As the name suggests, a group health insurance plan gives coverage to a group of people, usually for the employees working in a company. It covers the entire group members under a single policy, called the master policy. Group health insurance is also known as employee health insurance or corporate health insurance. Generally, employers offer health insurance benefits to their employees to stimulate employee motivation, reduce the attrition rate, and augment the mental well-being of the employees. With a health insurance plan in place, the employees don’t need to worry about financial distress during medical emergencies.
The premium of a group health insurance plan can be paid either fully by the employer or partially by the employer and partially by the group member. The premium paid for a group health insurance can get a tax exemption under Section 80D of the IT Act. Normally, the issuers of these health insurance plans allow you to extend the coverage to your family members as well.
Group health insurance policies are usually issued for one year.
Suppose the group members are satisfied with the previous policy period’s experience. In that case, they can extend the health insurance for another year, and the renewals are generally eligible to get premium discounts.
Additionally, if the number of claims from a group was low during the previous policy period, then the insurer may extend a discount on the premium for the following year.
These days businesses that have at least 10 team members can sign up for group health insurance. The businesses can customize the plans according to the number of team members and the firm’s financial condition.
While selecting a group health insurance for your employees, don’t forget to check the following parameters.
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Types of hospitalization expenses included in the policy
Many expenses are associated with hospitalization, but all of them may not get coverage under group health insurance. Hence check which all costs come under the umbrella of the group health insurance. Usually, insurers cover the following hospitalization expenses:
- Room rent and ICU charges
- Doctors’ consultation fees
- Medicine, oxygen, etc.
- Nurses’ fees
- Surgery expenses, and so on
To keep the premium amount at the lower side, many group insurance policies offer limited coverage.
For instance, many insurers offer a lower daily limit for room rent. As a result, the employee may need to pay the difference in the room rent from their pocket if the daily rent of the hospital room exceeds the limit.
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The sum insured
Unlike in a family or individual health insurance where a prospective policyholder can select the sum insured of their choice, the members can’t choose the sum insured of their choice in a group health insurance.
The employer and the insurer together decide the sum insured of the policy, and usually, the sum insured will be the same for all employees. However, it should be sufficient to cover the medical expenses of individual members for a year.
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Road ambulance charges
Gone are the days when hospitals were not earning any significant income from ambulance services. These days ambulance charges are skyrocketing, and if you need their services during a medical emergency, they may charge many times more.
In such a circumstance, if the group health insurance policy does not cover ambulance charges, it may leave a deep hole in the member’s pocket.
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Daycare procedure expenses
Daycare procedures are those that require less than 24 hours of hospitalization. Yet, the costs associated with these procedures are not negligible. Dialysis, radiation, chemotherapy, etc., are a few examples of daycare procedures. In order to reduce the financial distress of the members, the group health insurance should cover daycare procedures as well.
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Pre- and post-hospitalization expenses
Several tests and consultations of doctors may be required before and after hospitalization.
Insurance must cover both these expenses. In India, a few insurance providers give a lump sum amount to the group members to meet the post-hospitalization expenses without collecting bills or receipts.
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Accidental hospitalization cover
The insurance policy should cover hospitalization, road ambulance charges, as well as pre- and post-hospitalization expenses if a group member or their dependents meet with an accident.
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Network hospitals
The insurer must have sufficient network hospitals in the town/city where the firm is located so that the employees can benefit from cashless treatments.
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Waiting period
A waiting period is when you can’t make claims to avail of certain benefits. But several insurers waive off the waiting period if the organisation satisfies certain conditions. It makes sense to go with an insurer who provides such a waiver.
While selecting the health insurance policy for your employees, don’t forget to check the exclusion list of the policy as well. Also, check the claim process of the insurance. Always go for a group insurance plan which has a simple claim process.
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