These days it’s common to have a number of medical health insurance insurance policies. In such scenario, how one can declare medical bills from a number of insurance coverage insurance policies?
Medical bills are skyrocketing, and many individuals properly go for a number of medical health insurance insurance policies to make sure higher monetary safety. However on the subject of making claims, issues can get complicated. How do you declare from two insurance policies? Which insurer do you have to strategy first? Will each insurers pay your payments?
Should you’ve ever had these questions, this information will break down every thing in a easy and sensible manner, with real-life examples that will help you perceive how one can maximize your advantages.
Why Do Individuals Have A number of Well being Insurance coverage Insurance policies?
There are various explanation why folks maintain multiple medical health insurance coverage:
- Employer-Supplied Insurance coverage + Private Insurance coverage
- Many salaried people have a bunch well being coverage from their employer but in addition purchase a separate private coverage for higher protection.
- Base Coverage + Tremendous High-Up Coverage
- A base coverage covers common medical bills, whereas a brilliant top-up coverage kicks in when medical prices exceed a sure restrict.
- Completely different Insurance policies for Completely different Wants
- Some folks purchase an extra coverage to cowl particular medical circumstances that their main coverage doesn’t cowl.
How To Declare Medical Bills From A number of Insurance coverage Insurance policies?
Situation 1: Cashless Declare from One Coverage, Reimbursement from One other
Let’s say Rahul has:
- Coverage A (Rs.5 lakh sum insured)
- Coverage B (Rs.3 lakh sum insured)
He’s hospitalized, and the whole invoice involves Rs.6 lakh. Right here’s how he ought to proceed:
- Step 1: Use Cashless Facility with One Insurer
- Rahul submits his insurance coverage card for Coverage A, and the insurer settles Rs.5 lakh straight with the hospital.
- Step 2: Get Settlement Abstract
- The hospital provides him a abstract exhibiting that Rs.5 lakh has been coated and Rs.1 lakh is unpaid.
- Step 3: Declare Reimbursement from Coverage B
- Rahul submits the settlement abstract, unique payments, and discharge abstract to the second insurer (Coverage B).
- Coverage B processes the reimbursement and pays him Rs.1 lakh.
On this manner, Rahul efficiently makes use of each insurance policies and pays nothing out of pocket!
Situation 2: Claiming from Two Insurers for a Cashless Remedy
If the whole invoice is greater than what one insurer covers, some hospitals coordinate with a number of insurers. Nonetheless, this requires prior approval.
For instance, Priya has:
- Coverage X (Rs.3 lakh sum insured)
- Coverage Y (Rs.2 lakh sum insured)
Her hospital invoice is Rs.4.5 lakh. Right here’s how she will use cashless claims with each insurers:
- Step 1: Inform the Hospital About Each Insurance policies
- Earlier than admission, Priya tells the hospital that she has two insurance coverage insurance policies.
- Step 2: Get Approval from Each Insurers
- The hospital coordinates with each insurers for cashless declare approval.
- Coverage X approves Rs.3 lakh, and Coverage Y approves Rs.1.5 lakh.
- Step 3: Direct Settlement
- The hospital sends separate payments to every insurer, and all the Rs.4.5 lakh invoice is settled cashless.
Lastly, Priya pays nothing out of pocket and avoids paperwork hassles!
Situation 3: Dealing with Room Lease Limits
Many insurance policies have room hire sub-limits, which may result in out-of-pocket bills.
As an illustration, Amit has:
- Coverage A (Rs.5 lakh protection, Rs.5,000 per day room hire restrict)
- Coverage B (Rs.3 lakh protection, no room hire restrict)
He chooses a hospital room costing Rs.8,000 per day. What occurs?
- Coverage A will solely cowl Rs.5,000 per day, leaving a shortfall of Rs.3,000 per day.
- Coverage B can be utilized to cowl the remaining Rs.3,000 per day.
Assume in his case the invoice quantity is Rs.4 lakh. Regardless that coverage A has the utmost sum insured of Rs.5 lakh, it won’t compensate the entire Rs.4 lakh. As a substitute, it can compensate a proportionate quantity of Rs.2,50,000 ONLY (Rs.4 lakh*(Rs.5,000/Rs.8,000)=Rs.2,50,000). For the remaining Rs.1,50,000 declare, Amit has to strategy Coverage B. Amit well makes use of his insurance policies to keep away from out-of-pocket bills!
Situation 4: Deliberate Surgical procedure with Two Insurance policies
Suppose Neha is scheduled for knee surgical procedure costing Rs.7 lakh. She has:
- Employer Coverage (Rs.3 lakh sum insured)
- Private Coverage (Rs.5 lakh sum insured)
Right here’s how she ought to declare:
- Step 1: Use Employer Insurance coverage First
- Employer insurance coverage is normally used first because it’s usually a group coverage with fewer restrictions.
- The employer’s insurer covers Rs.3 lakh.
- Step 2: Use Private Insurance coverage for Remaining Rs.4 Lakh
- She then submits the steadiness Rs.4 lakh declare to her private insurer.
Neha efficiently makes use of each insurance policies and avoids excessive medical bills!
Vital Issues to Bear in mind When Claiming from A number of Insurance policies
At all times Inform Each Insurers
- Notify each insurers as quickly as attainable about hospitalization.
Perceive Your Coverage Protection
- Examine for room hire limits, co-payment clauses, and exclusions.
Maintain All Authentic Paperwork
- At all times make a copy of hospital payments, reviews, and settlement summaries.
Use the Cashless Facility The place Potential
- It reduces monetary burden and paperwork.
Keep away from Claiming the Similar Quantity from Each Insurance policies
- You can not declare Rs.1 lakh from every insurer for a Rs.1 lakh expense—it should be cut up logically.
Last Ideas: Ought to You Have A number of Insurance policies?
Having a number of insurance policies will not be against the law. Nonetheless, claiming with a number of insurers on the identical hospital invoice might lead you to hassle. You seen that within the above instance, how a lot protection you’ve got, room hire cap, deductions, and co-payment clauses are most vital earlier than you proceed with which insurer to knock the declare. Having a number of medical health insurance insurance policies is a good way to:
- Improve whole protection
- Cut back private bills throughout medical emergencies
- Cowl extra medical circumstances not included in a single coverage
By following the precise strategy to claims, you possibly can maximize advantages, reduce prices, and keep away from pointless monetary stress! However all the time ensure that your base and tremendous top-up must be throughout the identical firm as it can scale back the trouble of approaching a number of insurers.
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