Claim settlement by multiple insurers
I have two health policies for parents-one by my employer and other individual policy. Both have 20% copay and Rs 20000 limit for cataract. Say if I have to claim for cataract procedure, i will claim to retail policy where they will pay 16k. Can i claim balance 4k to other policy? If yes will I have to pay 20% of balance 4k out of pocket? Can you pls help understand.
Hi Pawan,
Since cataract is a treatment which already has a sub-limit in the policy, the co-pay clause is not applicable to it.
So as per my understanding, the entire 4k (as per your question) will be paid from the second policy and no co-pay will be applicable.
Regarding your question around OPD:
Any OPD expenses incurred before or after a covered treatment can be claimed under pre-post hospitalization expenses.
Stand alone OPD expenses (not leading to hospitalization or covered treatment) is not payable in a policy not covering OPD.
Hope this helps!
Cheers :)
Hi Pawan,
Yes and Yes to your both queries.
Just to add 2 more points:
Happy to answer any followup queries.
Anuj Jindal
Co-founder
SureClaim