What are the precautions for group health insurance claims?
Today, more and more enterprises and institutions regard insurance as an employee benefit, and group health insurance is the highest proportion of insurance. However, many people don't care much about the claims of group health insurance, which affects claims. So what are the
group health insurance claims ?
Everything should know ourselves and know each other. The insured first needs to understand the insurance rights that he or she has in order to obtain better protection. After insuring group health insurance, employees need to understand the insurance liability, the amount of insurance, the period of protection, the exclusion liability, and the materials that need to be provided when filing claims. This information can generally be obtained from the employee handbook provided by the insurance company for the company. Learned. Once the insurance is out, the customer can first call the company's human resources department, or call the insurance company's hotline to make relevant claims.
Some companies may insure health insurance at several different insurance companies at the same time, which may involve multiple use of medical expense receipts in the claim process. For example, if a group's group health insurance claims are used, if the customer has multiple health insurance benefits at the same time, they must indicate on the claim application form that they need to claim compensation from other insurance companies, and attach the original copy of the medical expenses receipt with a copy. . If the medical expenses are only partially compensated and the actual compensation ratio is less than 50%, the original cost of the customer will be returned to the customer and the original receipt of the medical expenses will be returned. At that time, the customer can claim the original insurance receipt and the original insurance receipt.
Since group health insurance is more applicable to the compensation principle, if the insurance company has paid the medical expenses in full or the actual compensation ratio is higher than 50%, the fee receipt will not be refunded.
Industry experts pointed out that group health insurance customers may not be fully aware of the procedures for security and claims, ignoring some details, and these details often make the claims process more difficult. To this end, we must remind the majority of group health insurance customers: In order to successfully settle claims, customers must pay attention to the “responsibility exemption” of the corresponding protection items, and should pay attention to the following details:
(1) The expenses for non-personal treatment cannot be settled, so do not Let others take a doctor. Here, I also remind you that you should carefully check whether the name on the invoice of the claim settlement is consistent with the person. If it is inconsistent, it will basically be rejected. Some reasons may be caused: some hospitals may infringe the patient's name when invoicing, or the name of the person may be inconsistent with the insurance policy. Therefore, the client must be as careful as possible in these links. If the name is changed, the name of the institution must be provided or Accounts, etc., it is best to inform the insurance company to update in time through the human resources department of the company.
(2) To know which hospitals are designated by the company's group health insurance, they must go to these hospitals, and if they are outside the specified range, they will generally not be compensated.
(3) Without special agreement, the cost of purchasing medicines outside the hospital pharmacy will not be compensated (such as the cost of purchasing medicines at the pharmacy). If it is true that the hospital pharmacy does not have the drug, it needs to go outside to buy it. It needs to be stamped by the hospital outpatient department and other departments.
(4) Simple prescribement without symptoms: Some employees ask doctors to open some medicines that are not related to the condition when they are seeing a doctor, in case of illness or health care. The drugs and related expenses thus issued will not be compensated.
(5) The materials provided should have a medical history consistent with the invoice. Only invoices, no medical history or incomplete medical history will affect the claims.
(6) No physical examinations are routinely checked by the same routine, and insurance companies will not reimburse claims. Therefore, only when the customer has a medical examination with symptoms, the part that meets the scope of reimbursement can get normal claims.
Insurance Network Tip: If you want group health insurance to make a smooth claim, employees must clearly understand the insurance liability, the amount of protection, the period of protection, etc., and pay attention to the "responsibility exemption". In addition, corporate employees need to know which hospitals are designated for group health insurance.