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what is the process for cashless claim for base and super top up of differnent companies

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09 Jul, 2022 by  Rayapu Ashok Kumar Reddy

Dear Members


I have a base policy in manipal cigna and super top up in care health. Is it possible for claiming both policies cashless . What is the procedure involed in claiming both at the same time. I cannot afford the amount first and again claiming for reimbrusement. In emergency cases once the base policy of one company finished will the another compay process it immedaitely for super top up? What are the IRDA guide lines regarding this?

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10 Jul, 2022
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Dear Rayapu,


Two policies in general do not work cashless unless they are from same insurers. Since you have policies from different insurers one will work as cashless and other reimbursement.

One way out could be you port one of your policies (either base or super top up) to the other company so that both base as well as super topup are from same insurer.


There are no guidelines from IRDA on a scenario like this.


It is best to consult a seasoned professional/advisor when you make such purchase in future.


Regards

Rohit Dhingra

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10 Jul, 2022
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Dear Mr.Ashok Kumar,


Please understand that two different insurance companies usually do not settle a single hospital on a cashless basis. This means if you have a base policy from one insurer & top-up plan from a different company & in a scenario where a single hospitalization bill is getting beyond the limit of the base insurance cover, the option left is to pay the balance difference of the bill, collect the required payment receipts from the hospital, request your primary insurer with whom you have the base policy to send the settlement letter & apply for reimbursement along with the attested copies of the documents submitted.

However, in the subsequent hospitalizations, you can avail cashless facility from the Top-up insurer since the deductible limits would have got completed & this event involves dealing with a single insurance company.

Hence, it is strongly recommended that one chooses to buy base + top-up plans from the same insurance company if possible.


Regards,

Satish Kumar H

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