How to Make Claims With Two Health Insurance Policies?

The spurt in lifestyle diseases, coupled with expensive medical treatment make health insurance a necessity. A medical emergency can destroy your savings, leaving you in a financial mess. It’s smart to have two health insurance plans as medical inflation rises. However, this presents the issue of having to make claims with two health insurance policies. Can you get a complete reimbursement on hospital bills?

It’s common to have an individual health insurance plan, along with the office-provided insurance cover. Suppose you have the employer-offered group insurance and personal health insurance with a sum assured of two lakh each. You may choose either of the policies for a claim settlement of one lakh.

A common problem is your hospital bill exceeding the sum assured of one insurance plan. You will have to claim the remaining amount from the other insurance plan. Assume the hospitalisation bill comes to Rs 3 lakh. You must claim Rs 2 lakh under the office group cover, and the remaining amount against your policy. Claim settlement is smooth with a group insurance plan. You also retain the No Claim Bonus on your insurance plan. It’s the additional cover offered by the insurer on not claiming in a policy year. 

It would help if you informed both the insurers on a hospitalisation. Intimate the insurers that you would be making a claim when discharged from the hospital. The insurance companies will insist on the original hospital bills. You cannot submit the same set of hospital bills to both the insurers. 

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Pick any one of the insurers and submit the original hospital bills. You must ask the insurer for certified copies of the hospital bills, along with the claim amount. The insurance company gives a settlement letter with details on the settlement. 

You must present the certified copies of your hospitalisation bills and the settlement letter to the second insurer. Fill the claim form to get the settlement for the remaining amount. The hospitals prefer dealing with a single insurer. So you can opt for reimbursement over the cashless settlement for a hassle-free experience. 

You may choose the cashless settlement, and one of the insurers honours the claim. Get the summary of the claim settlement and the attested copies of the hospital bill. You must approach the second insurer and ask for the reimbursement of the pending amount.

It’s easy to get the claim settled on a clearly defined cost of treatment. You must fill both the authorisation forms. The hospital sends the authorisation form to each of the insurers for a direct settlement. It is the easiest way for a claim settlement with the insurer directly paying the hospital. 

Having two health insurance policies enhances the cover for medical emergencies. Take a separate health cover apart from the employer group insurance plan. It is vital when you switch jobs or exhaust the protection of the previous policy. If an insurer doesn’t settle your claim, chances are the other insurance company would do so. You can assess quality medical treatment without having to worry about the financial burden. 

For any clarifications/feedback on the topic, please contact the writer at cleyon.dsouza@cleartax.in