5 Important Things to Know About Employee Health Insurance Policy

Employee health insurance, also known as group health insurance, is an insurance policy that offers financial coverage to the employees of a company.

This type of health insurance is purchased by the employer for their employees so that the employees can get financial benefits in case of medical emergencies.

While it is true that it consumes a part of employees’ resources, it brings valuable returns to the company in the form of better productivity and higher tax deductions.

If you are planning to buy an employee health insurance policy or if you are already a part of such a policy provided by your employer, here are the 5 most important things that you should be aware of to make the most out of it.

1. Coverage

An employee health insurance plan covers the insured for a range of health-related issues, even for pre-existing conditions.

To give you a more straightforward explanation, here are the common expenses for which you can get compensation under a medical insurance policy for employees:

• Pre-hospitalisation Expenses

• Post-hospitalisation Expenses

• Inpatient Care Expenses

• Daycare Treatment Expenses

• Domiciliary Treatment

• Maternity Cover

• Ambulance Cover

• Organ Transplant and more

2. Smooth Claim Process

Filing a claim for the best group health insurance policy is an easy and straightforward process. When raising a claim, you can either go for reimbursement or a cashless claim. The process you need to follow for both of these claim settlement methods is as follows:

-For Reimbursement:

• Inform your insurance company before 48 hours of hospitalisation for planned treatments and within 48 hours after hospitalisation in case of an emergency.

• At the time of discharge, pay the medical bills and remember to collect the receipts and claim form from the hospital.

• Fill out the claim form and submit it along with the required documents like hospital bills, discharge summaries, prescriptions, diagnostic reports and wait until the insurer reviews them, as he may ask for any additional documents if needed.

• Once reviewed, the insurer will notify you whether the claim was approved or rejected.

• Upon approval, you will get your compensation amount in your account within a few days.

-For Cashless Claim:

Inform your insurer 48 hours prior to getting admitted to the hospital for a scheduled treatment and 48 hours within your hospital admission for an emergency treatment.

• When getting admitted, submit your health card given by the insurer to the hospital authorities.

• On submission of this card, the hospital will provide you with the claim form.

• Fill out the claim form with all treatment-related details and give it back to the hospital official.

• The hospital will send this claim form to the insurer so that he can review it and approve or reject it based on its accuracy.

• On approval, your insurer will directly settle the claim with the hospital.

3. Eligibility Criteria

There are a few stipulations associated with the purchase of an employee health insurance plan, such as:

• The minimum number of members in the policy should meet the insurer’s requirement.

• The members of the group must have come together for a common economic activity. They may have an employee-employer or a non-employer-employee relationship, but the groups should not have been formed only to get health insurance benefits.

• So, before buying a group mediclaim policy, ensure that your group meets these conditions.

4. Family Cover

This is the best benefit of group mediclaim policy. Under this, employees covered under a group health insurance policy can also add their family members to the policy, per the policy terms.

The family cover in employee health insurance provides the same financial benefits to the family of the members and helps the insured stay stress-free.

5. Exclusions of the Policy

An employee health insurance plan has multiple advantages and uses, but it also has some exclusions. You must read your policy thoroughly before signing the contract to remain aware of what situations will not be covered under the plan.

Some of the most common exclusions of employee health insurance are:

• Health problems arising from addictions, like alcohol, drugs, etc.

• Cosmetic surgeries

• Gender change surgeries

• Injuries caused due to adventurous activities

• Sterility and infertility treatment, etc.

Employee health insurance is one of the most essential types of business insurance in India. It not only enhances employee morale and loyalty but also helps businesses fulfil their corporate social responsibility and build a better brand image.

Knowing the essentials of a group health insurance plan can help you choose the best option available and make the most out of your policy.

At Tata AIG, we offer extensive financial coverage under our group mediclaim policies at affordable costs. Our group mediclaim policies offer coverage from day 1 and allow mid-term addition of dependents in your family.

What are the top 5 benefits of health insurance?

The top five benefits of health insurance include financial protection against health emergencies, tax deductions, added peace of mind, coverage for pre-existing diseases, and a cashless claim facility.

What is the full form of TPA?

TPA stands for Third-Party Administrator, and this individual acts as an intermediary between the insured and the insurance company.