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Q. I am a senior citizen. My spouse and I hold health insurance policies of ₹5 lakh, ₹7 lakh and

Q. I am a senior citizen. My spouse and I hold health insurance policies of ₹5 lakh, ₹7 lakh and ₹6 lakh issued by two private and one public sector insurers. There is no top-up cover. As such, in case of any claim that exceeds the coverage of one policy, we might have to prefer claims against more than one policy. As the original documents of the claim would be required by every one of the insurers, we would be grateful if you could explain the procedure to be followed.

MADHUSUDHAN

A. In two different scenarios here is how you can take different approaches. If your claim is ₹5.5 lakh, while you can claim ₹5 lakh from the first policy and ₹50,000 from the third policy, make things simpler by claiming the entire amount from one policy that has sufficient limits, namely policy #3. Since they are all basic hospitalisation policies and not top-ups you have the option of claiming from any of the policies or any combination of them.

With this approach, only for claims above ₹7 lakh do you need to claim from more than one policy, namely from policy #3 plus either #1 of #2 depending on the claim amount.

What if you have to claim from more than one policy? When you bought these policies, you would have declared other hospitalisation policy details. With that as the basis, you can prefer your claim with different insurers.

As for documentation, these claims require original bills and hospital documentation like medical history and diagnoses, prescriptions, diagnostic test results and discharge summary. You can claim under one policy with the original documents and obtain a set of certified copies of all the required documentation from the hospital for every additional policy under which you are going to claim. Mention the details in the covering letter of your claim form and supporting documents to each of the insurers.

If you have cashless claims settlement on all your policies, these processes become simpler and your Third-Party Administrator (TPA) will advise you on the formalities and should take care of all of them for you.