One of the principal reasons for companies and employers to invest in group or employee health insurance is to offer an additional perk and a sense of security to valuable employees. This is seen to be a prudent investment aimed at improving employee morale and hence productivity. It is a very effective way in which to retain valuable talent within the organization and to attract new talent to the organization. Buying group health insurance is largely a simple, online process and is so by companies looking to make it easier for more people to buy group insurance. Here is what you need to get you started:
Find out more group health insurance and choose wisely
It is possible to buy the amount and the type of group health insurance that your organization requires in terms of features, coverage and premium payable. Employers can also decide whether they want to offer insurance, only for the individual employee or for their family; in the latter case, employees can be asked to contribute a portion of the premium amount in order to secure the health of their families. The documents required may vary accordingly from plan to plan.
Choose the right health insurance provider to buy group plans: look for a company with a good record and customer service, an insurance provider who is willing and able to tailor a plan to your requirements. It is also important to look for features such as graded cover (to cover different grades of employees) and functionality to easily add and delete employee records on the policy books in an efficient and streamlined fashion.
A well thought out employee insurance plan
can help employers save money, increase productivity and lose less money by way of sick leave and workers’ compensation. Add riders or additional coverage features depending upon the nature of work employees engage in, their average age (which helps decide whether critical cover is necessary), gender ratio (to decide whether or not maternity benefit is a key inclusion), income, standard of living etc.
Documents required for buying group health insurance
Health insurance providers offer the option of standard group health insurance or the option of creating a plan tailored to your requirements. The required documents could vary based on the insurance service provider’s rules and regulations, the number of people covered by the policy, the size of the organization and the nature of work (whether hazardous processes or substances are involved), whether accidental death cover is opted for and based on the age range of employees.
Most insurance providers do not require much in the way of documentation to issue a group health policy. Once a plan is chosen and customized as per requirements, the policy buyer should thoroughly read and check the terms and conditions of the policy document and then fill out the application form with all required details accurately and precisely filled in.
In most cases, when the insured individuals are below the age of 50, medical checkups are not required. Details about the covered individuals, their age and ID proof, details about their employment may need to be submitted along with the form. However, this also may vary from plan to plan and from one to another insurance provider and another.
In any event, the insurance company will typically require the policyholder to make certain declarations about the health and wellbeing of the covered individuals and to declare any material details about their health such as relevant medical history, preexisting diseases if any. The failure to make full disclosure of all pertinent could mean problems with the claims process.
Documents required for making group health insurance claims
While insurance companies require few documents at the time of creating and selling a group health insurance policy, set procedures have to be followed and requisite documents must be submitted at the time of making claims:
- A preauthorization form, duly completed, would be required at the time of being admitted to a hospital for a cashless claim. The claim acknowledgement number and the claim form with important details such as the employee code would have to be submitted.
- If an employee health insurance card is issued by the insurance provider, the same would have to be presented at the time of seeking hospital admission
- Intimation of such admission is required to be given to the health insurance company or to the TPA (Third Party Administrator) in the manner and within the specified time as required by the terms of the insurance policy. For planned hospitalization, advance notice is usually required; for emergency admissions, notice has to be given within a specified timeframe (usually within 24 hours).
- ID proof and possibly proof of employment would be other required documents for group health insurance claims.
- While for cashless claims the hospital would directly send documents to the TPA or insurance company, in the event of receiving treatment at non-network hospitals, the employee would need to keep track of and submit all original documents. These would be: duly completed claim form, doctor's report, medical bills, investigation reports like lab tests, X-rays and reports for establishing existence of the injury. Discharge summary with the final bill and detailed breakup would also be required.
- For accidental death claims, documents such as the police report, death certificate, postmortem report and other relevant documents would have to be submitted where necessary and applicable.
The policyholder company /employees can ensure a smooth purchase and claims procedure by ensuring that all required documents are accurate and complete in all respects and that they are submitted as and when required.