Many individuals have access to government health cover and also purchase private medical insurance to strengthen their financial protection. This gives them two potential sources of support when faced with hospitalisation expenses.
A common question in such cases is whether both policies can be invoked for a single hospital admission. Can a patient split the bill between the government scheme and private insurer, or is only one claim permitted?
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The answer depends on the terms governing each policy, but claiming under both is permitted in certain circumstances. Policyholders must ensure that the total amount received does not exceed the admissible hospital expenses. Any claim is also subject to the coverage conditions and exclusions specified by the respective insurers.
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When the benefits available under one health policy fall short of the admissible hospital expenses, the policyholder may be able to turn to another insurer for the shortfall. The primary insurer may request information about additional health policies and coordinate with the other insurance providers to process the claims.
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For instance, assume a patient's hospital expenses come to Rs 5 lakh. A government-backed scheme settles Rs 3 lakh, leaving Rs 2 lakh outstanding. The patient can submit a claim for this balance to their private health insurer, subject to the policy's coverage provisions and the applicable scheme guidelines.
Approval is not guaranteed. The private insurer will examine the outstanding expenses, verify whether they are covered and make a decision based on its own policy conditions.
Can You Receive Double Payment For The Same Treatment?
An individual cannot claim reimbursement twice for the same medical expense under indemnity-based health insurance. These policies are intended to cover the actual cost of treatment rather than provide an opportunity to earn a financial gain from hospitalisation.
Fixed-benefit insurance follows a separate approach. Hospital cash policies and critical illness plans offer a predetermined payout once the insured event meets the policy requirements. The payment is not linked to the amount reimbursed under another health policy, although the insurer's terms and conditions continue to apply.
Those planning to use government and private health cover together should first examine the scheme's rules on additional insurance. The private insurer must also be informed about the government policy and any payment already received towards the treatment.
It is advisable to retain all relevant medical and financial records, including hospital bills, discharge papers, receipts and settlement documents. These will help insurers calculate the eligible amount left to be paid.
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