insurance.
Bengaluru-based Sharad Tulsyan faced no issues with the first insurer in cashless except that the settlement letter came 30 days after the discharge. 'The second insurer asked for too many documents, even the ones which the hospital never submitted to the first insurer," said Tulsyan. They asked for internal case papers which comprised 1,000 pages in my case. The hospital was unwilling to release it and did it only after the treating doctor instructed them to do so."
If both your corporate and personal policies are from the same insurer, one can request for cashless treatment from both. "Two scenarios where the entire claim can be settled on a cashless basis are if the insurer is the same for your corporate and retail plans both. The other situation is when you have a super top-up and corporate or retail policy from the same insurer," said Nerurkar.
Treatment with sub-limits
Sub-limits apply in some treatments, such as maternity coverage. So, if you have exhausted the sub-limit of one policy, can further expenses be claimed up to the sub-limit of the other policy? Yes, this is possible.
In some cases, even three policies can be used. For instance, if both spouses have corporate insurance and a family floater plan with maternity coverage, all three policies can be utilised up to their respective sub-limits.
However, some corporate insurers may restrict dual claims if one spouse has already claimed under their employer's plan. "Couples should enquire about specific memorandum of understanding that their employers have signed with the insurance company," said Saurabh Arora, director, Sunglare Insurance Marketing.
Also, don't overlook pre- and post-hospitalisation expenses.. "In my case, my wife's corporate policy took care of hospitalisation expenses while I used mine to claim for pre-and-post hospitalisation expenses. My policy covered pre-hospitalisation expenses for the entire none months. Our private plan did not have maternity cover," said Tulsyan.
Also Read: Why health insurance during and after pregnancy is essential
Coverage for modern treatments
With medical advancements, modern treatments are increasingly common—but often subject to sub-limits. Having more than one policy can come in handy in such scenarios.
Mumbai-based CA Mayank Bhupendra Gosar's relative got diagnosed with tongue cancer stage 3 in January 2025. He had two private insurance policies. One, of ₹5 lakh coverage having 50% cap on modern treatment, and the second one having ₹20 lakh cover with no cap up to the sum insured. "The first chemotherapy was covered through the ₹5 lakh policy, while the rest fell under the second insurer," he said.
Notably, the second insurer scrutinised heavily for 2 months where a third-party investigator visited all earlier doctors and the hospital to verify the facts, said Gosar.
Also Read: In charts | The health insurance puzzle: 83% Indians aware but only 19% covered
When the second insurer rejects claim
In some cases, the first insurer may have settled the claim, but the second one might still reject it.
Faridabad-based Manju Sharma, 42, applied for maternity coverage from her corporate insurance policy. It had a sub-limit. The next day after delivery, she caught an infection and was put on a ventilator. Her total hospitalisation bill came in at ₹14 lakh.
'My corporate policy covered expenses up to the sum insured of ₹3 lakh cashless after which we paid from our pockets. When we reached out to the second insurer, it only cleared ₹25,000 saying the maternity hospitalisation has this sub-limit," she said.
"The first insurer did agree that my case had gone beyond the maternity treatment, but the second insurer did not. We had to furnish additional documents, especially a justification letter from the treating doctor, that the treatment of infection could not be classified under maternity expenses," said Sharma.
Mumbai-based Ashish Singodia faced a similar situation. His father got hospitalised for the treatment of prostate enlargement. His corporate policy took care of initial expenses up to ₹5 lakh, excluding the coverage for consumables. The remaining ₹1.9 lakh for reimbursement went to the second insurer.
"The second insurer raised too many doubts. We had already submitted the discharge summary, investigation documents, doctor prescription, copies of bills and the settlement letter, but they asked for more documents, such as old reports of when the issue was diagnosed first and prescriptions of previous doctors we visited. They were trying to classify the treatment under pre-existing diseases to reject it. Two months on, the claim is still pending," he said.
Also Read: Health insurance for senior citizens: No clarity on implementation of 10% premium hike cap
Key things to keep in mind
Which policy to choose for the cashless between the two you have? If you have a corporate and a retail policy, better to choose the corporate before retail. This is because corporate policies will have fewer restrictions and little or no waiting period.
"The other significant benefit is if the claim is within the sum insured of the corporate plan, it will help you preserve the cumulative bonus of your retail health policy, which you earn for each claim-free year," said Nerurkar. 'It is also advantageous if the private plan is a family floater because this ensures that its sum unsured remains intact and available for future emergencies for other members."
A policyholder must intimate the insurance company about hospitalisation within 24 hours of admission. If the second insurer comes into picture, inform it the moment you are sure that the second policy will get used. Do not wait until discharge or directly reach out for reimbursement without informing them beforehand.
Make sure to collect the settlement letter from the first insurer. Some insurers give it to you on the discharge day itself but others might take a month long time.
When filing with the second insurer, make sure the claim form clearly states that it's a partial claim. "The form should have details of the total hospitalisation bill with a highlight that x amount of it has been cleared by the first insurer," said Arora.