Tips To Remember To Claim Health Insurance Cover From Your Employer


Health insurance is a vital financial protection that can help you and your family cope with medical emergencies. However, buying a health insurance policy on your own can be expensive and complicated. That is why many Indian employers provide health insurance to their workers as one of the perks of their job. This way, you can enjoy health insurance benefits without paying the full premium or going through the hassle of choosing a suitable plan.

However, having employer-provided health insurance coverage does not mean you can claim it without hassle. In order to make sure your claim process goes smoothly and successfully, there are specific things you should keep in mind and follow. Here are some tips to help you claim health insurance coverage from your employer in India.

  1. Know your policy details

The first and foremost thing that you need to do is to know the details of your cashless health insurance plan provided by your employer. You should be aware of the following aspects:

  • The sum insured amount and the sub-limits for various expenses
  • Network hospital list where you can get treatment for free
  • The exclusions and waiting periods for certain diseases and treatments
  • The co-payment and deductible clauses that require you to share the cost of treatment
  • The claim settlement process and the documents required
  • The contact details of your employer, insurer, and third-party administrator (TPA)

You can get these details from your employer, insurer, or TPA. You can also read the policy document carefully and keep a copy handy for reference.

  1. Inform your employer and TPA

The next step is to inform your employer and TPA about your hospitalisation as soon as possible. This is especially important if you opt for cashless treatment at a network hospital. You must fill out a pre-authorisation form and submit it to the TPA with your e-card or identity proof. The TPA will verify your details and approve or reject your request within a few hours.

If you opt for reimbursement, inform your employer and TPA within a specified time limit after your discharge from the hospital. Collect all the original bills, reports, prescriptions, and discharge summaries from the hospital. Submit them to the TPA along with a duly filled claim form.

  1. Avoid common mistakes

While claiming health insurance coverage from your employer, you must refrain from common blunders that can lead to rejection or delay of your claim. Some of these mistakes are:

  • Hiding or misrepresenting your medical history or lifestyle habits, such as smoking
  • Getting treatment at a non-network hospital without prior approval from the TPA
  • Exceeding the room rent limit or opting for unnecessary services or procedures
  • Failing to submit the necessary documents or providing incomplete or incorrect information
  • Not following up with the TPA or insurer about the status of your claim

To avoid these mistakes, you need to be honest, careful, and proactive while claiming health insurance coverage from your employer.

  1. Have a backup plan

While employer-provided health insurance coverage is valuable, it may not be sufficient or suitable for your needs. For instance, it may have a low sum insured amount, a high co-payment clause, or a limited coverage scope. Moreover, it may not cover your dependents, such as parents or in-laws or cease to exist if you change or lose your job.

Therefore, it is advisable to have a backup plan in the form of an individual health insurance policy or family health insurance plan that can supplement or replace your employer-provided coverage. A personal health insurance policy can offer flexibility, customisation, and portability. It can also help you save tax under Section 80D of the Income Tax Act.


If you follow these tips, claiming health insurance coverage from your employer can be easy and hassle-free. However, you should not rely solely on your employer-provided coverage and consider buying a personal health insurance policy as well. This way, you can ensure adequate and comprehensive coverage for yourself and your family in case of any medical emergency.