Dear All,
Iam working as an HR executive and I am the only HR in my company. I am handling all the HR related activities including mediclaim. In mediclaim, usually when there is a claim, employee should intimate the HR, which is mandatory, so one my employee was admitted in the hospital, so she called me and said that she had some problem and wanted to process through cashless. I did all the back works to process with the mediclaim agency, but the next day I heard from one her friend in office that in the hospital, they are not co operating for the cashless, so she is paying all the bills and wanted to reimburse, but for doing reimbursement also intimation is mandatory. Now in this is situation as a HR what should I have to do???
• Call her directly and explain that she can’t claim without intimation
• Leave as it is and do my work
Require your valuable feedbacks in this regard.
From India, Madras
5Iam working as an HR executive and I am the only HR in my company. I am handling all the HR related activities including mediclaim. In mediclaim, usually when there is a claim, employee should intimate the HR, which is mandatory, so one my employee was admitted in the hospital, so she called me and said that she had some problem and wanted to process through cashless. I did all the back works to process with the mediclaim agency, but the next day I heard from one her friend in office that in the hospital, they are not co operating for the cashless, so she is paying all the bills and wanted to reimburse, but for doing reimbursement also intimation is mandatory. Now in this is situation as a HR what should I have to do???
• Call her directly and explain that she can’t claim without intimation
• Leave as it is and do my work
Require your valuable feedbacks in this regard.
From India, Madras
Hello Prema:
Since you are working in HR, you are aware that the mediclaim insurance is for the benefit of the employees and it is your duty to ensure that your employee who is admitted in the hospital gets it.
From what I can gather from the subject of your e mail, one needs to keep ego aside & simply pick up the 'phone and guide your friend as to how to go about it!
In our company, we have informed all employees how both cashless and reimbursement process works, through a formal power point presentation along with the Insurance Agent. The instructions, toll free numbers etc. are displayed in public folders / notice boards etc. And we have made it clear that following the procedures of the Insurance company and follow up is employee's job, but HR will facilitate the proceedings and mediate when required & if requested. And some times employees do not intimate immediately on lodging claims but refer to us only when claims are refused. But that's okay. There is no question of ego here. It is our job to assist them. And hopefully our expertise too!
Regards,
Kalpana Iyer
From India, Pune
Since you are working in HR, you are aware that the mediclaim insurance is for the benefit of the employees and it is your duty to ensure that your employee who is admitted in the hospital gets it.
From what I can gather from the subject of your e mail, one needs to keep ego aside & simply pick up the 'phone and guide your friend as to how to go about it!
In our company, we have informed all employees how both cashless and reimbursement process works, through a formal power point presentation along with the Insurance Agent. The instructions, toll free numbers etc. are displayed in public folders / notice boards etc. And we have made it clear that following the procedures of the Insurance company and follow up is employee's job, but HR will facilitate the proceedings and mediate when required & if requested. And some times employees do not intimate immediately on lodging claims but refer to us only when claims are refused. But that's okay. There is no question of ego here. It is our job to assist them. And hopefully our expertise too!
Regards,
Kalpana Iyer
From India, Pune
Prema,
I have handled mediclaim for my previous company for many years and has dealt with both Cashless and Reimbursement modes of availing the benefit.
Cashless Treatments can be availed at the empaneled hospitals , when the member of the policy plans for his treatment in advance and date of admission is pre-fixed by the doctor and intimated to the insurance desk in hospital. The hospital is supposed to send a "Pre Authorization Form to the TPA and get the approval for cashless treatment. This is a One/Two day process and in this case it is advisable for the employee to intimate the employer simultaneously for any cross checks done by the TPA(Insurance Agents).
Hospitals which are not empaneled will not entertain cashless treatment and certain hospitals which are empaneled, hesitate to process the cashless treatment as the admission is immediate and without advance intimation. In your case, the employee would have faced some problems on obtaining the cashless treatment and out of urgency decided to pay from her pocket and claim for reimbursement at a later stage (within stipulated period specified in the policy)
If the mediclaim facility is availed through reimbursement, there requires no prior intimation. The applicant has to fill in the claim form, add relevant details, obtain authorization from concerned doctor, attach relevant bills (original) and send it to TPA for payment through cheque.
Kindly go through the policy manual clearly and clarify the clause on reimbursement
What i suggest you to do :
Call her immediately and describe her how to go about the same. When you are in to HR , shed all your egos and work for the employees betterment. She may be in lot of stress and missed out intimating you. So keep your egos apart and talk to her
- " leave it and do my work" & "am working as an HR executive and I am the only HR in my company. I am handling all the HR related activities including mediclaim"
If medi claim is under your purview of work, how can you leave and get back to work
From India, Mumbai
I have handled mediclaim for my previous company for many years and has dealt with both Cashless and Reimbursement modes of availing the benefit.
Cashless Treatments can be availed at the empaneled hospitals , when the member of the policy plans for his treatment in advance and date of admission is pre-fixed by the doctor and intimated to the insurance desk in hospital. The hospital is supposed to send a "Pre Authorization Form to the TPA and get the approval for cashless treatment. This is a One/Two day process and in this case it is advisable for the employee to intimate the employer simultaneously for any cross checks done by the TPA(Insurance Agents).
Hospitals which are not empaneled will not entertain cashless treatment and certain hospitals which are empaneled, hesitate to process the cashless treatment as the admission is immediate and without advance intimation. In your case, the employee would have faced some problems on obtaining the cashless treatment and out of urgency decided to pay from her pocket and claim for reimbursement at a later stage (within stipulated period specified in the policy)
If the mediclaim facility is availed through reimbursement, there requires no prior intimation. The applicant has to fill in the claim form, add relevant details, obtain authorization from concerned doctor, attach relevant bills (original) and send it to TPA for payment through cheque.
Kindly go through the policy manual clearly and clarify the clause on reimbursement
What i suggest you to do :
Call her immediately and describe her how to go about the same. When you are in to HR , shed all your egos and work for the employees betterment. She may be in lot of stress and missed out intimating you. So keep your egos apart and talk to her
- " leave it and do my work" & "am working as an HR executive and I am the only HR in my company. I am handling all the HR related activities including mediclaim"
If medi claim is under your purview of work, how can you leave and get back to work
From India, Mumbai
Thanks for your comments Kalpana and Sriram
Actually iam not egoistic, here the problem was first for doing cashless she was calling every half an hour and asking lots of doubt. But the next day she had some problem in the hospital but she did not escalate it to me there is a friend of her who sits next me , she was keeping on informing her, that’s the reason I got irritated, and thought that why I have to go and help her voluntarily. She is already aware of all the mediclaim procedures, and inspite of that she did not get back to me.
Anyway……as Kalpana and Sriram said we should keep all are ego aside and serve them! I called her and informed all the procedures.
Thanks a lot….
From India, Madras
Actually iam not egoistic, here the problem was first for doing cashless she was calling every half an hour and asking lots of doubt. But the next day she had some problem in the hospital but she did not escalate it to me there is a friend of her who sits next me , she was keeping on informing her, that’s the reason I got irritated, and thought that why I have to go and help her voluntarily. She is already aware of all the mediclaim procedures, and inspite of that she did not get back to me.
Anyway……as Kalpana and Sriram said we should keep all are ego aside and serve them! I called her and informed all the procedures.
Thanks a lot….
From India, Madras
Prema u can call me . I will help u my no is 09810054915 regards, pravin agarwal director smc insurance brokers pvt ltd
From India, Delhi
From India, Delhi
it is nice to hear from prema that the need had been done.
but my humble suggestion is the person in distress will
yearn for help voluntarily.it will not be fair on our part to
stick on to rules,hierarchy etc .at this juncture.being in
HR let's be little more magnanmous.
warm regards
venu
From India, Madurai
but my humble suggestion is the person in distress will
yearn for help voluntarily.it will not be fair on our part to
stick on to rules,hierarchy etc .at this juncture.being in
HR let's be little more magnanmous.
warm regards
venu
From India, Madurai
Dear Prema:
Ideally, you should get the ppt from your service provider. If not now, you can ask during renewal, when you can definitely get it :) Our company policy may not permit me to send you our official copy.
Regards,
Kalpana Iyer
From India, Pune
Ideally, you should get the ppt from your service provider. If not now, you can ask during renewal, when you can definitely get it :) Our company policy may not permit me to send you our official copy.
Regards,
Kalpana Iyer
From India, Pune
Dear Kalpana Iyer
do you have any general idea about the Mediclaim rules and regulations in your company. Do you know how to prepare ppt presentation.
Then what restrains you from sharing such useful article
Remove your company name and logo.
Add your comments and you can give your own identity to the presentation with your added remarks
Otherwise prepare the points and give it in word file, which can be helpful to our members.
From India, Kumbakonam
do you have any general idea about the Mediclaim rules and regulations in your company. Do you know how to prepare ppt presentation.
Then what restrains you from sharing such useful article
Remove your company name and logo.
Add your comments and you can give your own identity to the presentation with your added remarks
Otherwise prepare the points and give it in word file, which can be helpful to our members.
From India, Kumbakonam
Dear Prema
Please talk to the hospital authorities that once our staff are approaching you means you have provide necessary treatment to them.
You make your own format that "Company will bear the cost of treatment given to them and it will be claimed by the company after submission of necessary documents within 3 days from the date of discharge from the employee or his representative. Whatever the differential amount can be recovered from the employees salary". Obtain the signature from the employee and get it approved from the management.
Then issue a letter to that effect to the hospital authorities to treat the employee as per the company standard and the cost will be bear by the company and make an agreement to that effect with the hospital authority.
From India, Kumbakonam
Please talk to the hospital authorities that once our staff are approaching you means you have provide necessary treatment to them.
You make your own format that "Company will bear the cost of treatment given to them and it will be claimed by the company after submission of necessary documents within 3 days from the date of discharge from the employee or his representative. Whatever the differential amount can be recovered from the employees salary". Obtain the signature from the employee and get it approved from the management.
Then issue a letter to that effect to the hospital authorities to treat the employee as per the company standard and the cost will be bear by the company and make an agreement to that effect with the hospital authority.
From India, Kumbakonam
Dear Prema,
Hope you are doing well. I have gone through your topic and i can understand your situation since i have a long experience in dealing with mediclaim issues and was the single point of contact for all mediclaim issues and queries both cashless and reimbursements. If you want i can help you in this matter.
I an explain the process to you through telephone so that from next time you dont have to face any issues.
you can call me at 8447412597.
Thanks
C.K.Mohanty
From India, Bhubaneswar
Hope you are doing well. I have gone through your topic and i can understand your situation since i have a long experience in dealing with mediclaim issues and was the single point of contact for all mediclaim issues and queries both cashless and reimbursements. If you want i can help you in this matter.
I an explain the process to you through telephone so that from next time you dont have to face any issues.
you can call me at 8447412597.
Thanks
C.K.Mohanty
From India, Bhubaneswar
Community Support and Knowledge-base on business, career and organisational prospects and issues - Register and Log In to CiteHR and post your query, download formats and be part of a fostered community of professionals.
Working with communities.ppt
Occupational Safety, Health & Working Conditions Code 2019.pdf