A quick guide on group health insurance for your employees

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A quick guide on group health insurance for your employees should contain the following information:

1. Hospitalization expenses: The hospitalization expenses such as In patient hospitalization expenses, outpatient expenses, OPD expenses, Organ donor expenses, Room rent, ICU charges, Alternative treatment expenses, Domiciliary treatment expenses along with their respective sum insured limits should be given to the employees who opt for group health insurance policy. The hospitalization expenses and the procedure to avail them and the difference between each of them should be clearly mentioned to the employees.

2. Sum insured: The other thing is the sum insured or the coverage available under the group health insurance policy. The coverage can either be floater or non floater depending on the option exercised by the insured customer. In case of floater sum insured the sum insured would float among the members insured under the policy. The sum insured should be clearly mentioned to the employees in case of group health insurance policy as the employees would plan their healthcare expenses based on the sum insured.

3. Network hospitals: A list of all the network hospitals should be shared with the employees for the group health insurance policy. In case of emergency the insured should give intimation to the insurance company regarding the hospitalization within 24 hours of admission whereas the intimation should be done by 48 hours in case of planned hospitalization. The network hospital list can be shared city wise or pincode wise and the employees can decide which hospital to visit in case of hospitalization.

4. Claim procedure: The claim procedure should be clearly mentioned to the employees as a part of the quick guide on group health insurance. The claim can be either on a cashless basis or on reimbursement basis. The list of contact numbers to be contacted in case of claim should be mentioned clearly in the quick guide to health insurance.

5. Exclusions: All the exclusions mentioned under the group health insurance policy should be intimated to the employees. Exclusions should be clear and prevent any ambiguity on the part of the employees at the time of claim settlement. There can be certain exclusions such as pre-existing waiting period, specific disease waiting period, initial waiting period, disease wise capping or certain diseases exclusions etc.

6. Addition or deletion of family members: The process of addition and deletion of family members or employees should be mentioned clearly in the quick guide of group health insurance policy. Additions and deletions can be done at any time during the policy period subject to additions happening only due to certain events happening such as marriage or child birth whereas deletions may happen due to employees leaving the organization or death of the employees. The addition and deletion of employees should be intimated to the insurance company within 15 days of the occurrence of the event. The policy period and the health cards availability should also be intimated to all the employees so that they can download the health cards and use them in case of hospitalization.