How to claim in case of multiple health insurance policies

Maximum coverage

In the light of rising infections, lifestyle conditions and unique conditions presented by the Covid-19 pandemic, an increasing number of Indians today are opting for multiple health insurance coverages to protect themselves and loved ones against financial loss due to the higher cost of treatment. While this increases the coverage and flexibility in making claims and can potentially mitigate more financial risks associated with hospitalisation as compared to a single policy, it also makes it pertinent for policyholders to be aware of nuances in the claim procedure to extract maximum benefit from multiple policies.

Let us look at how should one claim health insurance when multiple insurers are involved and the documents required in case of non-hospitalisation claims.

Cashless claims

Many salaried employees have at least two health insurance policies in effect: one provided by the employer and a personal health insurance coverage. In such cases, or those involving two or more policies purchased independently, one can get cashless hospitalisation at any of the network hospitals by raising a claim with either of the insurers. The insured needs to then obtain the claim settlement summary from the first insurer and then submit the same along with attested copies of the hospital bill to the second insurer. This is applicable when the bill exceeds the sum assured of the first policy and the balance amount will then be settled by the second insurer. The second claim is treated as a reimbursement claim and hence will require pre-payment by the insured while the applicable insurer will clear the balance amount within the prescribed timelines.

If the hospital is on the network of both the insurers, at the insistence of the claimant, cashless can be approved by both insurers.

Claims for non-network hospitals

In case of hospitalisation at a non-network hospital for either of the health insurance policies, the insured needs to settle all bills directly with the hospital and then follow the claim process. As part of the process, a claim form needs to be submitted along with attested copies of documents that include all lab reports, X-ray films, bills, receipts and discharge summary from the hospital. In case the total bill exceeds the sum insured, the remaining amount can be claimed with the other health insurance company as long as the attested copy for the claim settlement summary from the primary insurer is attached. It needs to be noted that such claims involve a higher lead-time for settlement as the insurance company will review the submitted claims manually and settle the amount based on applicability/eligibility.

Non-hospitalisation expenses

Often, any hospitalisation for surgery or illness is followed with treatment or post-hospitalisation therapy that incurs an additional cost for the insured. Such post-discharge expenses that include medicines, follow-up consultation visits, and diagnostic tests are covered up to 60 days from the date of discharge. However, certain therapies such as physiotherapy may not be covered and it depends on whether they are included as part of the policy coverage. In terms of claim procedure, the process is similar to that of reimbursement of hospitalisation expenses and is usually the case for expenses incurred prior to hospitalisation, too. Considering the fact that health insurance companies may exclude certain treatments or therapies, it is suggested to review the inclusions in all covers purchased and make claims for such expenses included in the policy coverage.

Choosing the right policies

While having multiple health insurance covers can provide financial relief in cases of medical exigencies, it is important to read the terms and conditions carefully for all the policies purchased. It is recommended to choose policies from the same insurer to ease the claims process and make reimbursements faster. There are multiple online avenues available today to make your search easier and it is highly recommended that all disclosures be made with utmost transparency to eliminate any chances of claim rejection.

(The writer is Head – Health Administration, Bajaj Allianz General Insurance)