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Have more than one health cover? Here’s how cashless refund requests work

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Cashless claims are more fluid as the hospital will deal directly with the insurance companies and settle the claims.

After the Covid-19 epidemic, the importance of having adequate health insurance coverage for yourself and your family members has increased. The cost of treatment was already rising and hospitalizations from the coronavirus have seen many pay hospital bills in lakhs. Those who did not have health coverage opted for new plans while those who already had existing coverage purchased new plans or increased coverage through top-up or super-top-up plans. Having multiple health insurance policies with the same or a different insurer is perfectly acceptable and there is not much of a problem when making a claim. We are authorized to address one or more insurers for the settlement of the claim, including the group insurance provider, if there is one.

“The policyholder can decide which plan to use and in what proportion. He can choose a single plan for the entire loss in case the coverage exists, ”explains Deepak Yohannan, CEO of MyInsuranceClub.

The sum insured (coverage) may differ depending on several policies you may have. You can still settle any insurer’s claim up to the sum insured in 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 wishes to claim the amount of the balance.

And, sometimes there is a partial payment of claims by the insurer. In accordance with IRDAI rules, the insured holder of multiple policies will also have the right to privilege claims under that policy for amounts denied under any other policy / policies, even if the sum insured is not exhausted. The insurer will then settle the claim independently in accordance with the general conditions of this policy.

When purchasing insurance, you should disclose all relevant information, especially important details regarding your current state of health, including that of your family history. But, should you also disclose the details of your existing policies? “It is not mandatory to declare any other health insurance plan you have. However, if there is a specific question for this purpose, it must be answered correctly. No erroneous information should be shared, ”Yohannan informs.

What can be a bit of a concern is when submitting the relevant hospitalization documents to the second insurer. For added security, here is what Yohannan suggests: “You should, however, obtain an additional copy of all invoices and documents certified by the hospital. At the time of discharge, you can ensure that reports such as discharge form, diagnostic tests, prescriptions and any other relevant documents are collected with an appropriate certificate from the hospital. But, yes, compared to cashless claims, claim reimbursement may require a little more attention from the policyholder. “Claims from more than one insurance company can be a bit of a pain. You must submit the originals to one and then make the claim first. Once you have received the claim from the first company, you can take the summary of the claim and send the copy of the invoice to the second insurer to claim the balance amount. Cashless claims are easier because the hospital will deal directly with the insurance companies and settle the claims, ”Yohannan explains.

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