Multiple health covers? Here's how cashless and reimbursement claims work

Soon after the outbreak of Covid-19 pandemic, health insurance coverage for self and family members has become almost indispensable. People have started to value the importance of a comprehensive health cover more than ever today. With galloping cost of medical treatment and hospital expenses, one must have sufficient health insurance coverage to ensure one gets adequate medical care. 

Those without health insurance must go for new plans while those with existing coverage should boost the coverage through top-up or super top-up plans. In fact, holding multiple health insurance policies either from the same or different insurer is also a good idea if that’s what suits you. In this case, you’re free to approach more than one insurer for claim settlement, if need be.

Multiple policies

The sum insured in case of multiple health policies can easily differ. Now you can choose to file the claim from a particular insurer up to the sum insured limit of your policy if it suffices. But, if the total claim amount exceeds the sum insured under a single policy, the insured is free to settle it by approaching another insurer from whom one is eligible claim the balance amount.

Accoridng to the IRDAI rules, customers holding multiple policies must have the right to prefer claims under this policy for the amount disallowed under any other policy/policies even if the sum insured is not exhausted. The insurer is allowed to independently settle the claim vis-a-vis terms and conditions of the concerned 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.

Document hassles

However, document submission can be a bit of hassle when it comes to settling claims via multiple policies from different insurers. To make things simpler, one can always ensure to keep an additional copy of all the medical bills and documents duly attested by the hospital.This would include a copy of discharge form, diagnostic tests, prescriptions and other relevant document undersigned by the medical staff at the designated hospital.

If it’s a network hospital, one can easily avial cashless facility. But, for reimbursement of claims  from a non-network hospital, the documentation may be a lot more complicated. This gets trickier when you’re claiming against multiple covers. You have to submit original copies to one insurer and file for the first claim. Once you get the claim reimbursed, you can take the claim summary and send the bill copy to the second insurer to claim the balance amount.

Thus, cashless claims are simpler as the hospital and insurers deal directly and work iut the finances within themselves. The policyholder is spared from the horrors of endless paperwork. In case of multiple covers or even individual policies, it’s better to go for cashless facility. Always pick an insurer with a wide scope of network hospitals.