CLAIMS FROM TWO HEALTH POLICIES

As a health insurance policyholder, you have the freedom to use more than one policy to pay for your hospitalization expenses. ? Read on to find out how.

In case of a reimbursement policy: When you use your policy for treatment in a non-network hospital, you will usually have to pay the bill yourself and later on get it reimbursed. The insurer would ask you to submit all original bills. The bills will stay with the insurer.

But what if you want to use two health policies? Let’s understand this with an example. Suppose you run a hospital bill of R3 lakh and you have two health policies from two different insurers, say insurer X and insurer Y. The health insurance cover in each of these policies is R2 lakh. So in order to claim R3 lakh, you need to invoke both the policies.

You will need to submit all the original documents to say insurer X. You can state the amount for the insurer to pay.

Suppose insurer X pays R2 lakh, you will then have to obtain a claims settlement summary from insurer X and get photocopies of all the bills.

These bills will need to get attested by the hospital and you can submit the attested photocopies along with the claims settlement summary to insurer Y. Insurer Y will then pay the remainder.

In case it’s cashless: The process is that you make a cashless claim on one insurer, obtain the claims settlement summary, get photocopies of the bills attested and approach the second insurer for the remainder.

However, in some cases where the cost of treatment is well defined, you could fill up two authorization forms which the hospital will send to both insurers. The insurers will settle the directly with the hospital.

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