Ask for the group policy's membership-termination and hospitalisation clauses before accepting that your claim ended with your last working day. The admission date, effective deletion date and policy wording may determine different parts of the claim. HR's instruction to remove you from the group is not, by itself, a reasoned insurer decision on an existing hospitalisation. Notify the insurer or TPA immediately and preserve the admission, authorisation and employment-exit records.
Which dates need to be compared?
Record the hospital admission, treatment period, discharge, last working day and date on which the employer asked the insurer to delete membership. Obtain the effective date actually recorded by the insurer. A request sent later may claim an earlier effective date, so keep both rather than describing them as one event.
Ask whether the policy covers the relevant event by reference to admission, treatment incurred during membership, or another defined condition. Do not assume that every group contract uses the same wording. Coverage of an admission already underway, later treatment and a new admission can require separate analysis under the actual terms.
What documents should HR and the insurer provide?
Request your certificate or membership record, the relevant master-policy wording and endorsements, the Customer Information Sheet, the deletion request and its effective-date confirmation. The IRDAI health circular requires a Customer Information Sheet for members of group policies as well as individual policyholders. A benefits brochure alone may omit the clause being relied upon.
Keep the cashless request, approval or denial, TPA communications and discharge documentation. An initial authorisation should be read for its terms rather than assumed to guarantee every later charge. If the claim is refused, request the insurer's written reason identifying the exact clause and dates applied.
Is this a missing-membership-record problem or an exclusion?
Separate those grounds. The IRDAI circular requires insurers to obtain group-member details from the master policyholder to provide cashless settlement from commencement of cover and states that a claim should not be denied for non-availability of those details. That provision may matter where HR failed to send an enrolled person's information.
It does not create indefinite cover after membership has lawfully ended or remove every policy exclusion. Ask the insurer to say whether it disputes your membership on the relevant date, the treatment's coverage or merely the availability of the employer's record. The evidence needed to answer each objection is different.
What if HR deleted me before my actual last working day?
Supply the accepted resignation, notice-period arrangement, attendance or payroll record and the employer's stated exit date. Request correction of an inaccurate deletion instruction and confirmation from the insurer of the resulting membership record. A change to HR's internal sheet alone may not update the insurer's system.
If the employer's benefit promise and the insurer's policy terms differ, there may be separate questions about the employer's contractual responsibility. Give the adviser both documents. Do not assume that the insurer must honour every informal assurance made by a manager, or that a policy rejection necessarily disposes of a claim against the employer.
Can migration solve the current admission?
Ask promptly about migration to an individual or family policy with the same insurer. The IRDAI circular recognises transfer of specified credits for indemnity policies, including group members, when migrating. Those credits can concern waiting periods and other accumulated benefits within the applicable scope.
Migration is not a reason to assume that a new policy will retrospectively pay a disputed admission. Ask for the new cover's effective date, accepted terms, credited periods and any requirements before accepting it. Keep the existing hospitalisation claim and the future-continuity request separately identified so that neither disappears in the correspondence.
What should I do while treatment continues?
Ask the hospital insurance desk to provide the claim reference and the precise information requested by the insurer. Share the relevant employment and membership evidence through the proper channel. Do not postpone necessary medical decisions solely while waiting for an HR response. Preserve payment receipts if a payment becomes necessary.
Raise a written grievance with the insurer if the explanation remains inadequate. The health circular requires a Claims Review Committee decision for repudiation. Ask whether the communication is a cashless authorisation refusal or a final claim repudiation and request the applicable review. Obtain advice on further remedies using the complete policy, dates and written decision, rather than relying on a generic assurance that employer insurance always lasts until discharge.
Read the related health-insurance guide for the wider issue. The employment and labour practice page identifies the relevant practice area.