Group Health Insurance for Insurance Industry

Importance of Group Health Insurance for Insurance Industry

Since the employees working in this industry knows the importance of staying covered under a group health plan, it becomes necessary for the employer to provide them sufficient coverage so that they do not have to bear the extra load of expense coming out of unexpected illnesses or injuries.

Coverage under Group Mediclaim Insurance for Insurance Industry

Group mediclaim insurance for insurance industry provides coverage for the following:

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

Group Mediclaim Insurance for Insurance Industry does not Cover

Group mediclaim insurance for insurance industry does not provide coverage for the following:

• Any complication caused because of drug abuse or alcohol abuse are not covered
• Ayurveda treatment or homeopathy treatments are not covered
• Diseases that are present in the body since birth are not covered
• Some of the insurers do not provide coverage to the parents of the insured
• Charges coming out of the treatment of AIDS and other similar diseases are not covered

Group Medical Insurance for Insurance Industry: Claiming Process

Follow below menitoned steps to raise cashless claim through 3rd party administrator:

• Reach out to the TPA’s desk in hospital
• Fill the form for pre-authorisation
• 3rd party administrator gets the pre-approval from insurance company
• Insurance company will settle the claim

For re-imbursement claiming:

• Tell the insurance company within 24 hours of getting admitted
• Keep all reports handy
• Fill in and submit the claim form with all the required documents within 7 days of discharge
• Insurance company will process the claim
• Cancelled cheque to be provided to get the claim amount processed
• Insurance company will reimburse the amount within 15 days

Group Mediclaim Insurance for Insurance Industry: Documents Required

Keep the below mentioned documents ready to submit with the claim from to raise the claim:

• Doctor’s prescription
• Medical test reports
• Discharge summary with list of treatments
• Medicine and drugs bill
• FIR, if any
• Cash memo
• Document required by insurer
• Final bill