A group health insurance is a policy that offers health coverage and benefits to a group of individuals, mostly employees, under one policy. Buying a group health policy is a critical responsibility for employers.
TATA AIG offers a comprehensive group mediclaim policy for employees with multiple benefits. However, buying the policy won’t suffice; you must understand the claim procedure for a seamless, hassle-free, time-saving and calm claim settlement process.
TATA AIG Group Health Insurance: Procedure for Cashless Claims
1. Contact TATA AIG
Contact TATA AIG 48 hours before the hospitalisation time in case of a planned hospitalisation. An advanced notice is always better than a last-minute one, considering it is a planned hospitalisation.
For emergency hospitalisations, you need to inform TATA AIG within 24 hours of hospitalisation. It is important to inform the company as soon as possible when it comes to cashless claims.
2. Request Pre-Authorisation
Visit the hospital’s desk and fill out the pre-authorisation form. This form helps the policyholder get approval for the cashless claim, where the insurer verifies whether the treatment is covered in the policy or not. Fill out the form accurately to avoid any complications.
3. Claim Approval
The TATA AIG claim management team will verify and assess your pre-authorisation form. If the details meet the criteria of the employer group health insurance coverage, the claim will be approved.
4. Company’s Query
After reviewing the pre-authorisation form, if TATA AIG has any queries or doubts about the details and treatment, they will ask for additional information and reports. As the policyholder, you must provide that information.
5. Claim Rejection
If TATA AIG’s claim management team finds the reports and evidence unsatisfactory, your group health insurance claim may be rejected. However, you can still apply for a reimbursement claim. A rejection of a cashless claim is not a rejection of the claim itself.
TATA AIG Group Health Insurance: Procedure for Reimbursement Claims
1. Contact TATA AIG
In case of planned hospitalisation, inform TATA AIG 48 hours prior to the planned admission and in case of emergency hospitalisation, inform the company within 24 hours of hospitalisation.
2. Submit Claim Form
You must submit your reimbursement claim form once you are discharged from the hospital. This form will contain all the necessary details about the group mediclaim policy for employees.
You must submit the necessary documents along with the form. These documents include hospital bills, discharge summaries, pharmacy prescriptions, reports, medical requirements and other bills.
3. Claim Approval
Once you submit the claim form, TATA AIG’s group medical insurance claim management team will review the documents and the form. If the details meet the claim criteria, your claim will be approved.
4. Company’s Query
If the company’s claim management team has any queries, they will ask for additional documents.
5. Claim Rejection
Even on submission of additional documents, if your claim does not fit the company’s criteria, your group health insurance claim will be rejected.
Documents Required for TATA AIG Group Medical Insurance Claims
Documents for Cashless Claims
The list of documents required for the cashless claim procedure is as follows:
- Insurance policy card or policy documents and paper
- Company’s photo ID
- Address proof (government ID)
- Admission note from the doctor in charge
- OPD consultation reports from the past (if available)
- Discharge summary or medical records stating your medical condition from the past
- Approved claim settlement letter from TATA AIG
- If the claim amount exceeds ₹1,00,000, the customer must submit a duly filled CKYC form.
Documents for Reimbursement Claims
The list of documents for the reimbursement claim procedure is as follows:
- Submit the duly filled claim form
- Insurance policy card or policy documents and paper
- A signed and official doctor’s medical certificate
- Original discharge summary
- Consolidated original bill
- Segments of expenses for the submitted final bill
- Payment receipt from the hospital or pharmacy
- Official name and bank details of the payee
- Reports that support your claim
- Invoices for implants used (if any)
- Submit FIR in case of accidental injury
- Nominee’s address and identity proof in case of policyholder’s death
- If the claim exceeds ₹1,00,000, the group health insurance policyholder must submit a CKYC form with a photograph, cross-signed and mandatory columns filled.
Conclusion
Navigating the process of filing a claim can be very confusing. Imagine the rush during a medical emergency, and then imagine not knowing what to do, forgetting documents and messing up the finer details. This may cause further complications.
Instead, follow the given procedure, and you will find it easy to traverse the claim settlement process. As an employer, a thorough understanding of TATA AIG group medical insurance claims will facilitate a smooth and hassle-free experience.
