Hi guru,
My wife is pregnant now, expected delivery is on aug and the amount of delivery is around 2 lacks in Hyderabad.
We both are corporate employees and holding corporate insurances, mine can be claimed upto 50k and my wife insurance can be claimed upto 70k
As i came to know that we both cannot be submitted for cashless claim,
Questions:
Can we pay the total amount by cash and claim individual insurances by submitting the hospital bills?
Can we go a head with my wife cashless claim for 70k and remaining bills can be submitted in my company insurance?
Whats the best procedure to claim the both our corporate insurance benefits?
Please suggest.
Note: recently my friend submitted their both corporate maternity bills and has been claimed.
Ans: Congratulations on the upcoming addition to your family! It’s great that you and your wife have corporate insurance to help cover the delivery costs. Let’s explore the best way to utilize both insurances effectively.
Understanding Corporate Insurance Claims
Corporate health insurance policies typically have specific rules and procedures for claims. It’s crucial to understand these to maximize your benefits. Here’s a step-by-step guide to help you navigate the claims process:
Cashless Claim Option
Cashless claims are convenient as they reduce the immediate financial burden. However, there might be restrictions when using multiple policies for a single claim.
Reimbursement Option
Reimbursement claims require you to pay the hospital bills upfront and later submit the bills for reimbursement from your insurers.
Strategy for Maximizing Insurance Benefits
Option 1: Using Cashless and Reimbursement Together
Cashless Claim with Your Wife's Insurance:
Since your wife’s insurance covers up to Rs 70,000, you can opt for a cashless claim for this amount.
Inform the hospital in advance about the cashless claim using your wife’s insurance.
Reimbursement Claim with Your Insurance:
For the remaining amount, you can pay out of pocket and later submit the bills to your insurance for reimbursement.
Ensure you get detailed and itemized bills from the hospital to avoid any issues during the reimbursement claim.
Option 2: Full Payment and Dual Reimbursement Claims
Pay the Total Amount by Cash:
Pay the entire hospital bill upfront by cash or card.
Submit Bills for Reimbursement to Both Insurers:
First, submit the bills to your wife’s insurance to claim the maximum allowed amount (Rs 70,000).
Once the claim is processed, submit the remaining bills to your insurance to claim up to Rs 50,000.
Clearly indicate to your insurance that your wife’s policy has already covered part of the expenses.
Recommended Procedure
Step-by-Step Process
Contact Both Insurers:
Reach out to both your insurance providers to understand their specific claim processes and requirements.
Confirm if they accept combined claims and get clarity on the documentation needed.
Pre-Authorization for Cashless Claim:
For a cashless claim using your wife’s insurance, obtain pre-authorization from the insurer. This typically involves submitting a pre-authorization form to the hospital, which then coordinates with the insurer.
Documentation:
Collect all necessary documents, including the hospital bill, discharge summary, and any other medical reports.
Ensure the bills are itemized and clearly mention the amount paid.
Submitting Reimbursement Claims:
After your wife’s insurance processes the cashless claim, submit the remaining bills to your insurance for reimbursement.
Include a cover letter explaining that the initial claim was processed by another insurer and attach a copy of the claim settlement.
Additional Tips
Keep Track of Communication
Maintain a record of all communications with your insurers and the hospital. This includes emails, phone calls, and any written correspondence.
Follow Up
Regularly follow up with both insurers to ensure your claims are being processed. Prompt follow-ups can help avoid delays.
Seek Clarification
If any part of the claim process is unclear, don’t hesitate to seek clarification from your insurers. It’s better to address any doubts upfront to avoid complications later.
Conclusion
Using both corporate insurances effectively can significantly reduce your out-of-pocket expenses for the delivery. By opting for a combination of cashless and reimbursement claims or full payment followed by dual reimbursement claims, you can maximize your insurance benefits. Ensure you communicate clearly with your insurers, follow their procedures, and keep detailed records to facilitate smooth claim processing.
Best Regards,
K. Ramalingam, MBA, CFP
Chief Financial Planner,
www.holisticinvestment.in