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How to claim health insurance from your employer?

The insured should try to get treatment in a network hospital. At the same time, the insured's family members should provide details of health insurance policy and the TPA e-card to the hospital.Premium
The insured should try to get treatment in a network hospital. At the same time, the insured's family members should provide details of health insurance policy and the TPA e-card to the hospital.

  • Always read the policy document thoroughly when purchasing any policy, not just medical insurance. Corporate health insurance policies frequently include restrictions, such as co-pay clauses and room-rent limitations

NEW DELHI: Amid the pandemic, many companies have rolled out suitable group health insurance policies for their employees. While most employers cover employees under group health insurance, there are a few formalities and profiles to be completed before the insurance kicks in. If not filled in time or correctly, the employer may not pay the claim in time of need. Hence, to make things easier, you must follow these four steps before filing for a group health insurance claim.

1. Update your family's profile: The first thing you should do after receiving your employee ID is to update your family's information on the company's portal. Raghuveer Malik, head- corporate business, Policybazaar.com, said, "You will not make claims if you have not entered the necessary information into the insurance portal. Prioritise this step."

2. Get an E-card: The employer will give you a third-party administrator (TPA) card once your health insurance policy is issued. If you intend to use a cashless facility at a hospital, this card will come in handy. Also, remember to bring your employer's E-card because if you misplace or forget your physical copy of your TPA card while in the hospital, you can always submit the e-card. You must also submit an ID proof in addition to the E-card.

3. Understand the benefits: Always read the policy document thoroughly when purchasing any policy, not just medical insurance. To avoid last-minute difficulties, you should first learn what is covered and what is not. "Corporate health insurance policies frequently include restrictions, such as co-pay clauses and room-rent limitations," said Malik.

4. List of network hospitals: Generally, insurance companies have an agreement with a select group of hospitals to provide cashless services to their customers. These hospitals are referred to as empanelled network hospitals. While reading the policy document, make a list of these hospitals.

How to file a claim

The insured should try to get treatment in a network hospital. At the same time, the insured's family members should provide details of health insurance policy and the TPA e-card to the hospital.

Sanjiv Bajaj, joint chairman and managing director, Bajaj Capital, said, "Your family should be well-versed in the office's healthcare policy. Keep them up to date on all of the lists you have created and keep the policy documents in an easily accessible location."

Once you get discharged from network hospital, all expenses related to medical bills are sent to insurance provider or TPA by the hospital. The TPA then evaluates the costs and gets the claim settled by the insurer.

Bajaj said, "In the case of employer insurance, you should inform the dedicated help-desk of employer or TPA who can help you on the claim process, approval and settlement altogether."

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