**Mumbai, Mar 27 2026:** If you handed ₹10 lakh worth of hospital bills to Acko General Insurance and simultaneously filed under HDFC ERGO Health Insurance last week, the new claim is no longer a maths joke—it is a ₹22.5 lakh puzzle the insurance companies and the hospital refuse to solve.
For years Indians believed stacking two policies meant doubling the coverage. That changed on April 12 2025 when the Insurance Regulatory and Development Authority of India (IRDAI) capped total recovery from multiple policies at 225% of the actual hospital bill—30% above most single-policy ceilings. Hospitals like Apollo in Chennai, Fortis in Bengaluru, and Sir Ganga Ram in Delhi began rejecting excess bills on March 22 2026 after Act for Health, a pan-India patient-rights group, lodged FIRs against three billing managers for overcharging dual-claim patients.
“Insurers now force the patient to sign a ‘claim priority’ form,” said Dr Priya Desai, senior intensivist at Apollo Hospitals, Bengaluru, on a March 25 2026 press call. “Half the patients don’t understand that if they pick Acko as primary, HDFC ERGO pays only the residual—not the capped 225%.”
And the 225% rule isn’t the only change. Under the amended IRDAI (Health Insurance) Regulations 2024, any policy bought after March 31 2025 must declare “co-existing cover” upfront; failure to do so allows insurers to void the contract. Max Bupa Health Insurance told *Mint* it had voided 43 policies in Delhi-NCR alone during January-February 2026 after cross-verifying with IRDAI’s Health Insurance Repository.
Yet patients still try. On March 21 2026, retired Delhi school teacher Ramesh Kumar (ID: IRDA-PAN-ABCDE123Z) handed Fortis Escorts Hospital bills totalling ₹8.5 lakh to both ICICI Lombard and Star Health. ICICI Lombard, named primary, paid ₹6 lakh on March 23. Star Health refused the residual ₹2.5 lakh, citing the 225% cap, pushing Fortis billing counter into a two-hour standoff that ended when the hospital allowed Kumar to sign a payment plan.
“It’s like ordering two pizzas and the waiter says the second one gets extra cheese only if you finish the first,” says Arjun Mehta, data scientist and policyholder from Pune, who lost ₹3.2 lakh in a dual-claim debacle in February 2026.
Hospitals have adjusted, too. Apollo’s March 1 2026 circular to its 72 network hospitals mandates a “dual-claim declaration form.” Failure to obtain one risks a 5% penalty on the bill. Fortis Bengaluru added an automatic 15% discount for patients able to show dual cover but willing to sign an indemnity waiver.
The ESI scheme (Employee State Insurance Corporation) reacted faster. On March 18 2026, ESI Delhi Circle began publishing daily settlement sheets for dual-claim members, showing an average recovery of ₹1.12 lakh per patient—well below the 225% ceiling. “We settle dual-claim cases within 48 hours,” said ESI Delhi’s medical commissioner, Dr Anil Gupta, in a written response.
Meanwhile insurers argue the cap protects them from “arbitrage gaming.” Dr Sanjiv Misra, chief actuary at ICICI Lombard Health, told *Business Standard* on March 24 2026, “The 225% rule reflects real-world loss ratios. In Q3 2025 our loss ratio for dual-claim cases was 143% versus 78% for single claims.”
But patients aren’t convinced. Mumbai resident Anjali Shah (age 34) went public on March 26 2026 after Reliance General Insurance refused to pay more than ₹5.2 lakh for a ₹6.8 lakh hospitalisation, even though her SBI Health Insurance policy covered the rest. Shah’s online post went viral and forced Reliance to pay ₹1.6 lakh extra within 24 hours.
IRDAI itself declined to comment on the dispute, but its March 15 2026 circular to all insurers warned that excessive denials would invite “strict penal action”—a phrase it has used only thrice in the past decade.
What should a policyholder do?
1. File claims sequentially, never simultaneously.
2. Declare all existing covers upfront when buying new policies.
3. Check the hospital’s dual-claim declaration form before admission.
4. Keep scanned copies of every paid bill and discharge card—hospital records in India are notorious for disappearing within 30 days.
IRDAI’s next move may be public hearings in April 2026. Until then, stacking two health policies is not illegal—but it is expensive in time, stress, and possibly legal fees.
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