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What Documents Are Needed To File A Claim For Group Health Insurance?

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This blog discusses the documentation required in group health insurance and how to file a claim if something goes wrong. By understanding these requirements, you will be in a better position to make an informed decision about whether or not health insurance is right for you.

Documentation required in group health insurance plans in India 

If you’re looking to buy group medical insurance in India, you’ll first need to gather some documents. Ideally, these details are readily available to your employer. Your employer will submit this information on your behalf to the insurance company when buying a group insurance policy for the entire organisation.

Here are the seven essential documents that you’ll need as an individual: 

1. Aashaar and PAN card (if applicable) 

2. Passport size photo 

3. A valid passport 

4. Two colour passport-style photos 

5. Proof of address in India – electricity bill, rent receipt, or bank statement

6. Medical certificate of any pre-existing conditions

7. Proposal form

Make sure to bring all these documents with you when you purchase your medical insurance plan. Many insurers have adopted the online method for buying health insurance. All you need to do is choose the right insurer and policy, upload the mentioned papers on your preferred insurer’s portal, make the payment via net banking, and the policy will be delivered straight to your inbox. 

Documentation required in group health insurance while registering a claim 

When it comes to filing a medical bill claim for group health insurance, it’s important to have all the required documents ready. Make sure you have your ID, proof of residency, and information about who is covered under the policy. Having all the important papers in one place will make the process a lot easier. Filing a claim can be confusing, but it will go smoother with these documents. So, don’t hesitate and get everything ready before filing your claim! 

  1. Claim intimation form is mandatory, irrespective of cashless or reimbursement, online or offline mode, network or non-network hospitalisation.
  2. Copy of your health card/policy number 
  3. Pre-authorisation letter from TPA, approval from the insurance provider in case of pre-planned hospitalisation. In case of an emergency hospitalisation, the forms must be submitted within 24 hours. 
  4. All original medical bills from the hospital.
  5. Medical reports and course of treatment prescribed by the acting doctor or surgeon.
  6. Discharge summary 
  7. FIR in case of an accident or death certificate for loss of life. Post-mortem status.
  8. Any form of cash memos, written prescription medicines, doctor consultation follow-ups post hospitalisation. 
  9. Invoice related to medical tests, health certificates, diagnosis reports, X-rays, MRIs, etc. 
  10. KYC documents and bank details of the employee’s nominee or beneficiary.

How do you go about filing your claim? 

Whether you’ve been physically hurt as a result of an accident or not, it’s important to know what documents are needed to file a claim for group health insurance. These documents vary depending on your injury’s severity, but you will typically need your original policy card, ID card, and proof of coverage. In addition to this, it can be helpful to have medical records to support your claim.

Filing a claim can be confusing and time-consuming, but it can go smoothly with the correct information and help. Make sure to consult with an insurance representative or claims specialist to get started on your claim. They insurer CS/CX will be able to walk you through the process step-by-step and help you get the most out of your group insurance policy. 

When do you need to file your claim? 

There are a few documents that you’ll need to file a claim for group health insurance. 

  • The first of these is your policy number. It would help if you had this to identify your coverage and process your claim. 
  • Next, you need to know the date your coverage starts. This is important as it will help determine when your policy starts and stops covering certain benefits. 
  • Next, you need to know the name of your insurance company. This will help you get in touch with them should there be any questions or problems with your claim. 
  • Finally, it’s essential to know which benefits apply to you. This will help you understand what needs to be documented in your claim. 

Make sure to keep track of the dates and times of any covered events, as this will help support your claim. With the information you’ve gathered, it’s now time to file your claim! 

Frequently Asked Questions

How can I determine whether I’m eligible for coverage under my group health insurance plan? 

You’ll first need to gather all required documents to determine if you’re eligible for coverage under your group health insurance plan. This could include your doctor’s diagnosis form, hospital discharge papers, medications list…etc. Next, ensure all of the necessary documents are with you when filing a claim. This means you bring everything with you to your doctor’s visit or hospital stay so they can easily document your case. Once you have all of the mandatory documents, it’s time to explore your plan’s website. There, you’ll be able to see what documentation is needed to file a claim and find out more about your coverage options. 

Which five documents are needed to file a claim for group health insurance? 

To file a claim for group health insurance, you will need the following: 

1. Proof of coverage (like a health insurance card or Medicare card). 

2. A completed claim form. 

3. Original signed contract. 

4. Copy of all member documents, including birth certificates and ID cards. 

5. Copies of all financial documents, including bank statements and pay cheques from the last six months. 

When do I need to submit these documents? 

You will need to submit these documents if you are filing a claim for group health insurance:- 

Claim Form – Fill out this form and include any relevant information, such as what services were provided and the amount paid. 

Medical Records – If an illness or injury led to the filing of the claim, you must provide medical records as proof. – 

Payment Info – Specify how much money should be sent to cover costs associated with the claim. – 

Proof of Coverage – This is typically a copy of your coverage letter. – You need to submit these documents if you file a life insurance claim.

Life Insurance Policy – Show your policy number and the dates of the policy. 

Death Certificate – Show the name of the deceased, the date of death, and the cause of death. 

Can I file a mediclaim if my policy has lapsed or been cancelled? 

Yes, you can file a mediclaim even if your policy has lapsed or been cancelled. To do so, you will need the following documents: 

1. Proof of insurance (policy ID card and seal/stamped copy of your insurance policy); 

2. Evidence That Coverage Existed At The Time Of Occurrence (if it was a late cancellation claim, for example); 

3. Proof of Loss (proof of the damage done, such as photos or video recordings). 

What happens if I don’t submit all of the required documents? 

If you do not submit all of the required documents for filing a Group Health Insurance Claim, your mediclaim may be denied or may take longer to process. Failure to submit any one of these will result in a delay or rejection of your claim. Some of the mandatory documents needed for filing a Group Health Insurance Claim are Proof of insurance coverage, Member ID Card, and Copayment Agreement. If you accidentally damage any of these documents, contact your health insurance company as soon as possible to file a claim. 


In this blog, we have outlined the various documentation required in group health insurance for Indian insurers. Following the instructions provided, you can file your claim smoothly and without hassle. 

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Hi everyone! I'm a growth marketer at Plum Insurance. I specialise in crafting functional and structural articles for search engine optimisation. I joined the insurtech space in 2018 and have been writing ever since. Also, I'm fluent in intermediate Python ๐Ÿ as well.