Holding multiple health covers? Here is how cashless and reimbursement claims work

By: |
September 15, 2021 11:23 AM

If the amount to be claimed exceeds the sum insured under a single policy, the policyholder has the right to choose the insurer from whom he or she wants to claim the balance amount.

how cashless and reimbursement claims workCashless claims are smoother as the hospital will be dealing directly with the insurance companies and getting the claims settled.

After the outbreak of Covid-19, the importance of having adequate health insurance coverage for self and family members has increased. The treatment cost was already going up and hospitalisation due to Coronavirus saw many paying hospital bills in a few lakhs. Those who were without health covers went for new plans while those who already had existing coverage either purchased new plans or boosted the coverage through top-up or super top-up plans. Holding multiple health insurance policies from the same or different insurer is perfectly fine and there is not much of a concern at the time of the claim. One is allowed to approach one or more insurers for settlement of the claim, including the group insurance provider, if there is one.

“The policyholder can decide which plan to use and in what ratio. He can choose just one plan for the entire claim in case the coverage is there,” says Deepak Yohannan, CEO, MyInsuranceClub.

The sum insured (coverage) may differ across more than one policy that you may hold. You may still settle the claim from any insurer up to the sum insured limit of your policy. But, if the amount to be claimed exceeds the sum insured under a single policy, the policyholder has the right to choose the insurer from whom he/she wants to claim the balance amount.

And, at times, there is a partial payment of claims by the insurer. As per the IRDAI rules, the insured holding multiple policies will also have the right to prefer claims under this policy for the amounts disallowed under any other policy / policies even if the sum insured is not exhausted. Then the insurer shall independently settle the claim subject to the terms and conditions of this policy.

While buying insurance, you need to disclose all pertinent information, especially material details regarding your current health including that of your family history. But, do you have to disclose details of your existing policies as well? “It is not compulsory to declare any other health insurance plan which you have. However, if there is a specific question to that effect, it should be answered correctly. No wrong information should be shared,” informs Yohannan.

What may come up as a bit of a concern is during the submission of relevant hospitalization documents to the second insurer. To be on the safer side, here is what Yohannan suggests, “You should however get an additional copy of all bills and documents attested by the hospital.” At the time of discharge, you may ensure that reports such as discharge form, diagnostic tests, prescriptions and any other relevant document is collected with proper attestation from the hospital. But, yes, as against cashless claims, reimbursement of claims may require a bit more attention from the policyholder. “Reimbursement claims from more than one insurance company can be a bit painful. You have to submit originals to one and then make the first claim. Once you get the claim from the first company, you can take the claim summary and send the bill copy to the second insurer to claim the balance amount. Cashless claims are smoother as the hospital will be dealing directly with the insurance companies and getting the claims settled,” says Yohannan.

Do you know What is ? FE Knowledge Desk explains each of these and more in detail at Financial Express Explained. Also get Live BSE/NSE Stock Prices, latest NAV of Mutual Funds, Best equity funds, Top Gainers, Top Losers on Financial Express. Don’t forget to try our free Income Tax Calculator tool.

Financial Express is now on Telegram. Click here to join our channel and stay updated with the latest Biz news and updates.

Next Stories
1Should you buy multiple life insurance policies?
2How to reactivate a lapsed life insurance policy?
3Why it is important to renew motor insurance despite the pandemic