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How to claim unpaid hospital bill from a second insurer
Policyholders with more than one health insurance policy can claim a hospital bill from a second insurer after the first policy's sum insured is used up, provided the total does not exceed actual medical expenses. The Insurance Regulatory and Development Authority of India's 29 May 2024 master circular requires the primary insurer to coordinate with other insurers for the balance. Expenses disallowed by the first insurer may still be paid by the second, but only if they are admissible under that second policy's own terms.
Under indemnity-based policies such as mediclaim or top-up plans, the combined payout is capped at the admissible expense incurred. The policyholder chooses which policy acts as primary. Benefit-based policies like critical illness cover pay their full benefit independently. The second insurer assesses the claim independently, and if it also excludes the same items, the policyholder bears that amount.
Indian Opinion Analysis
This is a practical guide for the growing number of Indians who hold more than one health insurance policy. The process works only for indemnity-based plans, where insurers share the bill but never pay more than the actual expense. The key risk the reader faces is the second insurer’s independent assessment: expenses the first insurer disallowed, such as non-payable consumables, may be disallowed again, leaving the policyholder to pay the difference. Nothing in IRDAI's rule compels the second insurer to accept the first insurer's admissible amount. The practical next step for any policyholder is to check both policy wordings before admission, especially the exclusions and sub-limits on consumables, room rent and doctor fees that trigger most claim rejections.
Source: economictimes.indiatimes.com
This brief was synthesised by AI from the source linked above. Methodology and corrections.
