Procedure of Health insurance of claim from multiple policies

Increasing your health cover is not a bad idea. What’s more important is to understand how your claims can be approved without facing any hassles. Here we have listed down the claim procedure for health insurance from multiple policies.

For a Cashless Claim- For cashless claims, you can use multiple health insurance plans in two different ways. The first method is to make a cashless claim on one insurer and obtain the summary of claim settlement. Once this is done, you need to get the bills attested, and then approach the second insurer to request for reimbursement of the remaining amount. If you have laid-out the cost of the treatment, you can duly fill both the authorization forms. The hospital will then send a form to both the insurance companies and based on the same, the bills will be settled accordingly and paid to the hospital directly.

For a Reimbursement Claim- Despite earning soaring popularity, there are some hospitals, which do not accept the cashless facility. In such cases, individuals need to pay the bill from their pocket and the insurance company will reimburse it later. You need to submit the original bills based on which the insurer will reimburse the medical expenses incurred by you. Please note that these bills will be kept by the insurer.

How To Use Two Health Insurance Policies to Pay the Bill?

Suppose your hospital bill sums up to Rs. 3 lakhs and you own two health policies from two different insurers. Let us assume that the sum insured in each of the policies is Rs. 2 lakhs and you wish to claim an amount of Rs. 3 lakhs, you need to make use of both the policies. For this, you will need to submit all the original bills and documents to the insurer. You should also clearly state the amount that you wish the insurance company to pay. After the insurer pays you Rs. 2 lakhs, you can ask for the claim’s settlement summary from the insurer and get photocopies of all the bills. Get them duly attested to the hospital and submit it to the second insurance company for the remaining amount.

Important Points to Remember While Claiming through Multiple Policies

Each claim process will generally take between 30-45 days. In the case, if you have multiple cashless policies, the claim settled by the first insurer will be cashless. Then the first insurer will calculate the claim amount after considering deductions and applicable sub-limits against the claim amount before finally settling out the claim. After that, the second insurer will follow the same process and treat it as an original claim. After calculating the payable claim, the second insurer will deduct the amount received from the first insurer and pay you out the remaining balance.

If a policyholder owns two individual health covers, it is important to avail the older plan first for settling the claim amount, as the waiting period related to pre-existing ailments of the older cover diminishes with the passing time. Additionally, while claiming two plans, first go with a plan that has relevant sub-limits to comprehend deductions made under various heads like specialist's fare, medical clinic room rent, and so on. The second insurance provider at that point repays the balance amount.  

Avoid opting for the top-up and super top-up schemes or enhancing the amount of sum assured under the same insurance plan at the time of renewal. Also, avoid making claims from different small insurance plans.

With the inclusion of a super top-up plan in the regular plan, you can initiate multiple claim settlement in a single year as it comprises all expenses from hospitalization to treatment-related bills in a policy year. The insurance providing firm repays the amount of the claim notwithstanding when the claim overshoots the limit of the deductible.  

If you have a group health insurance plan from your employer, make sure to claim that first. This is because they have simple clauses that make the claim process much faster.