Group health insurance or employee benefit plans are a type of health insurance plans in which the employer would pay the premium on behalf of the employees and the health insurance coverage would be enjoyed by the employees. Employers usually provide group health insurance as a part of employee benefits. There are other employee benefits which are provided to the employees such as Provident fund, pension schemes etc.
Let us understand how the group health insurance policies and employee benefit plans work in India:-
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Saturday 28 Dec. 2024
Step 1:-The first step is the employer would call for the quotes for the group health insurance policy from different insurance companies directly or through an insurance intermediary such as agents or insurance broker. The employee data and other coverage requirements would be provided to the insurance companies to work on the quotations and the premium to be paid by the employer. The insurance brokers would get the quotes from almost all the insurance companies which provide quotes matching the requirements of the customer.
Step 2:-The next step is for the customer to compare the quotes from different insurance companies and finalize the best quotes after discussion with the insurance broker. If an insurance broker is engaged as your insurance partner, then the premium negotiation would be done by the insurance broker with the insurance companies on your behalf. The insurance broker would negotiate to bring down the premium so that it is acceptable to the customer.
Step 3:-Once the premium is finalized the next step is to pay the premium and purchase the group health insurance policy. After the purchase, the insurance company would provide health cards to all the members of the group health insurance policy. These health cards contain the details of the members such as member ID, date of birth and other basic details. The health cards are required at the time of claim settlement in particular to cashless claim settlement as the approval for cashless basis would be given by providing the health card at the hospital.
Step 4:-The next step in the process is to approach the insurance desk at the hospital to avail the cashless facility as they will be intimating the insurance company and getting necessary approvals. Once the approval is received from the insurance company then the process would be started and the money will be credited directly to the insurance company without the intervention of the insured member. The cashless facility can be availed in any of the network hospitals available all over India. Reimbursement facility can also be availed in which the insured member has to settle the claim first and then claim it from the insurance company which will be reimbursed by the insurance company on production of original bills, discharge summary etc.
Step 5:- The claim would be processed either by the Third party administrator or the in-house claim settlement team of the insurance company. In-house claim settlement teams settle the claim without any need for third party.
