How to claim a policy in a situation where there are 2, 3 policies like personal policy and Health Insurance policy given by the employer?

In case of Life Insurance,  we can claim all the policies we have, individually but it a different process in Health insurance. Policy holders have an opportunity to claim the policy which is having improved facilities and conveniences. But the policy holders have to give a declaration stating the details of the other policies. If there are more than one policies then the two companies will share the claim. They pay the share of the claim depending on the Insurance amount of the two companies. For example, if the company, for which you are working, is giving health insurance policy worth of Rs. 2 lakhs, and personal insurance you took is for 1 lakh. If you claim for 1 lakh, then first policy’s share will be Rs. 66, 000 and the balance should be paid by the second. But the policy holders show negligence in revealing the details of the policies he already has to the new insurance company. They will be in a wrong notion that they can claim both the policies at time of need. But they can claim only one insurance policy. In case of cash less medical facility, first insurance company will pay the bill to the hospital. Then it claims its share from the second insurance company.

–Third Party Administrators (TPA) play an important role in the claim resolutions. Insurance companies depend on them right from the issue of the ID cards to claim payment. If the TPAs of both the insurance companies are same then the claim case will be settled soon. It prevents the time delay in transferring the claim documents from first TPA to second TPA.

–If the TPAs of both the companies are different, then a letter is given by the first TPA stating the closure of the claim. It also should confirm that the original certificates are with them. It is enough to submit with the photocopies of these documents while claiming the second TPA.

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