The Indian health insurance market is witnessing a rise in demand for more comprehensive and customized health coverage plans. This has led to expansion in the private health insurance products available which has unveiled newer avenues of growth for the insurance industry. In the last ten years, it has grown at a CAGR of 23%, […]
Group Health Insurance
How does the e-claim process work for group health insurance policy?
Insurers required policyholders to submit original claim documents for processing reimbursement claims. Policyholders used to courier claim documents to insurers/ TPAs for processing. However, this has changed since the Covid-19 pandemic hit the world. It has brought down all transportation and logistics to a standstill due to government-imposed lockdown throughout the country. Courier services were […]
What kind of disease-wise capping can be put in GMC to manage price?
With disease-wise capping, an insurer can reduce claims out-go and hence its risk for the GMC. Though you can select the list of diseases and respective capping for a group policy insurers have pre-defined slabs of lower limits, default limits, and higher limits. Below is an illustration of these slabs – Lower Limits – […]
How can a maternity claim be shared between 2 group health insurance policies?
It is common for insurers to cover maternity-related expenses in a health insurance policy. However since maternity claims are frequent, insurers cover them for a restricted policy sub-limit which is commonly between INR 50K – INR 1L. The total expenses incurred in maternity far exceed the limit offered by insurers in an individual policy. Therefore […]
Filing a claim under group health insurance policy
The process for filing a claim under a group health insurance policy depends on the hospital and the type of treatment. Claiming health insurance in-network hospitals A network hospital is one that has a tie-up with an insurer. Members covered under group health insurance can get cashless hospitalization from network hospitals. This means that the […]
Claim process of Group Health Insurance – Infographic
Group health insurance offers protection to employees of an organisation against any medical emergencies by covering them for hospitalisation costs. Below infographic explains the claim filing process of group health insurance policy for cashless and reimbursement claims.
Claim Documents Checklist for Group Insurance Policies
Documentation plays a very important role when it comes claims. If we submit the correct documents on time, claims get settled without any hassle. For cashless facility, health insurance card and one identity proof needs to be submitted at TPA Desk in the hospital by patient. Then, Hospital needs to submit following documents to the […]
Subrogation and group health insurance
Subrogation and group health insurance Does your employer offer corporate health insurance? Has the term ‘subrogation’ come up in the context of this employee insurance scheme? If you would like to understand what it means and how it affects you, this post is for you. What is subrogation? Have you ever been accidentally injured, visited […]
Claiming reimbursement under a group health policy
Claiming reimbursement under a Group Health Policy If you are covered by a group health insurance plan, you might have to claim reimbursement for medical expenses if you go to a hospital that is non-empanelled (or not a network hospital). You cannot avail cashless hospitalisation at non-empanelled hospitals. Another reason for claiming reimbursement could be […]
Co-pay in group health insurance
Co-pay in group health insurance For many young establishments, the costs associated with group health insurance might be daunting. So, if you want to provide your employees the security of medical insurance without a considerable cost burden, you might want to consider co-pay. This post attempts to help you better understand co-pay in group mediclaim […]