How Does the E-Claim Process Work for Group Health Insurance?

The insured is required to submit the original documents along with the claim form to the insurer to settle the claim. The policyholder is expected to send such documents via courier. However, such services were put on halt due to the advent of the Covid-19 pandemic. The pandemic hit the world which urged the government to impose lockdown. Such steps of the government gave rise to e-claim process under group health insurance.

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E-Claim under Group Health Insurance

Due to the lockdown, the courier services were not operational. Hence, the policyholder was not able to send the original documents to the insurer. At the time, several insured wished to settle their claim. Therefore, the insurance company was compelled to come to a conclusion in order to avoid such issues faced by people.

The insurance provider found a solution and gave recognition to e-claim process under group health insurance. The companies took this decision quickly in order to provide ease and relief to the public. As a result, the self-service e-claims came into force in order to help the policyholder to submit their documents via electronic means. Further, e-claim process under group health insurance enables the user to track the record of their claim until settled by the insurance companies.

Group Mediclaim Process

The users under the e-claim process are required to upload scanned documents or images on the e-claim module of the insurance companies. They are required to submit the following documents in order to file the claim.

  1. Claim Form

    The claim form comprises two parts. The insured may download the form from the official website of the insurance company. He may fill in both parts and scan them in order to upload them.

  2. Discharge Summary

    The hospital provides a discharge summary to the patient which includes important information about the disease. The insured must scan the document in order to upload and file the claim. 

  3. Hospital Bill

    The hospital provides a detailed bill to the insured. It comprises all the expenses incurred by the patient in order to obtain the treatment. The insured must scan the hospital bill and upload it to the e-claim module.

  4. Payment of Receipts

    The insured must produce the payment of receipts incurred in the hospitalisation. 

  5. Medicine Prescriptions

    The insured must provide the details of the medicine he was prescribed by the doctors. 

  6. Laboratory Test Reports

    In case of a laboratory test, he must produce the result of the reports to the insurance company.

  7. Copy of Invoice

    In the case of implants, the insured must share a copy of the invoice for such implants.

  8. ID Proof

    The insured is required to provide his ID proof to the insurance company. 

  9. Cancelled Cheque

    The cancelled cheque or the NEFT details is required to provide in order to receive the payment.

Benefits of E-Claim Process under Group Health Insurance

The hassle-free process highlighted the following benefits to the insurer and the insured. 

  1. Processing Time

    The processing time of the claim was reduced. Earlier, the policyholders were required to send the document via courier. However, the e-claim process enables them to scan the document and send it directly to the insurance company. Hence, it reduced the processing time and made the settlement claim easy. 

  2. Track Status

    With the advent of the e-claim process, the policyholder can check the status of the claim they have submitted. The status of the claim is available 24 hours. Therefore, they may check it at their convenience. 

  3. Accuracy

    The e-claim process increases the accuracy of group insurance schemes claim. This resulted in a reduction in the rejection of claims by the insurance company. This led to a reduction in lawsuits.

Conclusion

With the advent of e claim under group insurance, it becomes convenient for companies to keep a record of the claims and data of users. In addition, it simplified the whole process and reduced the overhead cost and time of the insurer and insured.

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Written By: PolicyBazaar - Updated: 18 April 2023

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3.8 April 09, 2023
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4.3 February 04, 2023
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Prompt Services
Policybazaar's efficient claims process was impressive. In case of any medical emergencies, my employees were able to get their claims settled swiftly, allowing them to focus on their health and recovery without worrying about financial aspects.Thankyou
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Budget Friendly Purchase
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Delhi
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Multiple Range Of Benefits
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Pune