Zee Exclusive: How to claim Health Insurance from 2 or more policies?


New Delhi: The second wave of Covid has questioned the entire healthcare system of India. Every medical facility doubling up as a makeshift hospital, longer tenure of hospitalisation and high medical bills; this has increased the incidence of multiple health insurance claims in order to clear the bills! So, yes, if you have multiple health insurance plans, you can choose to claim from any of them, in any proportion, as per your choice.

Claims from multiple indemnity health insurance policies could be confusing if one is not aware of the process in its entirety. But if known, it is actually not a difficulty at all. Check out the below mentioned example.

Assuming, you have 2 plans of Rs 5 lakh (Plan X) and Rs 5 lakh (Plan Y) each. You incur a single claim of Rs 7 lakh. You have the following options:

1. Claim Rs 5 lakh from Plan X and remaining Rs 2 lakh from Plan Y or vice versa.

2. Claim any amount less than the total amount, say Rs 4 lakhs from Plan X and the remaining Rs 3 lakhs from Plan Y.

This is completely your choice, which could be based on convenience or conditions. When it comes to claims, there is no set rule on utilising the sum insured of multiple plans.

However, when you apply for the claim, you have a choice of processing both the claims in a cashless manner in the same hospitalisation or opt for a reimbursement of the remaining amount.

Here is a simple process that you can follow to ease your claims from mutliple insurers/policies:

Type of claim When you should do? What should you do?

Cashless + cashless:

i.e. when you opt to

claim both your plans

in the same cashless

hospitalisation

This could be done when the total claim amount is more than the sum insured of the first plan

● Intimate both the insurance companies

● Submit two pre-authorization claim forms

● All claim related documents would be sent to both the insurers by the hospital

● The approved claims would be settled directly with the hospital

● At the time of discharge, pay the non-payable portion to clear the bill

Cashless + reimbursement: i.e. when you opt for one cashless hospitalisation and the remaining claim from another plan on a reimbursement basis. This could be done when the total claim amount is more than the sum insured of the first plan or there is a part that is not payable by your first plan.

● Intimate both the insurance companies

● Submit pre-authorization claim form to 1st insurer

● All claim related documents would be sent to by the hospital

● At the time of discharge:

a. Pay the remaining amount yourself

b. Obtain certified true copies from the hospital for the 2nd claim

● Fill up reimbursement claim for the 2nd insurer along with:

a. Certified true copies of all expenses that you need reimbursed, 

b. Discharge summary of the hospital and

c. Previous claim settlement letter from 1st insurer.

● The approved claim amount would be paid directly to your bank account.

Reimbursement +

reimbursement: i.e.

when you opt for

both claims on a

reimbursement

basis, one after

another.

This could be done when the total claim amount is more than the sum insured of the first plan or there is a part that is not payable by your first plan, or your treatment is done in a non-network hospital.

However, here you need to wait for one claim to be 100% settled before filing the next.

● Intimate both the insurance companies

● Get your hospitalisation treatment done and pay the entire amount upfront

● Fill up reimbursement claim for the 1st insurer along with: 

a. Original bills and reports of all expenses incurred

b. Discharge summary of the hospital

● The approved claim amount would be paid directly to your bank account.

● For the remaining amount, obtain certified true copies from the 1st insurer for the 2nd claim

● Again, fill up reimbursement claim for the 2nd insurer along with: 

a. Certified true copies of all expenses that you need reimbursed, and

b. Previous claim settlement letter from 1st insurer.

● The approved claim amount would be paid directly to your bank account.

***Chart as detailed by Turtlemint 

If you have a fixed benefit plan along with an indemnity plan, then you need to know that an indemnity health plan would pay for the expenses incurred in your hospitalisation alone.

However, your fixed benefit plan would pay for the entire sum insured, irrespective of the amount spent on hospitalisation, once the incidence is confirmed.

It is surely not a hassle to file for multiple claims in the same hospitalisation, provided you follow the process to the tee. All you need to take care of is intimating the insurers handling the claim and submitting the right paperwork to each insurer. Keep these things in mind, and your claim would become a breeze.

(Expert comments by  Dhirendra Mahyavanshi , Co-Founder, Turtlemint –An InsurTech Company).

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