What happens if an insured does not notify the insurer about other health coverage?

When an insured fails to notify the insurer about other health coverage, the insurer may pay benefits on a pro-rata basis. This means that the insurer will adjust the benefits based on the total coverage available from all policies. The rationale behind this is to prevent over-insurance, where an individual's total available benefits exceed their actual loss or need.

For example, if someone has multiple health insurance policies and does not disclose them, the insurer is entitled to ensure that they are not paying more than their fair share of the claim. By using a pro-rata approach, each insurer contributes towards the claim in proportion to the coverage they provide. This method protects both the insurer's financial interests and maintains fairness in how claims are settled among multiple policies.

Other potential answers, while they suggest serious consequences or actions, do not align with the standard practices in insurance regarding non-disclosure of additional coverage.