Employee health insurance is a type of health insurance to covers the hospitalization expenses of the employees of an organization. Employee health insurance is also known as group health insurance. Let us understand the procedure to file a health insurance claim under the group health insurance policy.
Cashless Claim:- Cashless claim settlement is the type of claim settlement in which the insured need not pay any amount to the hospital as the claim amount would be paid to the hospital directly by the insurance company. Below is the process to file a cashless group health insurance.
Step 1: The first step in the cashless claim settlement process is to check the list of network hospitals in your area. If there is a specific hospital in which you want to take the treatment, then the same should be checked from the cashless network hospital list on the insurance website. If your preferred hospital is on the network list, then you can avail the cashless facility in the same hospital.
Step 2: The next step is to approach the insurance help desk in the hospital and provide your health card and insurance policy in addition to the KYC documents to process the claim. If the surgery is pre planned, then it is recommended to approach the hospital 24 hours prior to the surgery. In case of emergency, the patient would be admitted to the hospital and the cashless approval would be taken from the insurance company. The insurance help desk would take care of all the insurance related approvals.
Step 3: The third step in this process is to undergo the treatment in the network hospital and get discharged from the hospital. The discharge would be done only after receiving the claim approval from the insurance company. If there is any amount to be borne by the insured such as Co-pay or other charges, then that should be settled directly with the hospital before the discharge.
Reimbursement Claim:- The reimbursement claim is where the insured would pay the hospital bill and then claim the same from the insurance company.
Step 1: The first step in the reimbursement claim settlement process is to get admitted in a non network hospital where there is no cashless claim settlement facility and get the treatment done. An intimation should be given to the insurance company regarding the hospitalization so that the claim intimation would be acknowledged by the insurance company.
Step 2: The second step is to get treated in the hospital and then collect all the required documents such as discharge summary, cancel cheque leaf, original bills, etc. The reimbursement claim settlement form should be duly filled and signed to be sent to the insurance company.
Step 3: The third step is to send the complete claim related documents as mentioned by the insurance company. The claim would be settled within 15 working days after receiving the complete set of documents.
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