How should I settle claims from two insurers at the same time?
My wife is about to undergo a surgery after a month. My employer insurance can take care of expenses up to ₹2 lakh. I also have a family floater policy of ₹5 lakh coverage. I am worried about the claims settlement process. What do I do when two insurers are involved and both require medical documents? —Name withheld on request Many medical claims use two insurance policies.
The practice is to use one insurance for cashless settlement and then charge the outstanding expenses as a reimbursement claim in the other policy. Selection of which insurance to use first should be such that it minimises the amount you have to pay out-of-pocket and, to the extent possible, use the company insurance rather than your own. If your medical expenses are likely to be closer to ₹2 lakh then use your employer insurance first and the small unpaid amount can be claimed as a reimbursement in your personal plan.
If the total expenses are closer to ₹7 lakh then use your personal insurance first and claim the smaller unpaid amount in the company plan. When you file for reimbursement of the excess amount, the first insurer or hospital will give you a settlement letter stating how much of the expense has been paid by the insurer. You will need this to file a reimbursement claim for the balance payment.
The hospital will also give you a set of original bills that you can use for your reimbursement application. The hospital can also give you two sets of originals if you explain the purpose to them. A fully cashless settlement is possible if you are willing to wait in the hospital.
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