Articles Tagged: Group Health Insurance

Group Health Insurance Policy

Customize employee group health insurance policy to your budget and requirements. For example, the inclusion of parents, spouses, or up to 3 children.

Factors like the number of employees in the organization, the average age of employees, the overall health of the group, etc. determine the relevance and cost of group health insurance policy. Hence, it is important to consider the overall health of your employees and their average age while picking a group medical insurance plan.

Group Health Insurance – Premium and Advantages

Group medical insurance costs a significant amount of money for an employer. Hence, you should think about affordable insurance plans that can offer extensive coverage and important features to your employees. You can also include add-on benefits after careful analysis of the policy’s cost and benefits.

Additional Read: What are the advantages and disadvantages of a group-based indemnity policy?

Following are the key points in policy design:

1. Cashless network hospital list
2. Sum Insured
3. Room-Rent (Normal/ ICU)
4. Maternity
5. Baby Day One Cover
6. Disease-wise capping
7. Co-payment

To make a claim under a group mediclaim policy, the insured needs to inform the insurance company immediately about the claim. If the member has sought treatment at a network hospital, the claims settlement will be done on a cashless basis. However, if the member is admitted to a non-network hospital for treatments, claims will be settled on a reimbursement basis. In a reimbursement claim, the insured needs to pay for the medical expenses, and then the mediclaim policy would reimburse the costs incurred. 

Group Health Insurance – Claims

Whether the claim is cashless or settled on a reimbursement basis, the insurance company usually requires a set of documents for processing the claim. These documents include the following –

• It is important to state the complete details of the insured member and the policy while filling the claim form. 
• To avail of cashless treatments, the employee should fill up a pre-authorization form and submit it to the insurance company.
• It is important to submit the original medical bills associated with the treatment taken by the insured to the insurance company.
• All the investigative reports of the insured are required to assess the cause of illness and the treatments taken thereof.
• A doctor’s prescription is necessary
• It is necessary to submit the hospital bill in original which should show the detailed break-up of the different costs incurred on treatments.
• In case of accidental hospitalization, the insured needs to submit a police FIR to the insurance company
• The cash memos of medical costs 
• In case of reimbursement claims, the insured needs to submit the Discharge Summary issued by the hospital.

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