SOP For Medical Insurance

Standard Operating Procedure for Medical Reimbursement Documentation
Ver 1.0
Dated: October 19, 2023
Ref No.ONE/HQ/HR/ONW/MedicalInsuranceSOP/0001
Table of Contents
1 Objective:.............................................................................................................................................. 2
2 Scope:.................................................................................................................................................... 2
3 Procedure: ............................................................................................................................................ 2
3.1 Medical Cases: .............................................................................................................................. 2
3.2 Maternity Cases:........................................................................................................................... 2
4 Submission:........................................................................................................................................... 2
5 Verification: .......................................................................................................................................... 2
6 Compliance: .......................................................................................................................................... 3
7 Assistance: ............................................................................................................................................ 3
8 Feedback: .............................................................................................................................................. 3
Ver 1.0
1 Objective:
The purpose of this Standard Operating Procedure (SOP) is to establish clear guidelines for the
submission of necessary documentation for medical claims reimbursement within our
organization. This procedure ensures that the required documentation is consistently provided
for the efficient processing of medical claims.
2 Scope:
This SOP applies to all employees submitting medical claims for reimbursement.
3 Procedure:
3.1 Medical Cases:
For medical claims in normal / routine cases, the following documentation is required:
a. Doctor's Notes / Recommendation
b. Payment Receipt
c. Discharge Summary / Certificate
d. Other relevant documents/files pertaining to medical case
3.2 Maternity Cases:
For maternity cases, the following document is mandatory:
a. Doctor's Notes / Recommendation
b. Payment Receipt
c. Discharge Summary / Certificate
d. Birth Certificate of new born
e. Other relevant documents/files pertaining to medical case
4 Submission:
a. Employees are responsible for collecting and submitting the required documents within the
policy period from the date of incurring the medical expense.
b. Claims should be submitted on the prescribed Medical Reimbursement Form available from
the HRMS on Employee Profile.
c. Employees reporting / deputed at Zones should submit their forms to the AM Coord Zone
who will then compile the documents and share with HR Department for further processing.
5 Verification:
The HR Department shall be responsible for the initial verification of the submitted documents.
Ver 1.0
6 Compliance:
a. Compliance with these documentation requirements is crucial to ensure efficient processing
of medical claims.
b. Failure to provide the necessary documentation may result in delays or rejection of the claim.
7 Assistance:
a. If employees have questions or need assistance in gathering the required documents, they
should reach out to the HR department or the designated point of contact within their
respective zone.
8 Feedback:
a. Encourage employees to provide feedback on the reimbursement documentation process to
make continuous improvements.
This SOP outlines the standard procedure for the submission of medical reimbursement
documentation within our organization. It is essential to ensure the completeness and accuracy
of the documentation to expedite the claims processing. Any deviations from this procedure
should be reported and addressed promptly.

SOP For Medical Insurance

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Standard Operating Procedure for Medical Reimbursement Documentation

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