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How to claim maternity benefits from two Corporate plans

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08 Aug, 2021 by  Udit

Hi,


My wife and I are both working. She has a maternity claim limit of 75000 and I have a claim limit of 35000 from our employers insurance plan. Both these include maximum of 5000 for Pre post expenses. Our hospital bill is around 85000 and Pre post expenses around 15000. How should we go about putting in the claims? What is the best way to get all our expenses approved? Kindly also help with the process to claim from two different companies.

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09 Aug, 2021

You can do as follows -


1) Apply for reimbursement of expenses from your wife's policy first.


2) Apply for the remaining amount (Rs 85,000 minus reimbursement from 1st policy) from your corporate insurance policy. You will be required to give photocopies of all documents, hospital discharge summary and the claim settlement letter from the 1st Insurer.


3) Apply for pre and post hospital expense reimbursement from both policies one after another. Since the SI for pre and post expenses is Rs 10000 both policies combined, maximum reimbursement here will be 10K.


Hope this helps.


Asad Akbar



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10 Aug, 2021

Hi Udit,


I slightly disagree with Asad. I've made these claims several hundred times. Here's the exact process.


1. File 85k in your wife's policy. Max 75k it will pay and limit will exhaust. You don't have 5k also to pay for pre post.


2. While you file the claim in your wife's policy, submit copies of the 85k hospitalization bill to your policy simultaneously. Send a cover note explaining that you have submitted originals to your wife's insurer and you will submit settlement letter upon claim approval. Your insurer will log the claim with copies and issue the claim id. It will ask for settlement letter within.3 week period, and you won't have it. So it will close your claim.


3. File pre post bills of 15k in your policy (Max 5k will come due to limit). Same process will repeat as in step 2. Your insurer will not approve pre post claim till main hospital claim is settled.


4. Once your wife's policy settles claim, request her insurer to send you hard copy of the settlement letter. Upon receiving it, submit the same to your insurer in the hospitalization claim id. Remember to add another cover note requesting to reopen the claim (since it got closed in step 2).


5. Submit a reopen request letter for pre post claim too. Both claims will get processed and payment will be done. Overall these claims can take 3.5 to 4 months to recover the entire money.


Anuj Jindal

Co-founder

SureClaim


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