Have to pay a big hospital bill? Here's how you can split this claim into multiple health insurance policies

Time of India

3 days ago

Navigating medical bills with multiple health insurance policies can be complex, but it's possible to split claims effectively. Inform all insurers, prioritising the least expensive plan first, which is often a family floater or employer's policy. for many.. Utilise Form 64 for smoother processing between multiple insurers. Read on to know how you can effectively split a big claim across more than one insurer.
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Inform all insurers, but focus on the least expensive plan first
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How do I split a big health claim across 3 different insurance policies?
Type of policy
Sum insured (In Rs)
Policy conditions, if any
Personal plan
Rs 35 lakh
No co-payment clause
Family floater plan
Rs 25 lakh
Common cover for you+spouse+children
No co-payment clause
Employer (Group) Plan
Rs 20 lakh
Covers you+spouse
10% co-payment
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Dont ignore co-payment, sub-limits clauses
Consider top-up, super top-up plans
Things to remember while making multiple claims
How many health insurance policies should I ideally have?
Medical emergencies don't exactly come with a warning, and often leave behind hefty bills. You might think having several health insurance policies -- like a corporate group policy from your employer, a floater plan that covers your family and even an individual health insurance plan -- would make handling those big medical bill easier.But here's the big question: if one of your health insurance plans doesn't cover the entire bill, can you use multiple policies to clear the bill? The answer is yes! However, the next question is, how do you split a large claim among different health policies? Many policyholders get pretty confused about how to allocate a significant claim across the various policies they have. Keep reading to find out how to split your claim wisely and maximise your payout.Also Read: Latest claim settlement ratio of health and general insurance companies released by IRDA in 2025, Navi, Acko take lead, Star Health, Zuno fall below 90% If you know that a big medical bill, like a long hospital stay, is coming up, it's a good idea to inform all your insurers ahead of time. This way, you can dodge any surprises or claim rejections. Plus, this is mandatory, as per IRDAI regulations.Explains Pankaj Nawani, CEO, CarePal Secure, 'Before deciding on your primary insurer, or the insurer on which you will be making the biggest claim, look closely at the benefits and exclusions under each policy. Some policies may have sub-limits for room rent or specific treatments. The total sum insured, any cumulative bonuses you've built up over the years, and how easy the claim process is—especially with corporate policies—should also guide your decision. Lastly, think about preserving your no-claim bonus and portability benefits in personal plans'.See this: Health and general insurance claim settlement: 5 fastest and 5 slowest insurers to settle claims within 3 months According to Suman Pal, Chief Claims Officer at Onsurity, individuals should opt for the most liberal, least expensive insurance policy to make their primary claim. 'For most, this is their family or personal floater policy. However, if your employer's policy has good coverage, low sub-limits or co-payment clauses and is cashless-in-network for your hospital, that can be used first', he adds.The reason why you should max out your corporate policy first in such cases is that, since the premium is paid by your employer, it won't affect your own policy's no-claim bonus or increase future premiums.Also, as Mr. R Balasundaram, Secretary General, IBAI explains, corporate plans often come with zero sub-limits, no waiting periods, and quicker claim processing as compared to other plans. However, the only downside is that coverage might be limited compared to personal plansSuppose you have a Rs 70 lakh bill to be paid. You have 3 different policies at hand, namely:To start, you can utilise your employer's (group) plan. If all other conditions are satisfied, the employer's plan will cover Rs 18 lakh due to a 10% co-payment clause, which means you'll still have Rs 52 lakh in pending bills.Next, you can claim another Rs 25 lakh from your family floater plan. Since there is no co-payment clause here, you can claim the full amount, which leaves you with Rs 27 lakh in bills. These can be claimed from your personal plan, and even after that, you'll have Rs 8 lakh left as sum insured, which you can use, if necessary, during the rest of the policy period.Keep in mind that sub-limits or co-payment clauses in your health insurance plans can create financial gaps that you might need to cover out of your own funds.For instance, if your personal health insurance plan had a sub-limit of Rs 15 lakh for this specific disease, you could end up paying the remaining amount yourself. With a co-payment of Rs 2 lakh and a Rs 10 lakh shortfall due to sub-limit, you'd have to fork out a total of Rs 12 lakh from your own pocket.So, pay close attention to these clauses in your corporate health insurance plan. Some employers might let you eliminate this co-payment clause if you are okay with paying a bit more in premiums. It's worth checking with your employer about this.You can also consider having a top-up or super top-up plan, since they are generally designed for bigger claims. However, they kick in only after you hit a certain threshold or deductible.'They're great for big medical expenses like surgeries, cancer treatment, or organ transplants. Hence, rather than purchasing multiple base plans, it is a good idea to buy a top-up or super-top-up policy above a threshold (e.g. 5L or 10L). This enhances your primary plan's SI (sum insured) and takes over when you spend down the base policy. It effectively adds overall cover without the hassle of a second identical policy', adds Pal from Onsurity.In case of multiple claims during one hospital stay, getting the entire treatment on a cashless basis is typically not possible. So you may use one policy to start the treatment on a cashless basis, and once its limit is exhausted, you may have to pay the remaining amount from your pocket. Afterwards, you can use the reimbursement process to claim the remaining amount from different insurers. Says Nawani, 'Submit original hospital bills to the first insurer you claim from. For others, send certified copies along with a claim settlement letter. Use Form 64 (Claim Settlement Summary) to make the process smoother between insurers'.Form-64, or claim settlement summary, is a statement you get when your primary insurer settles its part.'Once you have this statement, you can claim the unpaid balance to your subsequent insurers by presenting the first insurer's settlement letter and the hospital bills. They will process this as a new claim. Do this again if there is a third insurer. Each insurer pays up to its portion of the balance claim', says Pal.Experts suggest that while IRDAI allows multiple policies, more is not always merrier. Most suggest having 2-3 health covers at most.'A savvy policyholder typically maintains one good personal plan (or floater) plus one group cover, and maybe a top-up for extra buffer. Make sure the combined sum insured across plans comfortably exceeds your potential bill, but don't chase insurance in sheer quantity. Maximising the benefits of 2–3 policies usually suffices for any claim. Keeping it simple prevents claim delays and guarantees you receive the required coverage', explains Nawani.