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
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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
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Hello Prema,
Since you work in HR, you are aware that mediclaim insurance is for the benefit of employees, and it is your duty to ensure that your employee who is admitted to the hospital receives it.
From what I can gather from the subject of your email, one needs to set aside ego and simply pick up the phone to guide your friend on how to proceed.
In our company, we have informed all employees about how both the cashless and reimbursement processes work through a formal PowerPoint presentation with the insurance agent. The instructions, toll-free numbers, etc., are displayed in public folders/notice boards. We have made it clear that following the procedures of the insurance company and the follow-up is the employee's responsibility, but HR will facilitate the proceedings and mediate when required or if requested. Sometimes employees do not inform us immediately when lodging claims but only refer to us when claims are refused. However, that's acceptable. There is no question of ego here. It is our job to assist them and hopefully showcase our expertise too.
Regards,
Kalpana Iyer
From India, Pune
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Since you work in HR, you are aware that mediclaim insurance is for the benefit of employees, and it is your duty to ensure that your employee who is admitted to the hospital receives it.
From what I can gather from the subject of your email, one needs to set aside ego and simply pick up the phone to guide your friend on how to proceed.
In our company, we have informed all employees about how both the cashless and reimbursement processes work through a formal PowerPoint presentation with the insurance agent. The instructions, toll-free numbers, etc., are displayed in public folders/notice boards. We have made it clear that following the procedures of the insurance company and the follow-up is the employee's responsibility, but HR will facilitate the proceedings and mediate when required or if requested. Sometimes employees do not inform us immediately when lodging claims but only refer to us when claims are refused. However, that's acceptable. There is no question of ego here. It is our job to assist them and hopefully showcase our expertise too.
Regards,
Kalpana Iyer
From India, Pune
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Prema,
I have handled mediclaim for my previous company for many years and have 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 the date of admission is pre-fixed by the doctor and intimated to the insurance desk in the 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 inform 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 in obtaining the cashless treatment and, out of urgency, decided to pay from her pocket and claim for reimbursement at a later stage (within the 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 the 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 do:
Call her immediately and describe to her how to go about the same. When you are in HR, shed all your egos and work for the employees' betterment. She may be under a lot of stress and might have missed out on intimating you. So keep your egos apart and talk to her.
- "Leave it and do my work" & "I 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 mediclaim is under your purview of work, how can you leave and get back to work?
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From India, Mumbai
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I have handled mediclaim for my previous company for many years and have 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 the date of admission is pre-fixed by the doctor and intimated to the insurance desk in the 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 inform 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 in obtaining the cashless treatment and, out of urgency, decided to pay from her pocket and claim for reimbursement at a later stage (within the 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 the 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 do:
Call her immediately and describe to her how to go about the same. When you are in HR, shed all your egos and work for the employees' betterment. She may be under a lot of stress and might have missed out on intimating you. So keep your egos apart and talk to her.
- "Leave it and do my work" & "I 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 mediclaim is under your purview of work, how can you leave and get back to work?
Correct Spelling and Grammar: Identify and fix any spelling or grammatical mistakes in the text.
Handle Line Breaks:
Ensure there is a single line break between paragraphs.
If the user starts with “Hi, ” followed by a line feed, remove that line feed to ensure the first line does not appear blank.
Preserve the Meaning: While correcting the grammar and spelling, make sure the original meaning and tone of the message remain unchanged.
From India, Mumbai
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Thank you for your comments, Kalpana and Sriram.
Actually, I am not egoistic. The issue here was that, initially, when she needed help with going cashless, she was calling me every half an hour and asking numerous questions. However, the next day, when she faced some problems at the hospital, she did not escalate it to me. Instead, a friend of hers who sits next to me kept informing her. This continuous relay of information irritated me, and I questioned why I should voluntarily offer my help when she was already well-informed about all the mediclaim procedures. Despite her knowledge, she did not reach out to me.
In any case... as Kalpana and Sriram mentioned, we should set aside our egos and assist them. I called her and provided all the necessary information.
Thank you very much.
From India, Madras
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Actually, I am not egoistic. The issue here was that, initially, when she needed help with going cashless, she was calling me every half an hour and asking numerous questions. However, the next day, when she faced some problems at the hospital, she did not escalate it to me. Instead, a friend of hers who sits next to me kept informing her. This continuous relay of information irritated me, and I questioned why I should voluntarily offer my help when she was already well-informed about all the mediclaim procedures. Despite her knowledge, she did not reach out to me.
In any case... as Kalpana and Sriram mentioned, we should set aside our egos and assist them. I called her and provided all the necessary information.
Thank you very much.
From India, Madras
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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
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From India, Delhi
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It is nice to hear from Prema that the need has been addressed. However, my humble suggestion is that a person in distress will yearn for help voluntarily. It will not be fair on our part to stick to rules, hierarchy, etc. at this juncture. Being in HR, let's be a little more magnanimous.
Warm regards,
Venu
From India, Madurai
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Warm regards,
Venu
From India, Madurai
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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
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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
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Dear Kalpana Iyer,
Do you have any general idea about the Mediclaim rules and regulations in your company? Do you know how to prepare a PowerPoint presentation? Then what restrains you from sharing such a useful article? Remove your company name and logo. Add your comments, and you can give your presentation your own identity with your added remarks. Otherwise, prepare the points and give them in a Word file, which can be helpful to our members.
Thank you.
From India, Kumbakonam
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Do you have any general idea about the Mediclaim rules and regulations in your company? Do you know how to prepare a PowerPoint presentation? Then what restrains you from sharing such a useful article? Remove your company name and logo. Add your comments, and you can give your presentation your own identity with your added remarks. Otherwise, prepare the points and give them in a Word file, which can be helpful to our members.
Thank you.
From India, Kumbakonam
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Dear Prema,
Please talk to the hospital authorities that once our staff are approaching you, it means you have to provide necessary treatment to them. You should create a format stating that the company will bear the cost of treatment given to them, which will be claimed by the company after submission of necessary documents within 3 days from the date of discharge of the employee or their representative. Any differential amount can be recovered from the employee's salary. Obtain the signature from the employee and get it approved by management.
Then issue a letter to the hospital authorities to treat the employee as per the company standard. The cost will be borne by the company, and make an agreement to that effect with the hospital authority.
Thank you.
From India, Kumbakonam
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Please talk to the hospital authorities that once our staff are approaching you, it means you have to provide necessary treatment to them. You should create a format stating that the company will bear the cost of treatment given to them, which will be claimed by the company after submission of necessary documents within 3 days from the date of discharge of the employee or their representative. Any differential amount can be recovered from the employee's salary. Obtain the signature from the employee and get it approved by management.
Then issue a letter to the hospital authorities to treat the employee as per the company standard. The cost will be borne by the company, and make an agreement to that effect with the hospital authority.
Thank you.
From India, Kumbakonam
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Dear Prema,
Hope you are doing well. I have gone through your topic, and I can understand your situation since I have extensive experience in dealing with mediclaim issues. I 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 can explain the process to you over the telephone so that next time you don't have to face any issues. You can call me at 8447412597.
Thanks,
C.K. Mohanty
From India, Bhubaneswar
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Hope you are doing well. I have gone through your topic, and I can understand your situation since I have extensive experience in dealing with mediclaim issues. I 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 can explain the process to you over the telephone so that next time you don't have to face any issues. You can call me at 8447412597.
Thanks,
C.K. Mohanty
From India, Bhubaneswar
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