Claiming Group Medical Cover (GMC) For Employers

Employers remain the biggest group to subscribe to Group Mediclaim policies. The benefits of Group Mediclaim policies are that they provide protection to the employees of an organization and can be   claimed when necessary. Employers can pay premiums on behalf of their employees, and can later claim tax deductions under Section 36 (1) (i ) (ib) of the Income Tax Act. Claiming group medical cover is easy, and following are the steps employers should follow –

Informing the Insurance Company. This is where the company provides a list of network hospitals, wherein cashless claims can be made. If the employee has already chosen a non-network hospital, the employer can them make a reimbursement claim.

A claim form is to be filled and submitted to the Insurance Company. Filling up a pre-authorization form is mandatory for cashless claims. In addition to the forms, the following documents of the beneficiary employee are also required:

  • Doctor’s prescriptions
  • Investigative reports
  • Medical bills associated with hospitalization
  • Hospital bill with a detailed break up of medical expenses
  • Cash memos
  • Discharge certificate issued by the hospital
  • A police report if hospitalization is due to an accident
  • Any other document which the insurance company needs

Here are a few notes to keep in mind:

For pre-planned medical treatments, the forms need to be submitted 3-4 days in advance; while the rules have been relaxed in the case of emergencies, allowing the member to submit the form within 24 hours of hospitalization.

The insurance firm directly takes it up with the network hospital being used In cases of cashless claims.  However, for reimbursement claims, the insurance company settles the costs as per the insurance coverage amount, after is it has been paid for by the policy holder.

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