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Can We Claim Medical Insurance From Two Companies?
मार्च 30, 2021

आम्ही दोन कंपन्यांकडून हेल्थ इन्श्युरन्सचा क्लेम करू शकतो का?

हेल्थ केअर शुल्क, वैद्यकीय खर्च आणि जीवनशैलीतील बदलांमुळे दिवसागणिक आजारांच्या प्रमाणात मोठी वाढ होत आहे. त्यामुळे अधिक इन्श्युअर्ड रकमेचा पर्याय निवडण्याकडे अनेकांचा कल वाढीस लागलेला आहे. त्यामुळे अधिक लोक वेगवेगळ्या इन्श्युरन्स पॉलिसी कंपन्यांमध्ये विविध प्रकारचे ऑनलाईन हेल्थ इन्श्युरन्स पॉलिसी खरेदी करीत आहेत. या सर्व हेल्थ आणि वैद्यकीय इन्श्युरन्स पॉलिसी मध्ये व्यक्तिगत स्वरुपात खरेदी केलेला ऑनलाईन हेल्थ इन्श्युरन्स, and the second one from the employer, the most common question arises: Can we claim health insurance from two companies? The answer is yes. One can claim health insurance or medical insurance from two or more companies. Except there are some conditions and processes, the policyholder needs to understand while claiming. The policyholder needs to inform details of other ongoing health insurance policy to the insurance company while filing the proposal form . Also its best to inform both the companies about any expected hospitalization claim to avoid late intimation query The article below will explain everything about claiming health and how we can claim medical insurance from two companies. Make sure to read till the end before initiating any claims.

आम्ही दोन कंपन्यांकडून हेल्थ इन्श्युरन्सचा क्लेम कसा करू शकतो?

Claiming health insurance from two companies provides policyholders with flexibility during medical emergencies, but it can sometimes be a complex process. Here's a guide on how to handle this situation:

Evaluate Coverage:

Before making a claim, understand the coverage provided by each health insurance policy to determine the best approach.

Less Than Sum Assured:

If the claim amount is less than the sum assured of a single policy, the policyholder can only claim under one policy.

कॅशलेस क्लेम:

If the policyholder is eligible for cashless hospitalisation at a नेटवर्कमधील हॉस्पिटल, they should first raise the claim with their primary health insurance company and obtain the claims settlement summary. After receiving the settlement summary, the policyholder needs to submit the hospitalisation bills to the second health insurance company to request reimbursement for the balance amount.

प्रतिपूर्ती क्लेम:

If the hospital where the policyholder receives treatment is not part of the network hospitals of either insurance provider, they must pay the hospital bills upfront. After paying the bills, the policyholder can claim reimbursement from both insurance companies by submitting the necessary documents with one insurer and once settled he/she can next submit the settlement letter and additional documents to the next insurer for further claiming .

डॉक्युमेंटेशन:

Ensure all required documents, including bills, medical records, and claim forms, initial settlement details are are accurately filled out and submitted to the secondary insurance company .

Communication:

Maintain open communication with both insurance companies throughout the claims process to address any queries or concerns promptly.

How to claim health insurance from multiple insurers – An example

Claiming 2 health insurance plans at the same time requires a detailed study and a proper step-by-step process, which should be considered to make sure that you have a seamless process without any rejection. For example, let's consider Mr. Sharma, who has two health insurance policies: one with a coverage of Rs. 2 lakhs and another of Rs. 1 lakh. Now, when he required hospitalisation for hernia treatment costing Rs. 2.5 lakhs, he started his claim from both companies. Initially, Mr. Sharma approached his first insurer for cashless hospitalisation, utilising their network hospital. After treatment, the first insurer settled the claim up to Rs. 2 lakhs, with an outstanding amount of Rs. 50,000. However, the total cost is beyond the first claim accepted amount, Mr. Sharma has an option of putting a claim on the second insurance company. He would have to submit the initial insurance settlement details along with copy of claim documents and additional bills if any to the next insurance company. Who would then review the initial settlement details and process Mr. Sharma’s claim for the balance amount of Rs. 50000 basis the terms of the second policy.

Hedge against Rejection of Claims

Hedging against claim rejections in health insurance is like a strategic plan, with which you can reduce the financial risk, which is usually associated with denied claims. Multiple health insurance policies serve as a robust hedge, providing a safeguard against the adverse impact of claim rejection by one insurer. In essence, this strategy diversifies risk exposure, making sure that the insured individual or family is not left in an emergency, and ends up paying money from their own pockets. When a claim is denied by one insurer due to exhaustion of sum insured, policyholders can turn to another policy and ask for coverage for the medical expense. With this process, one can reduce the risk of potential financial burden, which often comes with the rejection of claims during emergencies. Moreover, it also highlights the importance of thorough policy evaluation and selection, as different companies have different criteria for their policy, and one should abide by it. Furthermore, by spreading coverage across multiple insurers, policyholders leverage the principle of risk pooling to their advantage. In the event of claim rejection by one insurer, the financial impact is reduced by the benefits provided by alternative policies. This proactive risk management approach underscores the importance of comprehensive coverage and diligent policy management in health insurance. However, it's imperative to exercise prudence and due diligence in navigating the complexities of multiple health insurance policies. Policyholders should carefully review policy terms, coverage limits, and exclusions to ensure alignment with their healthcare needs and financial objectives. Additionally, consulting with a knowledgeable insurance advisor can provide invaluable insights and assistance in optimising coverage strategies while minimising exposure to claim rejection risks.

हेल्थ इन्श्युरन्स क्लेम विषयी पॉलिसीधारकाद्वारे विचारलेले जाणारे नेहमीचे प्रश्न खालीलप्रमाणे:

1. पॉलिसीधारक किती दिवसांनंतर हेल्थ इन्श्युरन्सचा क्लेम करू शकतो?

There are various aspects to decide the admissibility of a claim . In a standard indemnity health insurance there is an initial waiting period of 30 days from inception before insured can claim under the policy. The waiting periods applicable will also be decided basis the nature of the claim as the products usually have a waiting periods applicable for certain conditions.

2. एका वर्षात, पॉलिसीधारक त्याचा हेल्थ इन्श्युरन्सचा किती वेळा क्लेम करू शकतो?

Multiple times until the sum insured amount is exhausted. However, certain products may have a condition on the numbers of claims admissible in a year e.g. cover for Daily hospital cash or a vector born illness cover . One needs to check with the insurer before purchasing the health insurance policies.\

अंतिम विचार

आकस्मिक आपत्कालीन वैद्यकीय परिस्थितीत सर्वोत्तम हेल्थ केअर सुविधांचा लाभ घेण्यासाठी हेल्थ इन्श्युरन्स पॉलिसी प्लॅनमध्ये गुंतवणूक करणे आवश्यक आहे. ज्याद्वारे तुम्हाला वैद्यकीय उपचारांच्या खर्चासाठी कव्हरेज प्राप्त होईल. पॉलिसी धारकाकडे एकाधिक हेल्थ इन्श्युरन्स पॉलिसी प्लॅन्समध्ये गुंतवणूक करण्याचे आणि आवश्यक वेळी कोणती पॉलिसी वापरली जाणे आवश्यक आहे ते निवडण्याचे स्वातंत्र्य आहे. पॉलिसीधारकाला दोन कंपन्यांकडे क्लेम करण्याचा अधिकार आहे परंतु ट्रीटमेंटचा खर्च दोन हेल्थ इन्श्युरन्स पॉलिसी कंपन्यांकडून क्लेम केलेल्या रकमेपेक्षा जास्त असू शकत नाही याची खात्री मात्र करणे आवश्यक आहे.   *प्रमाणित अटी लागू. **टॅक्स लाभ हे प्रचलित टॅक्स कायद्यांमध्ये बदलाच्या अधीन आहेत. इन्श्युरन्स हा विनंतीचा विषय आहे. लाभ, अपवाद, मर्यादा, अटी व शर्तींविषयी अधिक तपशीलासाठी, कृपया सेल्स पूर्ण करण्यापूर्वी सेल्स ब्रोशर/पॉलिसी मजकूर काळजीपूर्वक वाचा.

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