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What is the Electronic Claim Process (e-claim) in Group Health Insurance and How it works, and its benefits?

By December 17, 2021January 22nd, 2022No Comments
What is the Electronic Claim Process (e-claim) in Group Health Insurance and How it works, and its benefits - PlanCover

Know About The Working Ways And Benefits of the e-claim Process in Group Health Insurance

Whether you buy an individual healthcare plan or go for the group Mediclaim, it is vital to know the claiming procedures. It may not always be possible to find a cashless facilitated hospital during a medical emergency. In such cases, you have to keep a clear idea about the processing in the latter stages to retrieve the claimed amount. With the new-age insurance companies and flexible norms, the claiming procedure has become simpler. The electronic claim process is your go-to option to get the most convenient service while applying for reimbursement. 

How does insurance help you?

Before getting into the details of e-claim and the processing, know about the group healthcare features. For those who do not own an individual healthcare plan, group insurance is the best option. Even if you own one, there is no harm in keeping this one. Why? Because the employer of the organization pays for the annual premium charges so that the employees can enjoy plan benefits. As a policyholder, you should have sound knowledge about the claiming process, else it will be of no use in the future. Read along and know more about the e-claim procedure to ease the needs. 

Understand the procedure

There are two ways to get the medical treatment expense from the insurance company. If you have a group healthcare plan under your name, you can apply for reimbursement or get cashless treatment. For getting cashless treatment, you have to produce the insurance documents in a hospital that falls under the network of the cashless-facilitated list of the insurance company. The other way is to initially pay for the treatment and then go for claim and reimbursement. For reimbursement, you have to raise a claim by submitting the medical bills. Earlier, the only way to apply for reimbursement was to physically visit the TPA office or insurance company and provide the medical bills. With the updated setup, you can now carry out the process through online portals. Raise a claim through the online website and submit the e-copies of the bills. 

Cashless facilities or electronic claims?

If you have an option to go to the nearest hospital under the cashless-facilitated network of your insurance company, do not think otherwise. But for emergencies when you do not have the time to find the cashless-facilitated hospital, do not delay the treatment. In such cases, you should choose the e-claim procedure as the process has become simpler in the last few years. You no longer have to wait in the queues to submit the papers or rush to the insurance office multiple times. 

Documents essential for e-claim

For filing an electronic claim for reimbursement, you have to upload scanned copies of the original medical bills and treatment expenditure. Visit the website of the assigned TPA or the insurance company to find the portal to upload documents for e-claim. Submit the claim form by filling it with the following documents –

  • Hospital bills and detailed cost breakup notes
  • Discharge summary
  • Payment receipts for medicines and treatment
  • Patient’s ID proof
  • Canceled cheque (where the money will get deposited)

Why is it advantageous for the employees?

If you are doubtful about the benefits of trying the e-claim procedure, it is high time you thought otherwise. Why? Because with time, the process of reimbursement and functioning has updated. Thus, not trying the new-age features would be a loss on your part. Following are the top-most advantages of e-claim in group healthcare policies. 

  1. It saves your time: As an employee, you do not have the time to run between shifts to submit the documents for reimbursement. An online procedure saves this time and eases the whole claiming process. You can sit at your home and get the money in your accounts. 
  1. Need of the hour: The lockdown all over the country has made the e-claim an absolutely necessary insurance service. Most insurance offices and TPA centers are closed. Employees are working from home. So, for ensuring your own health protection, e-claim is the right option to pick. 
  1. Hassle-free and convenient: With e-claims, you can submit the documents at any hour of the day. You can relax at your home and submit the scan copy at your convenience. It not only saves the conveyance time but also makes the process hassle-free.
  1. Accuracy and settlement: When you submit physical photocopies of bills and documents, the chances of mishandling are high. But with online submission, you can never go wrong. It does not create any delays in the process and ensures optimal accuracy. 
  1. Easy to track: By submitting the documents online, you can get a link to track the claim progress. You do not have to visit the office and ask about the claim status. It is simple to do and very convenient on the policyholder’s part. Even if you are on rest, you can use the e-claim facilities and get money deposited in your account. 
  1. Record keeping is easier: As the whole procedure is online, there are no printed receipts. The physical copies of the submission receipts are highly-prone to getting misplaced. It delays the process further. Hence, eliminate the worries and pick the ideal option for the working employees.

Who can help you out?

An insurance consultant can help you out in the matter. As they have been serving in the professional field for a long period, they know the right ways. You can connect to them to understand the process. Go for a reputed and trustworthy insurance broker to get the best service without any delay. 

PlanCover – The right guide in every step.

PlanCover is your one-stop solution when it comes to anything related to a group health insurance plan. They have the best team and have been functioning as an insurance broker and consultant for years. You can buy employer health insurance with their assistance by browsing through the different insurance companies under their offerings. They can also assist you with other services related to insurance. Connect to their proficient team to know more about the working process of group healthcare policies and claims. 

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