What Documents Are Needed at the Time of Making a Claim for a Group Mediclaim Policy?

A group health insurance policy is also known as a corporate health insurance policy to provide coverage for people of a specific group like corporate employees against medical contingencies. This kind of medical insurance plan offers affordable coverage and is very easy to avail of. In case of medical emergency when a covered individual is hospitalized, a claim can easily be made under this insurance plan and it will provide coverage for the medical expenses incurred in case of hospitalization.

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For claiming a group medical insurance policy, the insurance provider has to be informed instantly about the claim. If the covered individual requires treatment at a hospital that is in the network hospital of the insurance provider, then cashless claim settlement is offered. However, if one goes for the treatment in a non-network hospital, then he/she has to opt for reimbursement of the claim. So, in the reimbursement process of claim settlement, one has to pay the medical expenses from his/her pocket, and then the medical insurance plan would reimburse all the cost that is incurred.

However, despite the claim settlement process, reimbursement or cashless, the insurance provider generally needs a specific set of documents to process the claim. These documents are:

List of Documents Needed When Making A Claim Under Group Health Insurance Policy:

  • The first and foremost requirement is the claim form. The claim form has to be duly filled with all the details of the claimant and the insurance policy.
  • For availing of the cashless treatment, the insured employee has to fill a pre-authorization form and submit it to the insurer. The insurance company approves the claim only when this form is submitted. This pre-authorization form has to be submitted to the insurance company at least three to four days before the hospitalization only when one is going for planned treatment. However, when one is going for emergency hospitalization, then the form has to be submitted with all the details at least within 24 hours of the hospitalization. If the insured is going for medical treatment in a non-network hospital, then he/she is qualified for claim reimbursement, and in this case, the pre-authorization form is not needed.
  • The original medical bills related to the medical treatment that is taken by the policyholder has to be submitted to the insurance provider.
  • All the medical reports of the policyholder are also needed to get to know the reason for illness and the medical treatment that is taken after that.
  • The original medical bills related to the treatment that is taken by the policyholder has to be submitted to the insurance provider.
  • The prescription of the doctor who was consulted for the illness or treatment is needed.
  • The bill of the hospital has to be submitted in original that should show the break-up details of different costs incurred for treatment.
  • In the case of hospitalization due to an accident, a police FIR has to be filed and the same has to be submitted to the insurance provider.
  • The bill of the hospital has to be submitted in original that should have the detailed break-up of all the incurred treatment cost.
  • If there are any cash memos of the treatment, then that has to be submitted.
  • The discharge summary provided by the hospital after the discharge of the insured is also needed in case of claim reimbursement.

With all these documents, the insurance provider may also need other documents as well as per the claim. All the required documents have to be duly submitted to the insurance provider so that the claim is easily and quickly processed and settled.

The Final Words!

Providing these documents can make the claim settlement process easy and quick. The time taken in settling the claim varies with the insurance provider. However, if the documents for claim settlement are as per the requirement of the insurer, then chances of claim settlement within time are high.  

Written By: PolicyBazaar - Updated: 26 August 2021
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