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HomeHealth"The Vitals of Group Health Insurance: What You Need to Know"

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

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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:

Group health insurance 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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Tycoonstory
Tycoonstoryhttps://www.tycoonstory.com/
Sameer is a writer, entrepreneur and investor. He is passionate about inspiring entrepreneurs and women in business, telling great startup stories, providing readers with actionable insights on startup fundraising, startup marketing and startup non-obviousnesses and generally ranting on things that he thinks should be ranting about all while hoping to impress upon them to bet on themselves (as entrepreneurs) and bet on others (as investors or potential board members or executives or managers) who are really betting on themselves but need the motivation of someone else’s endorsement to get there.
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