In light of the increase in infections, living conditions and unique conditions presented by the Covid-19 pandemic, an increasing number of Indians are now opting for multiple health insurance coverages to protect themselves and their families. loved ones against financial loss due to the higher cost of treatment. While this increases claims coverage and flexibility and can potentially further mitigate the financial risks associated with hospitalization compared to a single policy, it is also relevant for policyholders to be aware of the nuances in the claims process to get the most out of multiple fonts. .
Let’s see how to apply for health insurance when multiple insurers are involved and the documents required for non-hospital claims.
Many employees have at least two health insurance policies in force: one provided by the employer and personal health insurance coverage. In such cases, or those involving two or more policies purchased independently, one can obtain cashless hospitalization at any of the network hospitals by making a claim with one of the insurers. The insured should then obtain the summary of the settlement of the claim from the first insurer and then submit it together with certified copies of the hospital bill to the second insurer. This is applicable when the invoice exceeds the insured sum of the first policy and the amount of the balance will then be settled by the second insurer. The second claim is treated as a request for reimbursement and will therefore require prepayment by the insured while the insurer concerned will settle the balance within the prescribed time.
If the hospital is on the network of both insurers, at the applicant’s insistence, cashless can be approved by both insurers.
Claims for out-of-network hospitals
In the event of hospitalization at an out-of-network hospital for either health insurance policy, the insured must settle all bills directly with the hospital and then follow the claims process. As part of the process, a claim form must be submitted along with certified copies of documents that include all lab reports, x-ray films, bills, receipts, and hospital discharge summary. In the event that the total invoice exceeds the sum insured, the remaining amount may be claimed from the other health insurance fund provided that a certified copy of the main insurer’s claims settlement summary is attached. It should be noted that such claims involve a longer settlement time, as the insurance company will manually review the submitted claims and settle the amount based on applicability/eligibility.
Expenses outside hospitalization
Often, any hospitalization for surgery or illness is followed by post-hospitalization treatment or therapy which entails an additional cost for the insured. These post-discharge expenses which include medication, follow-up consultation visits and diagnostic tests are covered for up to 60 days from the date of discharge. However, some therapies such as physiotherapy may not be covered and it depends on whether they are included in the policy coverage. In terms of the claims procedure, the process is similar to that of reimbursement of hospitalization costs and this is generally the case also for expenses incurred before hospitalization. Considering the fact that health insurance companies may exclude certain treatments or therapies, it is suggested that you review the inclusions in all purchased coverages and make claims for those expenses included in the policy coverage.
Choose the right policies
Although several health insurance coverages can provide financial relief for medical requirements, it is important to carefully read the terms and conditions of all policies purchased. It is recommended to choose policies from the same insurer to facilitate the claims process and speed up reimbursements. Many avenues online are available today to facilitate your search and it is strongly recommended that all disclosures be made with the utmost transparency to eliminate any risk of claim rejection.
(The author is Head of Health Administration, Bajaj Allianz General Insurance)