Can you exercise cashless claims from two health policies at the same time?

I'm 40 years old and working in a private company. I have Rs 3 lakh cover from my office and Rs 10 lakh cover from a private health insurer. I wanted to apply for a claim of Rs 4 lakh from both policies for a planned surgery. However, one of the agents told me that you cannot get a cashless claim from both policies. Secondly, he asked me to make a claim on the corporate policy and not from the private one; instead, pay the remaining amount since the amount is less. This way, I can retain benefits from other policies in future. Can you explain why he said that? What are the reasons for not processing a cashless claim through two health policies? Why does only one policy give cashless, and others give reimbursement? 

Reply by Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com 

It’s a common dilemma that policyholders face about being able to use multiple health insurance policies at the same time. I want to assure you that the most optimal approach is to claim the entire hospital expenses through one or both policies, without dipping into your pocket, even for smaller amounts. It's essential to recognise that completely forgoing the use of your private policy might not be the most financially prudent decision. Your private health insurance is a valuable asset, and judiciously leveraging both policies can provide you with comprehensive coverage.

To answer your question about cashless claims from both the policies, I’d like to say that yes, theoretically, it is possible. However, given the kind of time it will take to get a cashless claim, furnishing the proof and claiming from the second policy, your discharge time will significantly go up. The practical advice, therefore, is to go for a cashless claim with the bigger amount from the first policy and then go for a reimbursement from the second. This approach streamlines the discharge process, ensuring a smoother and more efficient experience during your hospital stay. Now, there are two ways to go about it. One, you could exhaust the sum insured from your corporate policy and then use your private policy for reimbursement. Alternatively, if you are keen on an entirely cashless claim, you could just use only your personal health plan since that will cover your entire expense. The advantage of a cashless claim lies in the direct settlement between the insurer and the hospital, minimising the financial burden on your end. 

Additionally, the specific features of your personal policy are crucial to understanding your options fully. Some policies allow claims without affecting cumulative bonuses, while others offer unlimited restoration benefits that replenish the sum insured multiple times for the same or different illnesses. Exploring these aspects ensures you make the most of your policy benefits.

Also, considering the evolving landscape of digital services, exploring online platforms for claims processing is advisable. These platforms often provide enhanced transparency into the claims status, allowing you to track and manage your claims more effectively. The use of online platforms also streamlines the claims process, offering a more convenient and user-friendly experience. In conclusion, while the agent's advice to use the corporate policy for a cashless claim and retain the private health insurance for future benefits is strategic, it is not recommended to completely disregard the private policy. Leveraging both policies intelligently ensures that you make the most of your insurance coverage, providing comprehensive protection for your healthcare needs.

(Views expressed by the investment expert are his/her own. E-mail us your investment queries at askmoneytoday@intoday.com. We will get your queries answered by our panel of experts.)