With increasingly stressful work environments and very less activity, majority of organizations are aware of the need to cover their employees with some sort of medical and personal accident coverage. While providing a group health insurance policy an organization or association, mainly covers various health aspects, health insurance coverage, affordability, and scope of benefits.
What is Group Insurance Policy?
Group health insurance offers cover to people belonging in a particular group. The groups could be employer- employee groups or other groups as per the group insurance guidelines given by Insurance Regulatory and Development Authority of India (IRDA).
In case of group medical insurance policy one is not asked to submit any medical reports and one can get coverage against pre- existing conditions amongst other benefits. Reasonable premium is another factor which makes it so popular. It is necessary to note that benefits of a group health insurance can only be availed through a group policy.
Customizing a group insurance policy
The scope and nature of an insurance policy will differ according to the company and business. Some companies will opt for an insurance cover which provides medical insurance of up to a fixed amount for employee and their family members; along with covering pre-existing ailments. It may also include health checkups and other benefits.
Generally, while customizing a policy organizations look for group policies that offer considerable benefits in negotiating premium amounts and better policy term; along with a lot of waivers as compared to individual policies. Here are few important benefits that an organization must consider customizing into a group insurance policy.
- Single policy for employee and his/her immediate dependents- This is one of the most common forms of group health insurance offered by employers to their employees. In this kind of a group medical insurance policy; health coverage is offered not only to the employee but also to their spouse, dependent parents and dependent children up to certain age. This helps in the employee not having to take an additional cover for their family as well.
- Favorable variables while including family members- Most insurance policies do not allow fresh applicants beyond the age of 60 years; however in case of many group medical insurance policies one can include family member from the age of 3 months right up to 80 years of age. With this benefit an employee whose dependent parents have still not have availed of any sort of insurance; can get the advantage of having insurance through this policy.
- Can claim medical benefit immediately – Normally there is a lock in period of 30 days for any sort of health care policy where the insured can make use of the terms of the policy only after a period of 30 days. In case of group medical policies there is no type of lock in period and the employees can avail benefits immediately after being included in the policy. This is very useful for employees that require immediate hospitalization and also protects the employer from any sort of financial trouble when an employee gets unwell within a short period of getting employed.
- Limitations for miscellaneous charges on hospitalization- Majority of medical policies have limitations or capping on miscellaneous charges like bed charges, medications, and ICU charges and so on. In group policies capping limitations are flexible can be set by the employer, which also affects the premium amount. Hence an employer as per their budget can fix the capping amount or even put no capping limit on the sum assured.
- No Medicals- Normally health policies require medical check-up for a person after 45 years of age. But the best part of availing a group policy is a huge benefit of no medical check-up for employee or their family up to the age of 80 years; also providing cover from the day they receive the policy.
- Maternity Benefits– Most individual health insurance policies do not cover maternity benefits; however, group health policies offer this benefit and can be easily availed immediately either by a woman employee in case they require or in case of a male employee by their wife/spouse.
- Baby cover from birth- Most group health policies offer insurance cover to a newborn child of an insured mother from day one for expenses (subject to policy limitations) incurred for treatment. The treatment needs to be taken in registered Hospitals/Nursing Homes/Day Care Clinics provided by the policy. The mother requires being an in-patient and in turn newborn child can be treated as a part of the mother.
- Low Cost – Compared to individual health plans an organization can avail of group health plans which are 30-35% cheaper; making the premium paid per person much lower than an individual health plan.
- Pre Existing Diseases Clause- Normally health insurance policies do not cover pre existing diseases and if they do would have a lock in period of around 4 years. But in a group medical insurance there is no locking period applicable for pre-existing diseases and the employees and their family are covered under pre existing diseases from day one of the policy. This is very beneficial both to the employees and employer.
- Value Added Benefits- A medical policy usually brings to mind doctor visits, hospitals and so on. But often one doesn’t know that the insurance carrier may also provide services like “Value Added Benefits”. In a group policy these services help to encourage healthy lifestyles; which in turn help keep employees healthy; which keeps insurance claims down. A company can opt for various value added benefits from an insurance carrier for their employee’s such as- discounts or reimbursements for nutritional supplements, discounts on programs that relate to quitting smoking, discounts available for health club membership, and so on.
Keeping in mind today’s high stress work environment, employer-sponsored group medical insurance policies are a vital part of any good human resources management team, as it helps the employer to build trust among employees and is also one of the most important ways to motivate and retain employees.
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