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My Father recently underwent angioplasty , the total cost of which is exceeding the total sum ensured of my father's individual mediclaim policy from NIC and my mediclaim policy being issued through my employer . I want to know whether I can raise mediclaim under these two policies . What is the process to be followed since in one of the claims , I would not be in a position to submit the original documents
You can lodge the claim under any of the two insurers. However, experts say one must first exhaust the group claim limit. So start with Group Insurer. Once the Group insurer has processed the claim and made payment, then you will have to write to the serving TPA that you would like to claim the balance. The TPA will then issue a settlement note and certified copies of original documents submitted by the you, which you will submit to the another insurer.
The second insurer will pay on the basis of a certificate from the first stating that it has the original documents and a settlement note giving details of the amount the insured has already claimed.
Thank you Manish for sharing, this is something that every person with a health insurance policy must learn about.