Mediclaim | Riskbirbal-Insurance-Brokers-Private-Limited


How To Manage Group Mediclaim Policy Effectively?

A group Mediclaim policy is a kind of health insurance that provides coverage for individuals who are employed by the same company. Given that the business pays the cost, it is frequently provided as a useful benefit to employees. In some circumstances, the employee's family may be covered by the group health insurance.

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However, the cost is significantly lower than individual health insurance plans, and companies also benefit from tax breaks, making it advantageous for both the employer and the employee.

What is covered in Group Mediclaim Insurance Policy?

A Group Mediclaim Insurance Policy covers all the following aspects-

A Group Mediclaim Insurance is applicable only if the below-mentioned criteria are followed:

What is not covered in Group Mediclaim Insurance Policy?

Process To Be Followed In Planned And Unplanned Hospitalization

In case of a planned authorization, all non-emergency hospitalization situations require prior authorization from the Help Desk. This is done to guarantee that the insured member receives the best treatment available and is not inconvenienced when seeking admission into a Network Hospital.

You must get hospital admittance after your hospitalization has been pre-authorized. Raksha TPA will give the hospital a letter of credit or a cashless approval letter. Please provide your government-issued and health ID cards at the hospital entrance desk. In the event of a network hospital, the insured member is not needed to pay the hospitalization bill. The invoice will be issued to and paid for by Raksha TPA, but the employee or patient must cover any disapproved amounts.

However, in case of an unplanned hospitalization, employees can get up to seven days before the entrance to request cashless approval. The cashless authorization form is accessible at the hospital's TPA assistance desk. When visiting TPA, the employee must have TPA Card and a valid ID. Once the hospital has given you all the necessary information, it takes no longer than three hours to approve cashless claims.

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What to do and Not for HR while managing GMC/GPA policies?

Employee satisfaction is a crucial aspect affecting an organization's productivity. It significantly affects how a firm grows and maintains its competitiveness. Taking care of the employees is the basic task of HR. they do everything they can to make their employees happy and safe in the office environment. Employers provide a range of perks, such as preferred leave and insurance, to keep workers happy and motivated.

GMC/GPA Policies

The two most prevalent insurance plans offered by employers to insure their employees are group medical coverage (GMC) and group personal accident insurance (GPA). These plans aid companies cover the costs of unlucky workplace accidents. Both these policies guarantee the employees' welfare by providing them with financial and medical coverage.

What is a GMC insurance policy?

A sort of health insurance called a Group Medical Cover, or GMC, is for a group of people, such as the staff of a single company. It also extends to their dependents, such as their spouse, kids, and parents.

Typically, an employer provides such a policy as a perk and pays the premium. The costs for this type of health insurance are kept cheap since the risk is shared among a large group of people who are already covered.

What does GMC cover?

A Group Mediclaim Insurance is applicable only if the below-mentioned criteria are followed:

What is a GPA insurance policy?

A type of insurance called group personal accident insurance (GPA) covers a group of people financially in the event of unanticipated incidents that cause death, serious injury, or disability.

Accidents can happen at any time and have unanticipated negative effects on your health. Therefore, GPA insurance has some built-in provisions to protect employees if an accident results in their death or a handicap that affects their ability to earn a living. It offers them or their families some level of financial security.

What is a GPA cover?

The employees must enroll themselves to obtain coverage for themselves and their eligible dependents. The HR should collect relevant enrolment data like Employee ID, Name, Date of Birth, Gender, Relationship, etc., they have to make sure that the data is relevant and valid and thereafter submit the details to the insurer. The employee's data must reach the insurer within 30 days of their joining. Employees also have to inform HR whenever they need to get a new dependant added to their policies, like in case of marriage, birth, or adoption of a child. All this information has to be submitted to the insurer within 30 days of the process.