Importance of Group Health Insurance for Pharmaceutical Industry

Covering your employees under a group health insurance plan in the pharmaceutical company plays an important role. The insurance plan not only help the employees get financial coverage as well as help the employer retain employees and reflect goodwill among them. Hence providing group medical plan to the employees become necessary.

Coverage under Group Health Insurance for Pharmaceutical Industry

Group medical insurance for Pharmaceutical firm provides coverage for the following:

• Doctor’s fees
• Consultations charges
• Covers pre-existing diseases
• Pre and post hospitalisation charges
• Room rent charges
• Maternity coverage
• Employee’s new born baby is covered from the day of delivery
• Domiciliary charges
• Day care charges
• Medical tests such as radiotherapy, chemotherapy, etc. are covered
• Financial coverage for medicines, x-rays, etc.
• Ambulance charges

Group Medical Insurance Does not Cover

Group medical insurance does not provide coverage for the following:

• Homeopathy and Ayurveda treatments
• Expenses incurred in treatment of AIDS or any other related illnesses
• Complications arising because of drug or alcohol abuse
• Several insurance companies do not provide coverage for the parents
• Diseases present since the birth of the employees

Group Mediclaim for Pharmaceutical Industry: Claim Process

Follow the steps given below to raise cashless claim through TPA:

• Reach out to the TPA desk in the hospital
• Ask for pre-authorisation form and fill it in
• TPA gets the pre-approval from insurance company
• Insurer then settles the claim

Follow the below mentioned steps for re-imbursement

• Inform insurer within 24 hours of getting hospitalised
• Collect all the bills, reports and other required documents
• Submit claim form within 7 days of discharge with all the required documents attached
• Insurer will process the claim after cross checking the documents
• The amount gets reimbursed within 7 working days

Group Medical Cover for Pharmaceutical Firm: Required Documents

You need to submit the following documents along with the claim form to raise the claim:

• Claim form
• Cash memo
• Discharge summary
• Doctor’s prescription
• Any other documents as per insurer’s request
• FIR, if any
• Final bill