How to file a claim in case of multiple policies – including GMC and individual – are cashless available if both insurers are empaneled?

Post pandemic, health insurance has become a top priority for many in India due to the heightened awareness of the importance of financial protection against unforeseen events. Given the potential financial strain of medical treatments, having multiple health insurance policies can be a wise choice. This not only broadens coverage but also offers a reassuring safety net, especially in the event of hospitalization where the sum insured may not always suffice to cover all medical expenses. Therefore, the secondary health insurance policy can serve as a valuable backup, providing a sense of security and peace of mind, to address any outstanding bills.

You can maximize your coverage when covered by multiple health insurance plans, like a personal indemnity policy, a top up cover and one provided by your employer. Here's how it works: Firstly, if you need to make a claim, you typically start with your insurance company based on your preference. Once you've filed your claim and received a settlement summary from them, you'll need to gather any necessary documents, such as hospital bills. With the settlement summary and the relevant documentation, you can approach your secondary insurance company. They will review the information and cover any remaining eligible expenses not fully covered by your primary insurance. This straightforward process ensures that you're leveraging the benefits of both insurance plans to cover your medical expenses effectively. By following these steps, you can feel empowered, knowing you're in control of the claims process and ensuring you're getting the most out of your coverage.

The health insurance claim process is structured based on the cashless and reimbursement methods for coverage. If your sum insured is insufficient and hospital expenses exceed it, you can make claims under multiple policies through convenient cashless or reimbursement methods. This flexibility in claim methods is designed to make the process as easy as possible.

To initiate cashless hospitalization at a network facility, begin by informing both insurers through the insurance desk at hospital if you have an estimate of the expenses or anticipate utilizing another policy. Next, file a claim with your primary insurer for a settlement summary. Finally, submit attested hospital bills to your secondary insurer for reimbursement of any remaining balance. You can utilize cashless facilities for both claims if the provider is within the network of both insurance companies. Alternatively, circumstances may arise where cashless claims are not applicable. In such cases, you are required to pay the hospital bill upfront and then seek reimbursement from the insurance company. 

To ensure a smooth reimbursement process, you must provide attested documents alongside the claim form, including original hospital documents, such as a discharge summary, hospital bill, paid receipts, lab reports, medicine bills, and a pre-printed cancelled cheque. The insurance company will then review the claim and settle the amount accordingly. 

Securing a medical policy to cover your healthcare expenses is crucial for swiftly accessing top-notch medical resources during unexpected emergencies. Policyholders can avail various health insurance options and determine the appropriate one to utilize when needed. The policyholder is allowed to submit claims to two insurers but must ensure that the total actual costs of the treatment do not exceed the total amount claimed from both insurance companies.

Mr. Bhaskar Nerurkar, Head - HAT, Bajaj Allianz General Insurance