Hi Seniors,
I have been working in an Engineer in a company as engineering Manager from past 1.5 years. Our company has provided Mediclaim(both GMC & GPA) to me and my family which has been lapsed due to non renewal of policy (policy ended on 5th aug23). they renewed it on 27 sep23 . In between my wife and daughter admitted in hospital and both have to eat regularly medicine for 3 years. during lapse of medi claim policy can i make my medical daughter and wife's medical bills to employer to claim or get reimbursement due to expiry of policy. Then my question is whether company has the liability to pay for me medical expenses???? how can I claim for 3 year continue medical expenditure to employer for this situation.
thanks in advance for your valuable suggestion
Regards,
From India, New Delhi
I have been working in an Engineer in a company as engineering Manager from past 1.5 years. Our company has provided Mediclaim(both GMC & GPA) to me and my family which has been lapsed due to non renewal of policy (policy ended on 5th aug23). they renewed it on 27 sep23 . In between my wife and daughter admitted in hospital and both have to eat regularly medicine for 3 years. during lapse of medi claim policy can i make my medical daughter and wife's medical bills to employer to claim or get reimbursement due to expiry of policy. Then my question is whether company has the liability to pay for me medical expenses???? how can I claim for 3 year continue medical expenditure to employer for this situation.
thanks in advance for your valuable suggestion
Regards,
From India, New Delhi
If the medical assistance and reimbursement of medical expenses are part of your service conditions then you can ask for reimbursement either from the insurers or from the employer. If the hospitalisation had happened during the time when there was no active policy, the insurance company will not own the liability. In such situation the amount spent would have to be paid or reimbursed by the employer.
Under normal circumstance, the medical insurance would cover the hospital expenses including the medical bills during hospitalisation. I don't think that if your dependents have to take medicine for three years, the same will be met by the insurance company. Similarly, in the absence of medical reimbursement as part of your remuneration structure, you will not get reimbursement of medical bills for three years. Therefore, please check the service conditions to ensure that you have medical reimbursement in your remuneration structure. Also go through the insurance guidelines and see what all are covered.
From India, Kannur
4246Under normal circumstance, the medical insurance would cover the hospital expenses including the medical bills during hospitalisation. I don't think that if your dependents have to take medicine for three years, the same will be met by the insurance company. Similarly, in the absence of medical reimbursement as part of your remuneration structure, you will not get reimbursement of medical bills for three years. Therefore, please check the service conditions to ensure that you have medical reimbursement in your remuneration structure. Also go through the insurance guidelines and see what all are covered.
From India, Kannur
Hi,
Typically, when a health insurance policy lapses, it may not cover expenses that occurred during the lapse period. Renewing the policy after the fact might not retroactively cover expenses incurred during the lapse. However, companies may have different policies and may provide some flexibility in certain cases.
Here are some steps you can consider:
Review Company Policies: Check your company's policies regarding medical claims during lapses and the reimbursement process. Your employee handbook or HR department should provide information on how such situations are handled.
Contact HR: Reach out to your HR department to explain the situation. They may be able to guide you on the company's policy in such cases and provide assistance on how to proceed.
Provide Documentation: If your company allows for reimbursement, gather all necessary documentation, including medical bills, prescriptions, and any other relevant information. Make sure you have a clear record of the expenses incurred during the lapse period.
Request Clarification: If the policy renewal date was delayed for reasons beyond your control, such as a delay on the part of the insurance provider or company, explain this to HR. It's possible they may consider the circumstances and make an exception.
Explore Other Options: If your company cannot provide reimbursement, you may want to explore other options, such as negotiating payment plans with healthcare providers or seeking financial assistance programs.
Consider Legal Advice: If you encounter difficulties and believe you have a case, you may want to consult with an employment lawyer to understand your rights and options.
The specific details and regulations may vary depending on your location and the terms of your employment contract. Always seek professional advice to ensure you are making informed decisions based on your unique circumstances.
Thanks
From India, Bangalore
Typically, when a health insurance policy lapses, it may not cover expenses that occurred during the lapse period. Renewing the policy after the fact might not retroactively cover expenses incurred during the lapse. However, companies may have different policies and may provide some flexibility in certain cases.
Here are some steps you can consider:
Review Company Policies: Check your company's policies regarding medical claims during lapses and the reimbursement process. Your employee handbook or HR department should provide information on how such situations are handled.
Contact HR: Reach out to your HR department to explain the situation. They may be able to guide you on the company's policy in such cases and provide assistance on how to proceed.
Provide Documentation: If your company allows for reimbursement, gather all necessary documentation, including medical bills, prescriptions, and any other relevant information. Make sure you have a clear record of the expenses incurred during the lapse period.
Request Clarification: If the policy renewal date was delayed for reasons beyond your control, such as a delay on the part of the insurance provider or company, explain this to HR. It's possible they may consider the circumstances and make an exception.
Explore Other Options: If your company cannot provide reimbursement, you may want to explore other options, such as negotiating payment plans with healthcare providers or seeking financial assistance programs.
Consider Legal Advice: If you encounter difficulties and believe you have a case, you may want to consult with an employment lawyer to understand your rights and options.
The specific details and regulations may vary depending on your location and the terms of your employment contract. Always seek professional advice to ensure you are making informed decisions based on your unique circumstances.
Thanks
From India, Bangalore
Dear Sir,
Employer doesn't offering reimbursement, how ever they also not sharing there policy. The saying that Reimbursement of family is not in our policy. My question is if my family covered in GMC , They not renewed GMC in between CMC lapse period they are liable to paid medical expanses ? If yes where to file complaint against employer?
From India, New Delhi
Employer doesn't offering reimbursement, how ever they also not sharing there policy. The saying that Reimbursement of family is not in our policy. My question is if my family covered in GMC , They not renewed GMC in between CMC lapse period they are liable to paid medical expanses ? If yes where to file complaint against employer?
From India, New Delhi
You cannot file a complaint against an employee for not giving you any employee benefits which is not statutory in nature. Certainly, you can move against the employer for breach of contract in a civil court. You will get a verdict after ten or fifteen years. At the same time, had it been a statutory benefit, say the employer failed to pay ESI contribution due to which your family members did not get the benefits, then you have remedy and that will be an immediate remedy from the department concerned. Giving insurance coverage to employees and their family members is not a statutory obligation but it is just an employee benefit offered by the employer as part of contract of employment. If the employer has not extended it, the employee can file complaint for breach of contract and that will be maintainable only in a civil court and not in a labour court.
Taking the matter to that extent would make the employer hostile and your working in the company would become miserable. At the same time, it is not at all advisable to work with such organisations who do not follow the principles of HR or ethics of doing business. Hence, you can also try for other opportunities. Naturally, if your presence is required, the employer would come for a settlement and would readily reimburse the cost of hospitalisation.
From India, Kannur
Taking the matter to that extent would make the employer hostile and your working in the company would become miserable. At the same time, it is not at all advisable to work with such organisations who do not follow the principles of HR or ethics of doing business. Hence, you can also try for other opportunities. Naturally, if your presence is required, the employer would come for a settlement and would readily reimburse the cost of hospitalisation.
From India, Kannur
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