In an era where healthcare costs continue to rise, people are seeking convenient and efficient ways to manage their medical expenses. One such solution that has gained popularity is the concept of cashless transactions facilitated by Third-Party Administrators (TPAs).
A cashless TPA, also known as a cashless claims management service, acts as an intermediary between policyholders, healthcare providers and insurance companies. It serves as a facilitator in the smooth processing of insurance claims, eliminating the need for individuals to pay out-of-pocket and seek reimbursement later. But can you avail this facility from two TPAs? The answer is yes.
If you find yourself in the position of possessing two health insurance policies, you are entitled to make a claim under either one or both of them. It is essential to ensure that the total hospitalisation expenses do not exceed the maximum coverage provided by one or both of your insurance policies
To simplify this process, it is recommended to initiate a cashless claim with the first insurer and subsequently claim reimbursement from the second insurer for the residual amount. Upon discharge from the hospital, the first insurer will provide a final settlement letter, detailing the total bill and the amount paid by the policyholder. This document, along with medical papers and original receipts for the residual amount, can then be submitted to the second insurer for reimbursement.
Recognising the potential benefits of policyholders availing multiple health insurance plans, the Insurance Regulatory and Development Authority of India (IRDAI) has made significant changes to the rules and regulations. In the past, the IRDAI mandated that insurance companies proportionally share the total medical expenses based on the sum assured by each company, a practice known as the ‘Contribution Clause’ in health insurance. However, this requirement has been eradicated, and policyholders are now free to approach any one of the insurers to settle their claim.
The recent reforms implemented by the IRDAI aim to make it easier for individuals to leverage the advantages of multiple health insurance plans. By staying informed and understanding these changes, policyholders can navigate the complexities of their coverage, protect their financial well-being and ensure access to quality healthcare when they need it most.