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Things to Remember while claiming Health Insurance Cover from your Employer
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Things to Remember while claiming Health Insurance Cover from your Employer

Sarvesh (31-years-old) works in an eminent corporate conglomerate as an admin manager. Sarvesh has been working with his present organization for the last 3 years. When he joined, the company offered him corporate (employer) group health insurance of Rs. 4 lakh to cover Sarvesh and his wife (as a dependent member of the employee). This health policy offers coverage for all basic healthcare requirements of both. Now, Sarvesh’s wife is suffering from some kidney issues that need an immediate operation. Sarvesh wants to claim from his employer for his wife’s treatment and healthcare expenses. However, Sarvesh should remember certain things so that his claim won’t get rejected at any cost.

Let’s take a look at 5 important things that people like Sarvesh should consider while making a claim from the employer. But before that, let’s consider what medical insurance from an employer is?

An employer group health plan is an employee welfare benefit plan that employers offer to their employees. This type of plan provides medical care to employees and their dependents directly or through insurance, reimbursement, or otherwise.

How Does Corporate Health Insurance Work?

Generally, this type of health insurance plan welcomes employees with a fixed sum insured amount that will compensate for the cost of hospitalization in the case of a healthcare emergency or accident. The hospitalization should be for more than 24 hours. If you want to enhance the sum insured amount, then you need to pay an additional premium.

Can your Employer see your Health Insurance Claims?

Yes, employers can see and monitor corporate group health insurance utilization by employees. Your employer is free to see the reimbursement amount of claims being charged against its group health insurance plan. Medical claim companies can share both cumulative charges for the whole workforce as well as claims per employee to employers.

5 things to consider while making a health insurance claim from the employer

An employee needs to update profiles and a chunk of formalities before the group health insurance plan takes effect. If you didn’t fill it on time or properly, your claim may get rejected in case of healthcare contingency. To make your claim process simple and convenient, you must remember 5 things when joining your new job. First, always keep updated with the terms and conditions of the corporate group health policy.

Top Things to Keep in Mind While Making a Health Claim

1. Update all personal information about your family

After getting your employee ID, you need to update your family’s details on the insurance portal of the company on an immediate basis. If you didn’t fill in this information properly on the insurance portal, you or your dependent members can’t raise any claims. So, complete this step on a priority basis to avail yourself of corporate group health insurance policy benefits.

2. Get an E-card

Once your group health insurance policy is issued, you will get a TPA (third-party administrator) card. This card is beneficial if you opt for a cashless treatment facility at a network hospital. Don’t forget to take an e-card from your employer. If you mislay or forget the physical copy of your TPA card at the time of hospitalization, you may submit the e-card. You also need to submit your Id proof along with the e-card at the time of hospitalization.

3. Know your Benefits

Always go through the policy documents carefully before making any commitment. Don’t proceed without reading the documents thoroughly. From day one, you should have adequate knowledge of what is covered and what is not. This will help you to know when you shouldn’t raise a claim to avoid the pain of rejection. Corporate health insurance policies often include some restrictions like copay clauses, room-rent limitations, etc.

4. List network Hospitals

Usually, health insurance companies are partnered with some selected hospitals where the insured person can get cashless facilities. These hospitals are called impaneled hospitals or network hospitals. You should prepare a list of these hospitals while going through the policy document. This will help you know what your nearby impaneled hospitals are so that you don’t need to face any problem at the time of contingency.

5. Keep Your Family in Loop

If you need hospitalization for any treatment, your family members should be informed to initiate the claim process. Your family should be well-informed about the group health policy that your employer offers. You must inform them regarding any communication and keep them in the loop of all the lists that you have prepared. Keep your policy documents in such a place that they can be easily accessible by all family members. Don’t forget to create digital copies of all the relevant policy documents so that if anything gets misplaced, you can manage with e-copies. Mail the digital copy to every family member so that they can show them whenever needed.

How to Claim Group Insurance?

The insured employee should choose a network hospital for the treatment. At the same time, the family members of the insured employee must submit all the details of the health insurance policy along with the TPA e-card to the hospital.

Your family members should be updated with your policy details. After getting discharged from the network hospital, your hospital will submit all healthcare expenses, including medical bills to the insurance provider or TPA. The TPA first analyses the costs of the treatment and settles your claim. A dedicated TPA manager will handle your claim process, approval, and settlement so that you can enjoy a hassle-free claim settlement process.

This article gave you enough info about corporate group health insurance, how it works, and what things you need to remember to initiate a claim from your employer.

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