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Step to claim from multiple health insurance companies

The cost of healthcare has increased tremendously in the recent past, and it has been moving northwards ever since the COVID-19 pandemic. To cover these costs, having health insurance is the best solution, but there is a possibility that these health plans also become inadequate to fund medical expenses. In such cases, you may try to file a claim through another health insurance policy that could have been offered by your employer or purchased as a top-up or purchased a new backup after going through the policy claim settlement ratio of health insurance companies.

While it is possible to raise claims from two health insurance policies, certain rules to be followed were recently changed by the Insurance Regulatory and Development Authority (IRDA). Before this, a contribution clause was added to every health insurance plan, and in the case of a claim request, each insurer will contribute an amount equivalent to the sum insured.

For example, let’s say a person holds two health policies for Rs.1 lakh from an insurer with the best claim settlement ratio in the health insurance sector and Rs.2 lakh from a new-age health insurer. He files a claim of Rs. 50,000, for which the 1st insurance company will pay Rs. 16,666 (for Rs 1 lakh sum insured) and Rs. 33,333 (for Rs. 2 lakh sum insured).

Now, a simpler and easier procedure has been brought in as part of the health insurance claim process. As per it, if the claim amount is less than the sum insured, the contribution clause does not apply but if the claim amount is higher than the sum insured, then the clause shall apply. But, the policyholder may choose the insurance company from whom they want to make the first claim form.

How to file a claim from two health insurers? 

Although it is considered normal to have multiple health plans, remember to disclose all the health insurance policies you are holding while filling the proposal form of any new health insurance policy. Also, it is necessary to disclose your existing policy details to the insurer beforehand after knowing how to claim health insurance, or your claim might get rejected for non-disclosure of policies.

Let us say, for example, you have two health insurance policies with a sum insured of Rs 2 lakhs (policy X) and Rs 3 lakhs (policy Y). If you want to claim Rs 1 lakh, you can choose to get the claim from either of the two policies. But if your total claim value is Rs 5 lakhs, then the insurance companies with whom you have taken the policies can choose to settle the claim in an equal ratio of the sum insured.

The only important thing to do while filing claims with two different insurers is to collect the claim settlement summary and relevant documentation, bills from the first insurer before approaching the second insurer for their claim.

Steps to file a cashless claim

In a cashless claim, the policyholder can avail treatment for medical emergencies from any of the network hospitals of the health insurance provider by producing the cashless health card issued by the insurer at the hospital’s insurance desk. All the expenses relating to hospitalization shall be paid directly to the hospital by the insurer. Follow the below steps right after getting admitted to the hospital for treatment:

  • Choose a hospital from the hospital network list provided by your health insurance company, which will ensure your cashless claim settlement is processed faster without any trouble.
  • Contact the third-party administrator (TPA) at least 3 days beforehand and inform them about getting admitted to the hospital with the medical condition. If it is an emergency claim hospitalization, you may choose to inform the TPA within 4 hours of hospitalization.
  • At the insurance counter of the hospital, submit the cashless health insurance claim form request form along with all the necessary relevant medical reports.
  • Once all the details are verified, your cashless claim will get approved by the TPA and insurer, and the status will be let known to you within a few hours.

After the approval process is completed, the insurer shall settle all the bills directly with the hospital. If, by any chance, your cashless request is disapproved due to certain reasons, you could get it reimbursed after discharge.

Steps to file a reimbursement claim

In this case, the reimbursement of medical treatment costs is done by the insurer after your treatment at any hospital is completed. However, as a policyholder, you may be required to pay the hospital initially and then file a reimbursement claim to the TPA or insurer with all the proofs of bills and medical records. Usually, a reimbursement claim is filed when the policyholder undergoes treatment at a hospital that does not feature in the network list of the insurer.

  • Pay all the hospital bills from your pocket and get discharged.
  • Collect all the bills related to treatment, prescriptions, discharge summaries, medical reports, and any other relevant documents from the hospital before leaving.
  • Call up the TPA or the insurer, quote your membership ID number and fill the reimbursement form with proper details of the claim and attach all the requested documents with it for the claim processing.

On successful verification of the submitted details, the health insurer or TPA will reimburse the medical costs through a cheque or direct credit to your bank account. For the reimbursement claim to be accepted, It is necessary to submit the forms within seven to fifteen days of discharge.

While choosing to buy two different health insurance policies, it is better to opt for a plan that offers cashless claims as the steps are straightforward just in case you need to file for a claim. And suppose the second policy does not provide cashless claims. In that case, you can always opt for a reimbursement claim after obtaining the necessary documents from the first insurer and refer it to the second insurer after getting discharged from the hospital.

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