Group Health Insurance Claim Rejected After Leaving the Job

Reviewed on: 2026-06-12.

Direct answer: Group cover usually ends when your employment ends, often on your last working day or when HR removes your name from the master policy. Whether your claim is valid turns on one comparison, the date of admission against the date your cover ceased, not your salary. First, get the exact cover-cease date and the deletion date from HR and the third-party administrator (TPA) in writing. If the admission fell within the cover, send a written appeal to the insurer's grievance officer, then escalate on IRDAI's Bima Bharosa portal, and finally to the Insurance Ombudsman. If the admission fell after cover ended, the original claim may not revive, but IRDAI portability lets you carry your continuity benefits into an individual policy. Save every email; the date trail is your case.

This guide is for salaried employees and their dependants in India whose hospitalisation claim was rejected on the ground that the employee had already resigned, retired, or been separated.

Almost every group-cover-after-exit dispute turns on this single comparison:

• Date of admission (or date of service) on the hospital record.
• Date your cover ceased, shown by your relieving letter and the deletion endorsement.

If the admission falls within your cover period, the claim should be payable and the rejection is likely wrong. If it falls outside, your route is portability or a personal policy, not an appeal on the original claim. Salary credit rarely decides this; the policy roster does.

A group health policy is a contract between your employer and the insurer. You are a member, not the policyholder. When you leave, the employer normally removes your name and your cover ends. The exact trigger varies by policy. It may be your last working day, the end of the policy month, or the date HR sends the deletion request to the insurer. There is no single national rule, so you must read the actual clause. Ask HR in writing which date applies, and for a copy of the cessation clause.

1. Find the rejection in writing. SMS, email, or letter. Read the exact reason, usually “member not active on date of admission” or “cover ceased on exit”. Note the date the insurer says cover ended.
2. Pull two dates. Date of admission from the hospital record, and last working day from your relieving letter. Write both down.
3. Email HR. Ask for your relieving letter, last working day, the exact date your name was deleted from the policy, and the cessation clause.
4. Email the TPA or insurer. Ask for the master policy number, your member endorsement with inclusion and deletion dates, and a written rejection stating the reason and clause. A verbal “no” is not enough.
5. Build a one-page timeline of all key dates and keep every document in one folder.

If the admission genuinely fell after your cover ceased, the original claim may not be revivable, but your continuity still matters. IRDAI rules allow a member to port or migrate from a group policy to an individual or retail policy, subject to conditions and timelines, usually within a window around exit. Acting quickly protects waiting periods you have already served. Ask the insurer and TPA in writing about portability, any grace period, and the deadline. For the full comparison, read our companion guide on corporate health insurance continuity after a job change.

To,
The Grievance Redressal Officer
[Name of Insurance Company], [Address]

Subject: Appeal against rejection of group health claim -
Policy No. [Group Policy No.], Claim No. [Claim No.]

Respected Sir / Madam,

1. I am [Your Name], a member / dependant under the group health policy taken
   by my former employer [Employer Name], Policy No. [Group Policy No.].
2. I was hospitalised at [Hospital] with admission [DD/MM/YYYY] and discharge
   [DD/MM/YYYY] for [brief description]. The claim amount is Rs [amount].
3. The claim was rejected vide [letter / email / SMS] dated [DD/MM/YYYY] on the
   ground that cover had ceased on exit.
4. Key dates: joining [DD/MM/YYYY]; last working day [DD/MM/YYYY]; deletion from
   policy [DD/MM/YYYY]; admission [DD/MM/YYYY].
5. As the admission falls within the period I was a covered member, the claim is
   payable. I rely on the cessation clause, enclosed.
6. I request you to reconsider and settle Rs [amount], or to issue a written
   speaking order stating the exact clause and the exact date cover ceased.

Yours faithfully,
[Your Full Name], [Member ID], [mobile, email]

Enclosures: rejection letter, relieving letter, member endorsement, hospital
records, final bill, one-page timeline, email trail with HR and TPA.

The RTI Act, 2005 applies to public authorities. Here it helps only when your former employer is a government department or a PSU that holds the group policy. Then you can ask the Central Public Information Officer for a copy of the master policy and the cessation clause, the exact dates your name was added and deleted, and any internal correspondence with the insurer or TPA about your membership around the hospitalisation. These records settle the date dispute. See how to file an RTI online and first and second appeals.

• Private insurers and private TPAs are not public authorities. RTI does not reach their internal claim notes.
• RTI cannot pay or reverse a claim. It only gives information. The substantive remedy is the insurer grievance route, then IRDAI Bima Bharosa, then the Ombudsman.
• It is slower than the dedicated channels. Use it to support your case, not as your main remedy.

• Arguing about salary instead of the two dates.
• Accepting a verbal rejection without a written reason and clause.
• Not getting the deletion date from HR.
• Missing the portability window while arguing about the old claim.
• Skipping the insurer grievance stage; the Ombudsman expects it first.
• Putting guessed timelines or section numbers in your complaint.

Group cover usually ceases on your last working day or the date your name is removed from the policy roster. What matters is the admission date against the cover-cease date, not your salary credit. If the admission falls after the cover-cease date, the insurer treats you as uncovered. Check your relieving letter, the date HR informed the insurer, and the exact admission date.

It depends on the master policy and the terms agreed with the insurer. For some policies cover ends on the last working day; for others it runs to the end of the policy month or until HR deletes your name. There is no single national rule. Ask HR in writing for the exact deletion date and the cessation clause.

Not automatically; it belongs to the employer. But IRDAI rules allow portability or migration from a group policy to an individual policy, subject to conditions and timelines, usually within a defined window around exit. Ask the insurer and TPA in writing about portability and the deadline, ideally before you leave.

Send a written representation to the insurer's grievance officer and keep the acknowledgement. If the reply is unsatisfactory or none comes in time, register a complaint on IRDAI's Bima Bharosa portal. If that does not resolve it, approach the Insurance Ombudsman for your area, which handles personal-line disputes free of cost.

Generally no. The RTI Act applies to public authorities, not private insurers or TPAs. RTI helps only in the narrow case where your former employer is a government department or PSU, where you can seek the group-policy records and your inclusion and deletion dates. For the dispute itself, use the insurer grievance route, Bima Bharosa, and the Ombudsman.

Yes. You normally approach the Ombudsman within a defined period after the insurer's final reply or after the grievance went unanswered for the prescribed time, and the matter should not already be in court. The exact timelines and monetary limits are set by the ombudsman rules. Confirm current limits on the official portal before filing.

• Corporate health insurance continuity after a job change
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• Practical Guides hub

Official links: IRDAI, Bima Bharosa grievance portal, Council for Insurance Ombudsmen.

Download the group-health-after-exit appeal checklist (PDF).