Group Health Insurance for Healthcare Industry

Importance of Group Health Insurance for Healthcare Industry

The healthcare industry works for the welfare of the citizens, the employees working in this industry also deserves to get healthcare benefits such as group health insurance coverage. Since the healthcare industry workers would be aware of everything that could go wrong and turn out to become an expensive affair, group medical plan helps in taking off the burden of unexpected expenses.

Coverage under Group Medical Insurance for Healthcare Industry

Group medical insurance for healthcare industry provides coverage for the following:

• Doctor’s fee
• Consultation charges
• Pre-existing diseases
• Pre and post hospitalisation cover
• Room rent charges
• Maternity coverage
• Day care charges
• Domiciliary charges
• Financial coverage for x-rays, medicines, etc.
• Medical test expenses as specified in the policy
• New born baby is covered from the day of delivery
• Ambulance charges

Group Medical Cover for Healthcare Industry Does Not Cover

Group medical cover for healthcare industry does not provide coverage for the following:

• Ayurveda and Homeopathy treatments are not covered
• Diseases present in the body of the insured are not covered
• Any complication cause due to drug or alcohol abuse are not covered
• Several insurance companies do not provides coverage for the parents
• Charges incurred in treatment of AIDS or other related diseases are not covered

Group Medical Cover for Healthcare Industry: Claim Process

Follow the steps to raise cashless claim through Third-party Administrator:

• Go to the TPA desk in the hospital
• Fill the pre-authorisation form
• Third-party administrator get the pre-approval from insurance company
• Insurer settles the claim

Follow the steps below for re-imbursement claim:

• Tell the insurer within 24 hours of getting hospitalised
• Keep all the reports, bills and other documents handy
• Fill and submit claim form within 7 days of discharge
• Insurer will process the claim
• Provide cancelled cheque to process claim amount
• Insurer reimburse the claim amount within 15 days

Group Mediclaim Policy for Healthcare Industry: Documents Required

Keep the following documents handy to submit along with the claim form to raise the claim:

• Doctor’s prescriptions
• Claim Form
• FIR, if any
• Discharge summary with list of treatments
• Cash memo
• Any other document as per insurer’s requirement
• Final bill