How to claim health insurance benefits successfully from multiple policies

GUIDE TO HEALTH INSURANCE CLAIMS

Representational image by Gerd Altmann from Pixabay

Many of us have multiple health insurance policies such as a retail policy, a corporate plan and a family floater plan. And yet, we almost never consider claiming health benefits using them together for a treatment.


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The reason is that most people don’t know how to leverage multiple policies for a maximised claim. Yet, multiple policies can help you recover the maximum amount of treatment cost at times. But an important point to note here is that you can never claim an amount more than the treatment expenses.

To benefit from multiple policies when filing a medical insurance claim, here are the four steps that you must follow:

Step 1: Send timely intimation

Whether the hospitalization is planned or unplanned, the first step is to intimate the insurance company about the hospitalization. In case of planned hospitalization, intimate the insurance company 3 to 4 days before the hospitalization. If it is an emergency case, inform the company within 24 hours of hospitalization.

If due to some circumstance you fail to intimate the insurance company or send a late intimation, a query will be raised when you file a health insurance claim. Hence, you will have to explain the reason to the representative to be able to start the claim process.

Step 2: Decide the policy sequence and file the claim

When filing a claim from multiple health insurance policies, the sequence of the policies you use to recover the expenses plays a major role. Here’s an example to explain why:

Let us assume Mr. Patel has two policies, A and B, offering coverage of Rs 3 Lakh and Rs 2 Lakh respectively.

Policy A has a maternity limit of Rs 75,000 and a limit of Rs 20,000 on pre and post hospitalisation expenses (within the maternity limit). The maternity limit on policy B is 50,000 and there are no pre and post hospitalisation benefits.

The expense on account of hospitalisation of his wife for delivery comes to Rs 100,000 while the pre- and post-hospitalization expenses are Rs 25,000, rendering a total of Rs 125,000.

On filing from policy A first, he gets Rs 75,000. Moreover, he can’t claim the pre and post hospitalization expenses due to the maternity limit of Rs 75,000 on policy A. Mr. Patel can claim the remaining hospitalization expense which is Rs 25,000 from policy B next. But he ends up paying the pre and post hospitalization expenses out of his own pocket since policy B doesn’t have this benefit. His out-of-pocket expense in this case is Rs 25,000.

Now, if he files a claim from policy B first, he can recover Rs 50,000 of the total hospitalisation expense. And the remaining  Rs 75,000 (Rs 50,000 hospitalization expense and Rs 25,000 pre and post hospitalisation expenses) can be claimed from policy A. He will then be able to recover the remaining hospitalisation cost, Rs 50,000, and Rs 20,000 of the pre and post hospitalisation cost due to the pre and post hospitalisation limit.

The out-of-pocket expense in this case is just Rs 5,000.

So, decide the sequence wisely, and once that is done, fill the claim form correctly and attach all the necessary original documents.

Step 3: Get the attested copy of originals from the first insurance company

You can submit the original treatment-related documents to only one insurance company. Hence, you will have to ask the first insurance company to give you an attested copy of the original documents along with the claim settlement summary. However, you can get attested documents and the claim settlement summary only after the first insurance company has settled your claim.

Step 4: Claim Using Attested Copies

Once you have the attested copies of the original documents, submit them to the second insurance company at the time of claim. Also, don’t forget to submit the claim settlement summary that you receive from the first insurance company. Claim settlement summary is important for the second insurance company to verify the amount that has already been settled by the first company.

Once the claim form, the copies of originals attested by the first insurance company, and the settlement summary are verified by the second insurance company, you will receive the reimbursed amount in your bank account as per the policy terms and condition.

Though the process may be a bit tricky, if it is followed with zero errors, you will certainly receive the maximum payout.


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About Anuj Jindal 1 Article
Anuj co-founded SureClaim to fix the broken claim experience of insurance customers. He believes technology can play a major role in empowering customers, an understanding shaped by his decade-long stint in healthcare and health-tech companies. You can reach him at anuj.jindal@sureclaim.in or by filling up the contact form on https://sureclaim.in/