Group Health Insurance

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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 not operational and therefore policyholders were not able to send claim documents to the respective insurer/TPA office. This gave rise to the e-claim process for group health insurance policies.


Electronic claim processing (commonly known as e-claims) was the answer insurer’s found to address this problem. They acted fast to implement self-service e-claims solutions to help policyholders submit and track their claims until they are settled.


To file an e-claim under a group health insurance policy, the policyholder needs to upload a scanned image of the claim documents over the e-claims module on the insurer/TPA website or mobile application. The list of claim documents required for reimbursement are –


  1. Claim form (part A and part B)
  2. Discharge summary
  3. Hospital bill with detailed cost breakup
  4. Payment receipts
  5. Medicine prescription and bills
  6. Laboratory test reports and bills
  7. Copy of the invoice/sticker/barcode in case of implants
  8. Patient’s ID proof
  9. Cancelled cheque/ NEFT details of the policyholder


Upon successful document upload, a unique claim reference no. is generated which is used for all future reference and tracking purposes. The process is extremely intuitive and hassle-free.


Filing claims electronically offers multiple benefits, including:


  1. Processing time – An e-claim under group health insurance policy is processed quickly, resulting in faster settlement time and payment to policyholders.


  1. Track status – You can check the status of your submitted claims at your convenience, any time during the day or night.


  1. Increase accuracy and reduce claim rejections – Paper claims are often rejected due to inaccuracies, omissions or lost documents. If claims are submitted electronically, it results in fewer lost or incomplete claims. Claims can also be checked for accuracy before asking policyholders for submitting an original copy of claim documents.


  1. Record keeping – Electronic claims help cut down on paperwork. It eliminates the need to store paper claims helping in streamlining billing procedures and simplifying record-keeping.


  1. Overhead costs and staff time – Submitting claims electronically reduces the clerical time and cost of processing, mailing, resubmitting and tracking the status of paper claims, freeing up the time of administrative staff to perform other important functions.

To know more about an e-claim and to find out how does it work under a group health insurance policy, visit or connect with us on Linkedin