Can My Employer Reimburse Medical Bills During a Lapsed Mediclaim Policy?

Hi Seniors,

I have been working as an Engineer in a company as an Engineering Manager for the past 1.5 years. Our company has provided Mediclaim (both GMC & GPA) to me and my family, which lapsed due to non-renewal of the policy (the policy ended on 5th Aug '23). They renewed it on 27th Sep '23. During the lapse of the Mediclaim policy, my wife and daughter were admitted to the hospital, and both have to take regular medicine for 3 years.

My question is, can I submit my daughter's and wife's medical bills to the employer for reimbursement due to the expiry of the policy? Does the company have the liability to cover my medical expenses? How can I claim for 3 years of continuous medical expenditure from the employer in this situation?

Thanks in advance for your valuable suggestions.

Regards,

If 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 hospitalization occurred during a time when there was no active policy, the insurance company will not assume liability. In such a situation, the amount spent would have to be paid or reimbursed by the employer.

Under normal circumstances, medical insurance would cover hospital expenses, including medical bills during hospitalization. I don't think that if your dependents need to take medicine for three years, the insurance company will cover it. Similarly, in the absence of medical reimbursement as part of your remuneration structure, you will not get reimbursement for 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 to see what is covered.

Hi, Typically, when a health insurance policy lapses, it may not cover expenses that occurred during the lapse period. Renewing the policy afterward might not retroactively cover expenses incurred during the lapse. However, companies may have different policies and may provide some flexibility in certain cases.

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

Dear Sir,

The employer doesn't offer reimbursement; however, they also do not share their policy. They state that reimbursement of family expenses is not in our policy. My question is, if my family is covered in GMC, and they do not renew GMC during the lapse period, are they liable to pay medical expenses? If yes, where can I file a complaint against the employer?

Filing a complaint for non-statutory benefits

You cannot file a complaint against an employee for not providing any employee benefits that are not statutory in nature. However, you can take action against the employer for breach of contract in a civil court. The legal process may result in a verdict, but it could take ten to fifteen years. On the contrary, if the benefit is statutory, such as the employer failing to pay ESI contributions leading to your family members being deprived of benefits, you have immediate recourse through the relevant department.

Insurance coverage as a contractual benefit

Providing insurance coverage to employees and their families is not a statutory requirement but an employee benefit outlined in the employment contract. If this benefit is not honored by the employer, the employee can file a complaint for breach of contract, which is only actionable in a civil court, not a labor court.

Impact on employer-employee relationship

However, escalating the issue to this level may strain the employer-employee relationship and create a hostile work environment. It is advisable not to continue working for organizations that do not adhere to HR principles or ethical business practices. Therefore, seeking other job opportunities may be a viable option. In many cases, once your presence is deemed essential, the employer may opt for a settlement and cover the hospitalization costs promptly.