“The Vitals of Group Health Insurance: What You Need to Know”

A group medical policy covers a certain group of people, like members of a professional association or employees of a company, society, etc., including health-related and medical expenditures. The Group Health Insurance Policy, also called Corporate Health Insurance, spreads its coverage to employees, which includes pre and post-hospitalization expenses, pre-existing diseases, etc. Basically, it includes employees of an organization and their family members, such as spouses, dependent parents, and children, under the same policy.

Salient Features

• Ancillary expenses:

Corporate health insurance also includes some costs, such as ambulance charges for employees and their dependents.

• No Medical Screening:

No medical screening is required for enrollment purposes for corporate health insurance.

• Cost-Effective Protection:

It is an economical alternative if compared with personal health insurance plans.

• Cashless Treatment:

Employees at any of the network hospitals do not need to make upfront payments, which reduces the financial strain.

• Added Health Benefits:

Employers can also provide extra benefits such as regular health check-ups, OPD consultations, and mental health support for employee’s well-being.

• Pre and Post-Hospitalisation Coverage:

It also covers pre and post-hospitalization expenses, i.e. 30 days before hospitalization and 60 days after discharge.

Documents Required

• Original Detailed Discharge Summary

• The original final hospital bill includes a detailed cost-wise breakdown of all the components included.

• Original Payment Receipt

• Original Investigation reports and pharmacy bills, along with the doctor’s advice.

• Valid Photo ID of the patient and employee.

• The original invoice and sticker of the implant are required, if applicable.

• Hospital Registration certificate or declaration from the hospital mentioning the number of beds with facilities available, duly signed and stamped on the letterhead of the hospital.

• Cancelled cheque with the name printed on the insured or self-attested bank statement with IFSC code or copy of the front page of the passbook with beneficiary’s details.

In case of an Accident Claim:

• Copy of MLC/ FIR, if any. The treating doctor shall explain if it is not applicable.

• The doctor shall confirm that harmful substances were not a factor.

Steps to Get a Cashless Claim – Planned Hospitalisation

• Fill out the pre-authorisation form at least 48 hours in advance.

• TPA will now register the insurance claim and process the cashless claim within the next 2 hours.

• On the day of hospitalisation, you are required to provide your health card number along with your photo ID card.

• The insurance company will now disburse the amount at the time of discharge.

Steps to File a Reimbursement Claim – Unplanned Hospitalisation

• Inform your relationship manager within 24 hours of hospitalisation.

• Provide the claim form along with documents within 30 days of discharge.

• Provide all hard copies of bills, reports and discharge summaries.

• The claim will be approved by the insurer company once all relevant documents are verified.

• A cancelled cheque is to be provided to know the bank details.

• The insurance claim amount will be processed within the next 15-21 days of the details being provided.

Conclusion

Organisations should consider group health insurance policies to offer health-related benefits to their employees, enhancing retention and employee satisfaction. All kinds of businesses shall ensure their staff’s financial safety against medical expenses, further which promotes a productive environment.

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