8 Hacks to Ease The Health Insurance Claim Process for Employees

Indians have always shied away from health insurance. That’s probably why around one-third of the country’s population still misses out on the benefits of being medically insured.

Around 82% of Indian companies get their employees medically insured. During the second wave of the pandemic, coverage of frontline workers increased 4x. As of today, only a little over 35 million frontline workers are insured.

Most employers perceive their employees as their biggest asset. In that case, lending support in a medical emergency becomes the need of the hour. A health crisis often leads to a financial crunch.

Employers get their workforce medically insured to improve their lives. But when the need arises, employees often find themselves waiting, suppressed by a pile of documents, or facing rejections.

Every employee needs utmost support when faced with a personal or a family health crisis. In case of emergencies, amidst panic and stress, it gets even more challenging.

As employee caretakers, you try to find the best insurance company that promises the maximum coverage, lowest claim rejection rates, and faster reimbursements. However, there are eight hacks for you to ease the health insurance claim process and take some burden off the employees.

1. Employee Awareness

There is superior tech available to assist you in training your employees while onboarding. However, the health insurance claims process is an area that escapes most employees. Therefore, the onus for comprehensive employee awareness lies with recruiters such as you.

You need to impart health insurance training to all employees, which covers:

• Thorough knowledge of the insurance claim process.
• Healthcare facilities or network hospitals included.
• Insurance coverage.
• Things not covered by the insurance policy such as consumables, any co-payments, or deductibles.
• Money-saving approaches: For example, if they have an individual health insurance policy, encourage them to use the employee health insurance in case of need. The group insurance doesn’t offer a no-claim bonus (NCB), but individual policies do. Using the employee health insurance claim makes them eligible for the NCB in their policy.

2. Timely Distribution of TPA Cards

Many companies and their employees don’t receive the TPA cards on time, thus delaying the claim process. As an HR personnel, you must clarify this point with the insurer during negotiation.

If a hard copy is not readily available, the insurance company must provide an e-version for reference. If such documents are available via a dedicated app, the claim process can become more manageable.

3. Annual Updates

It would help if you also looked after the annual and timely updating of employee and their family records. All details like name, relation, age, and nominee need to be reviewed or updated every year.

Incorrect information in the claim form can delay the claim payout or rejection. Having up-to-date information can help avoid hassles during the insurance claim process.

4. SPOC Allocation

Having a single point of contact (SPOC) makes the claim process easier for the employee. They can connect with the designated person in case of any challenges.

As the HR Manager, you can ask the insurance company for one SPOC for the organisation or one per hundred employees, depending on the organisation’s size.

5. Timely Renewals

Health insurance renewals tend to be a tedious process for you. It could involve renegotiating the terms or simply renewing the previous. If not done on time, expired policies make the task difficult for the employees.

Organisations with a large blue-collar workforce can rely on a partner that digitises the insurance claim process and makes information accessible.

6. Transition Period

Similar to expired health insurance policies, the transition from one policy to another can be cumbersome for employees suffering a medical crisis during that period. All HR managers must take care of this while signing the deal with a new insurer.

Therefore, keeping your employees apprised of the transition duration and the corresponding health insurance claim process is essential.

7. Option for Voluntary Top-Ups

Many employees experienced companies reducing the insurance coverage amount in challenging times. You must ensure the employees know they can increase their insurance claim coverage (voluntary top-up), by investing from their salaries.

With healthcare costs rising, most employers may not offer more than Rs 2-3 lakh as the sum assured. Employees can increase coverage by paying a little extra from their pockets. This extra insurance coverage can help them during a crisis.

8. Adding Dependents to the Policy

Group health insurance policies are customisable and allow the employees to add their spouse, children, and, in some cases, parents. However, some insurers charge an extra premium for adding parents to the policy.

Your employees can also opt for critical illness cover for the family members for a hiked premium. You should inform your workers about such add-ons.

The past few years have taught us that blue-collar workers’ and their families’ well-being are crucial. Well-formulated supportive policies boil down to nothing if such employees cannot reap their benefits.

Moreover, their financial circumstances and living conditions often lead to a health crisis and slower recovery. While laws and regulations can curb mishaps up to a certain extent, corporates need to do more than comply.

Needless to say, a comprehensive health insurance plan with a smooth claim process is the need of the hour.