Splitting hospital expenses across 2 policies: Key rules

A step-by-step guide to using both corporate and personal health covers to manage claims

- Aprajita Sharma

If you're a salaried employee, you likely have a corporate health plan—and possibly a personal one too. In case of a high hospital bill, you can use both to maximize coverage. Start by settling the claim with one insurer and get a settlement letter. Submit this, along with copies of paid bills, original unpaid bills, hospital receipts, and KYC documents, to the second insurer.

If both insurers are involved, use the first for a cashless claim up to its limit. Pay any shortfall out of pocket and claim it from the second insurer. If both deny cashless, you can still seek reimbursement—after the first insurer settles. "You may be asked to submit attested copies of bills settled by the first insurer. You can request your first insurer to directly send them to the second insurer," said Bhaskar Nerurkar, head - health administration team, Bajaj Allianz General Insurance.

Bengaluru-based Sharad Tulsyan had no issues with the first insurer, barring a 30-day delay in getting the settlement letter. "The second insurer asked for too many documents, even the ones which the hospital never submitted to the first insurer," he said. "They asked for internal case papers which comprised 1,000 pages in my case. The hospital was unwilling to release it and did it only after the treating doctor instructed them to do so."

If both your corporate and personal policies are from the same insurer, one can request for cashless treatment from both. "Two scenarios where the entire claim can be settled on a cashless basis are if the insurer is the same for corporate and retail plans. The other situation is when you have a super top-up and corporate or retail policy from the same insurer," said Nerurkar.