Group health insurance is a valuable benefit provided by employers or organisations to their employees or a group of individuals. This policy typically offers cashless treatment at network hospitals or the option to file for reimbursement. If you need to file a reimbursement claim, it is important to follow the correct steps to ensure you receive the reimbursement you are entitled to. In this blog, we will guide you through the process.
Process of reimbursement claim in group health insurance
If you are covered under group health insurance, you can file two types of claims – cashless and reimbursement. If you receive treatment at a network hospital, you can file a cashless claim, meaning the insurer settles the bill directly with the hospital. However, if you choose a non-network hospital, you can file a reimbursement claim to get back the costs of your medical treatment.
A reimbursement claim in health insurance is when you pay your hospital bills first, and then submit the necessary documents to your insurance company to get reimbursed based on what is covered in your policy. You will need to submit all your bills, receipts and any required paperwork to the insurer, and once they review everything, they will reimburse you for the eligible expenses.
The following are the steps to file a reimbursement claim in group health insurance:
- Notify the insurer or TPA: Inform the insurance company or Third-Party Administrator (TPA) about your hospitalisation and treatment either 72 hours before hospitalisation or within 24-48 hours of admission. The notification timeline may vary from insurer to insurer, so it is important to check your policy documents for specific details.
- File a claim: After notifying the insurer or TPA, you will need to file a claim for reimbursement. This usually involves completing a group insurance claim form provided by the insurer or TPA. Remember to collect the claim number after filing, as this will be your reference for tracking the status of your claim.
- Get treated: You can choose any hospital for your treatment. However, make sure you fill out the group medical claim form provided by the hospital during admission or at the time of treatment. This form is a key part of the reimbursement process.
- Collect your treatment bills and receipts: After treatment, collect all the bills, invoices and receipts related to your hospitalisation. This includes doctor’s fees, hospital room charges, tests, medications and any other relevant expenses. The insurer or TPA will need these to assess your claim.
- Submit the necessary documents: Along with the completed claim form, submit all the required documents to the insurer or TPA.
- Claim review and approval: Once your claim is submitted, the insurer or TPA will review the documents and evaluate the treatment bills. They might contact you for additional documents or information if something is missing or unclear.
- Reimbursement: After the claim is reviewed and accepted, the insurer or TPA will approve the reimbursement. The approved amount will be credited directly to your bank account. This usually happens within a few weeks, depending on the insurer's process.
Documents required for group insurance claim
While filing a claim, you must submit the following reimbursement claim documents to the insurance company:
- Group insurance claim form duly filled and signed
- Your employee health insurance card
- A certificate from the doctor treating you
- All doctor and hospital reports related to the treatment
- All hospital bills, pharmacy receipts and any other proof of payment for the treatment
- A discharge card from the hospital
Conclusion
A reimbursement claim in group health insurance is a simple process where you pay for your medical treatment upfront and then file a claim with the insurer to get reimbursed. Whether you are filing group health claims for a network or non-network hospital, it is important to follow all the necessary steps to ensure a smooth process. With group insurance, you get the financial support you need for your treatment, making healthcare more affordable and accessible.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure / policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.