How to Understand Your Group Medical Benefits

• Review Your Policy: Ensure you receive materials from HR, such as policy documents, online access, and contact details for your insurer. Store these in a safe place for easy reference.

• HR Briefings: Your company may offer a briefing to explain the benefits. This is a great opportunity to clarify any questions.

• Key Benefits in Your Policy

• Inpatient Benefits: Coverage for overnight hospital stays, surgeries, ICU care, and other hospital-related costs.

• Out patient Benefits: Includes doctor consultations, diagnostic tests, prescription medicines, and some alternative treatments like Traditional Chinese Medicine.

• Additional Benefits: Depending on the plan, your coverage may include:

o Dental Care (routine check-ups and procedures)
o Annual Health Checkups
o Optical Care (eye exams and glasses)
o Mental Health Support
o Maternity Coverage
o Life Insurance (available in larger companies for executive-level staff)
o Wellness Programs (fitness programs and discounts)
Important Details to Review

• Sub-limits: Some plans may have restrictions on coverage per category of care. Review these limits to avoid unexpected out-of-pocket expenses.

• Area of Coverage: Does your plan cover local care only, or does it include international coverage?

• Hospital Room Class: Plans may vary in terms of room level covered. It’s crucial to understand which room classes are included to avoid additional charges.

• Specialist Referrals: Some plans require referrals for specialist services. Be sure to get the necessary paperwork from your primary doctor.

Coverage for Dependents
Check if your spouse and children are included under your company’s group medical plan. If not, you may want to consider top-up insurance to extend coverage to your dependents.
Exclusions and Portability

• Exclusions: Be aware of what is not covered under your plan (e.g., cosmetic surgery, professional sports injuries, and certain self-inflicted conditions).

• Portability: Some plans allow you to transition to an individual policy upon leaving the company, ensuring you retain coverage for pre-existing conditions.

• Managing Claims

• To efficiently manage your claims:

• Gather the Necessary Documents: Claim forms, medical receipts, and any proof of treatment will be required.

• Claim Process: Submit claims through your insurer’s web portal or mobile app. Ensure all necessary documents are in place for timely reimbursement.

• Seeking Medical Care

• Finding Healthcare Providers: Use the insurer’s network of doctors and clinics for direct billing access, especially if your plan offers cashless treatment.

• Hospital Stays: Contact your insurer before any hospital admission to ensure pre-authorization and a guarantee of payment.

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How to File a Claim

1. File your claim through the insurer’s platform.

2. Document Requirements: Include all necessary forms, receipts, and medical documentation.

3. Multiple Claims: If using both your group plan and personal insurance, file from the group plan first, then submit the remaining balance to your personal insurer.

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Need More Help?
If you need further clarification on your employee health benefits, feel free to reach out to HR or your insurance advisor. We're here to help you navigate your coverage and ensure you make the most of your benefits.