Navigating Health Insurance: How to Maximize Your Coverage

Understanding Health Insurance Options

While many individuals obtain health insurance through their employers, others opt for personal policies to enhance their coverage during critical situations. Although workplace insurance is convenient, it often comes with limitations such as coverage caps, treatment restrictions, and potential lapses when changing jobs. Siddharth Singhal, who leads Health Insurance at Policybazaar, noted in a report that if a claim surpasses the insured amount of one policy, the remaining balance can be claimed from another policy. However, he emphasized the importance of disclosing all existing policies to both insurers, as failure to do so is a common reason for claim denials.

Vineet Gupta, Head of Product Development at ManipalCigna Health Insurance, elaborated on the claims process: the total reimbursement from both policies cannot exceed the actual hospitalization expenses, and one cannot claim the same expense from both policies. For instance, if your hospital bill amounts to Rs 10 lakh, and you have Rs 5 lakh coverage from your corporate policy and another Rs 5 lakh from a personal plan, you would first utilize the corporate policy for Rs 5 lakh. The remaining Rs 5 lakh can then be claimed from your individual policy. It is essential to submit all original bills and the settlement summary from the first insurer to the second.

Gupta recommends using the corporate coverage first, as it is funded by the employer and ceases when you leave the job. Many individual policies also provide renewal benefits, such as no-claim bonuses or premium discounts for years without claims.

Common Challenges and Claim Denials

Experts point out that the second claim may face partial or complete rejection due to several factors:

• Non-disclosure – Not informing the second insurer about the first claim.


• Duplicate claims – Attempting to claim the same expense more than once.


• Incomplete documentation – Missing bills or settlement certificates.


• Delayed notification – Failing to promptly inform insurers.


• Policy exclusions – Different sub-limits or caps that may limit coverage.

Gupta further stated, “While corporate insurance provides immediate coverage, an individual policy ensures long-term continuity, portability, and flexibility to address personal and family health requirements over time.” In the current landscape of escalating medical expenses, maintaining both types of policies is a prudent approach.