New Delhi: The second wave of Kovid has put a question mark on the entire health system of India. Every medical facility is doubling as a temporary hospital, with longer hospitalization times and higher medical bills; This has increased the incidence of multiple health insurance claims to clear the bills! So, yes, if you have multiple health insurance plans, you can choose to claim any proportion of them, as per your choice.
Suppose, you have 2 plans of Rs 5 lakh (Plan X) and Rs 5 lakh (Plan Y). You make a single claim of Rs 7 lakh. You have the following options:
1. Claim Rs 5 lakh from plan X and balance Rs 2 lakh from plan Y or vice versa.
2. Claim an amount less than the total amount, such as Rs 4 lakh from scheme X and balance Rs 3 lakh from scheme Y.
It is entirely your choice, which may be based on convenience or conditions. When it comes to claims, there is no rule on using the sum insured of multiple plans.
Here is a simple procedure that you can follow to simplify your claims with multiple insurers/policies:
claim type
when should you do it?
what should you do?
Cashless + Cashless: ie when you choose Claim both your plans in the same cashless admitted to hospital
This can be done if 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 documents will be sent by the hospital to both the insurers Accepted claims will be settled directly with the hospital At the time of discharge, pay the undue portion to clear the bill
Cashless + Reimbursement: i.e. when you opt for a cashless hospitalization and claim the balance on reimbursement basis from any other plan.
This can be done if the total claim amount exceeds the sum assured of the first plan or there is a portion which is not payable by your first plan.
Intimate both insurance companies Submit the pre-authorization claim form to the insurer first All claim related documents will be sent by the hospital At the time of discharge: a. pay the balance yourself B. Receive attested true copies from the hospital for second claim File a reimbursement claim for another insurer: a. Certified true copies of all expenses you need reimbursed for, B. Hospital discharge summary and C. Previous claim settlement letter from the first insurer. The accepted claim amount will be paid directly to your bank account.
Reimbursement + Reimbursement: ie when you choose both claim payment base, one after the other Second.
This can be done if the total claim amount exceeds the Sum Assured of the first plan or there is a portion which is not payable by your first plan, or you are treated in a non-network hospital. However, here you need to wait for 100% settlement of one claim before filing the next claim.
Intimate both insurance companies Get your hospitalized treatment done and pay the full amount in advance First fill the reimbursement claim for the insurer: a. Original bills and reports of all expenses incurred B. Hospital Discharge Summary The accepted claim amount will be paid directly to your bank account. For balance, get certified true copies from first insurer for second claim Again, file a reimbursement claim for another insurer: a. Certified true copies of all expenses you need reimbursed for, and B. Previous claim settlement letter from the first insurer. The accepted claim amount will be paid directly to your bank account.
*** Detailed chart by Turtlemint
If you have a fixed benefit plan with an indemnity plan, you need to know that an indemnity health plan alone will pay for your hospitalization expenses.
However, once the incident is confirmed, your fixed benefit plan will pay the entire sum assured, irrespective of the amount spent on hospitalization.
It is certainly not a hassle to file for multiple claims on a single hospitalization, provided you follow the procedure to T. All you need to take care of is to notify the insurers handling the claim and submit the correct paperwork to each insurer. Keep these things in mind, and your claim will be a breeze.
(Expert comments by Dhirendra Mahavanshi, co-founder of Turtlemint, an insurtech company).
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