The Claims Process Of 2 Different Health Insurance Policies From Different Companies

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If you are a working professional, your job may give you certain benefits. These may include travel allowance, corporate discounts, paid parental leaves, free tickets and coupons, stock options, etc. You may also be eligible to be covered under a corporate health insurance plan - without having to go through any tedious research, paperwork, and buying process. Plus, it’s affordable!

But is corporate insurance the best bet for keeping you financially secure? Well, no.

Firstly, a corporate cover has certain limitations since it is your employer who manages it. For instance, you can’t customise it to your needs, you will need to exit it if you switch your job, or it may have restricted coverage.

And secondly, looking at the ever-rising healthcare costs and surge in lifestyle diseases (diabetes, hypertension, high cholesterol, etc.) - it’s extremely necessary to invest in a health insurance plan that fits you and your family’s requirements and medical history. Which is why you should also purchase a personal healthcare plan!

So, let’s consider that you have two plans now - one corporate and one personal. Can you claim from both these policies at the same time? If yes, how does that work? Which policy should you claim under first?

We'll find out answers to these questions and more in this article.

How To Claim From Two Different Health Insurance Policies?

A person with two health insurance policies can claim from both - if one of them is not enough to cover the medical expenses. If you want to know whether you need to use both policies, seek an estimate from the hospital in advance. You can plan ahead accordingly.

Let's see how you can claim from both of your health insurance plans.

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How To Claim From The First Health Insurance Policy?

As far as possible, you should use the cashless claims process with your first policy.

What Is A Cashless Claim?

In a cashless claim, the insurer directly compensates the hospital. For this, you must be treated in any network hospital of the insurance company.

Cashless claims save a lot of time as you won't have to spend time collecting documents, submitting them, and following up with insurers. The claim will be handled by the hospital insurance desk on your behalf.

How Does The Cashless Claims Process Work?

The first step is to confirm whether a cashless facility is available at the hospital desk. You should also get a list of the required documents. These include your insurance policy copy, PAN card, ID proof, etc.

Keep a copy of these documents on email since most hospitals accept these documents digitally.

An initial approval of the treatment cost is requested by the hospital from your insurer. This is called pre-authorization. Pre-authorization can get delayed if the hospital desk or insurer's office is closed or there is a holiday.

Once you know the discharge date, contact the insurance desk to submit the bills and documents.

A final approval from the insurer usually takes between 2-6 hours once all the paperwork has been submitted.

If your final approval is delayed, you can either wait until the claim is approved or pay and claim reimbursement later.

Your insurer will send you a claim settlement summary informing you whether your claim is approved or declined. In case your claim is approved, the summary shall enclose what portion is approved.

In this document, you will find details of all the expenses incurred during your treatment. Expenses that are approved and those that are not approved are also listed in this document.

What Should You Do If The Hospital Rejects Your Cashless Claim?

If the hospital denies your cashless claim request or your preferred hospital is not on the insurer's network list, you will have to pay the hospital bill yourself and then apply for reimbursement.

What Is A Reimbursement Claim?

If you opt for Reimbursement Claim, you need to pay the entire medical bill upfront and then submit the necessary paperwork and bills to the insurer. They shall verify the submitted documentation and then reimburse you the bill amount.

How Does The Reimbursement Claims Process Work?

Insurers must be informed of hospitalisation within 24 hours of admission. For planned hospitalizations, notify them a day in advance.

Submit all the original documents and bills, along with a duly filled out claim form, to the insurer.

In case your insurer needs any missing documents, make sure to provide them as soon as possible

The insurer will send you a claim settlement summary that details the reimbursement amount and the deductions made, as well as the expenses that were approved and rejected.

Reimbursement payments will be credited to the bank account you specify in the claims form.

How To Claim From The Second Health Insurance Policy?

You will have to claim the remainder from your second policy based on what is approved and what isn't in your first policy claim. The second claim will always happen on a reimbursement basis.

The first insurer will return all paperwork and bills that they have not paid, after settling the claim under the first policy. They may not hand over the settled bills and receipts.

In order to claim reimbursement from your second policy, you'll need to submit the following documents to the insurer:

A photocopy of the bills that were submitted and settled by the first insurer.

Originals of bills not paid by the first insurer.

Claim settlement summary received from the first insurer.

Let’s Understand How Reimbursement Claims Work In The Second Policy With An Example:

Rajesh has a corporate health insurance plan and a personal health insurance plan. Let’s assume each of these policies has a sum insured of Rs 3 lakhs.

Rajesh needs to be hospitalised for a minor surgery.

The hospital bill for his treatment amounts to Rs 4 lakhs, and so, he will need to utilise both policies.

He will be required to submit all the original bills and documents to his first or the most preferred insurer.

As soon as they pay Rs 3 lakhs, Rajesh will have to obtain a claim settlement summary and photocopies of all the settled bills. The first insurer shall return the remaining bills that they did not pay for.

As for the remaining Rs 1 lakh, Rajesh must pay it from his own pocket, collect the bill for the same, and submit them along with the first policy claims settlement summary to the second insurer.

The second insurer will then reimburse the remaining amount - Rs 1 lakh.

When Claiming From Your Health Insurance Policies, Which One Should You Choose First?

If you have two personal policies, you should claim from the policy with the higher sum insured first so that most of your claims can be settled on a cashless basis.

When you have a company plan and a personal plan, it is advisable to exhaust the sum insured under the corporate plan before you use the personal plan.

Why Should You Use Up The Corporate Plan First?

  • When you use your employer's policy first, you ensure that your personal policy coverage remains secure. In the event that you need to take a break or leave your company during the policy year, you can use your personal policy.

  • It is possible to retain the sum insured for your family members if you have a family floater as your personal policy.

  • In the event that you decide to port your policy, it will be easier if you haven't made any claims on your personal policy.

  • You will have difficulty upgrading your health insurance once you have made a claim. Maintaining a claimless status makes upgrading easier.

  • Additionally, if you you can earn a No Claim bonus in your personal policy if you do not make any claims in a year.

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What Should You Do If Your Employer Health Insurance Coverage Is Low?

Previously, we discussed how you should exhaust your corporate health insurance coverage before using your personal insurance. Nevertheless, if your employer's health insurance coverage is low, say only 3 lakhs, allocating an emergency fund or having an active credit card will be necessary. Using this setup, you can foot the remaining bill and then seek reimbursement for the same from your personal health insurance.

Suppose your hospitalisation costs INR 6 lakhs, but your employer's health insurance covers only INR 3 lakhs, you'll need to arrange for the remaining 3 lakhs and settle the hospital bill before you can be discharged.

The reimbursement process consumes quite a bit of time and hence, it's important that either your active credit card or your emergency health fund is ready to assist you. You can later seek reimbursement from your second insurance policy for the remaining 3 lakhs.

Is It Possible To Claim Reimbursements From Both Policies If Neither Offers Cashless?

The reimbursement method can be used for both policies. It will be necessary for you to wait to get reimbursement cleared from the first insurer and inform the second insurer by email. If the first insurer approves and reimburses your bills, you won't receive the original bills back.

After the first insurer reimburses you and returns the remaining bills, you can submit them along with the claim settlement summary to the second insurer to request reimbursement.

Summing Up!

In this day and age, where diseases are on the rise, having more than one health insurance policy is certainly not an unnecessary expense. Different health insurance plans offer different levels of coverage for hospital treatment. In addition, when you exhaust the claim limit on one policy, you can raise claims on the second, ensuring broader coverage.