To ensure the health of your business, it is necessary to take care of your employees’ health. By offering a group medical insurance policy, you can take care of your employees’ rising medical expenses that could otherwise be a major burden on their finances.
Often, organizations review the background of insurers and the policy but fail to customize policies. Most group health insurance policy offers basic coverage like pre- and post-hospitalization medical expense cover, cashless hospitalization, advanced technological surgery coverage, etc. However, there are other benefits you can discuss with your insurer and include in your corporate health insurance.
Key Takeaways
Expanding the Safety Net: Extending parental age limits to 80 ensures employees aren’t forced to buy expensive individual senior citizen plans, though co-payments can help manage the employer’s cost.
Fixed Benefit for Critical Care: Since treatments like chemotherapy can cost ₹10–20 lakh, adding a critical illness rider provides a lump-sum payout that helps cover loss of income and non-medical costs.
Eliminating “Hidden” Costs: Many claims leave 35% of costs unpaid due to caps on PPE, ICU, or bed charges. Customizing these terms allows for a much higher settlement percentage for the employee.
Modern Surgical Coverage: As technology advances, many complex procedures no longer require 24-hour stays. Increasing the list of covered daycare treatments ensures these are not skipped due to cost.
Comprehensive Life Events: Including maternity and accident riders (covering even non-hospitalized injuries like minor burns or fractures) creates a holistic plan that supports employees through various life stages and mishaps.
Additional Read: What are the benefits of group health insurance?
Extending the age limit for parents’ coverage
Many group mediclaim policies extend coverage to dependent parents of employees. However, such coverage often comes with an age limit of 65 years. You can customize this cover, increasing the age limit to at least 80 years.
Some health insurance companies might charge higher or extra premiums for this. In such cases, you can introduce co-payment or deductibles, which will allow you to share the cost with your employees. For employees, this will still be a better alternative than individually shouldering the rising healthcare costs that their parents may incur. It will also deter them from filing unnecessary claims.
Providing critical illness cover
Cancer killed 7.8 lakh people in India in 2018. The sad part is that even youngsters now suffer from critical ailments like cancer, heart disease, kidney failure, etc. The treatment costs for such illnesses can be very high. For example, chemotherapy can cost Rs 10 to 20 lakh in some cases. The situation is worsened if the person contracting the illness is the family’s breadwinner and is unable to work. Thus, cover for the total treatment cost of critical ailments and cover for the loss of income incurred would offer considerable relief to employees.
You can structure a fixed benefit to be paid if an employee is detected with a specified critical illness. Some insurers will insure up to 30 different critical illnesses.
Reducing non-payable hospitalization expenses
Expenses such as ICU charges, bed charges, etc. can be huge in case of a long-term illness requiring hospitalization. Normally, a cap is prescribed on these in an employee insurance scheme. However, employers can have this cap removed to enable employees to avail the best facilities at network hospitals.
This cap has been an issue for Covid treatment. Many insurers will not pay for more than 2 or 3 PPE kits per day. The cost of devices such as oximeters that are a part of Covid care is not payable. In fact, we estimate that in Covid claims, insurance does not pay about 35% of hospital costs. You can reduce, if not eliminate, this by agreeing on terms with the insurer.
Increasing the list of day-care treatments
Most day-care treatments can be expensive and might involve complicated procedures like eye surgery, angiography, and appendectomy. Employees might skimp on such procedures in the absence of necessary cover. As an employer, you can personalize your group mediclaim policy for employees by adding more daycare treatments; you can add well over 100 daycare procedures.
Covering maternity and baby care needs
The government recently decided to increase paid maternity leave for female employees from 12 weeks to 26 weeks. Similarly, you can help by covering maternity expenses and baby care expenses under a group health insurance policy. Though you might have to incur a slightly higher premium for providing maternity coverage, both female and male employees are likely to appreciate this move.
Adding accidental death riders
Employers can also choose to avail of personal accident cover as a rider to their group medical insurance policy. This will help employees in case they meet with an unfortunate mishap that leads to death or partial or total disability. You can also customize accident riders to include medical expenses arising from accidents. For example, fractures or burns that do not require hospitalization can be paid for under an accident rider.
A policy that that does not suit the needs of your employees might not be very useful. Additionally, customization helps provide extra provisions unavailable in the basic policy laid out by the insurer. These special provisions will depend on the size and type of your organization, location (metro, tier 1, or tier 2 cities), preferences of employees, etc.
Additional Read: How Group health insurance plans can help small-and-medium-scale businesses
Summary Table: Customizable Benefits in Group Health Insurance
| Customization Area | Standard Feature | Enhanced/Customized Benefit |
| Parental Age Limit | Often capped at 65 years. | Can be extended to 80 years or more. |
| Critical Illness | Basic inpatient costs. | Fixed-benefit payout for up to 30 specified illnesses. |
| Room/ICU Caps | Prescribed limits (e.g., 1% of SI). | Removal of caps to allow for better hospital facilities. |
| Daycare Procedures | Limited list of surgeries. | Inclusion of 100+ procedures (e.g., eye surgery). |
| Maternity & Newborn | Usually excluded in basic plans. | Comprehensive cover for delivery and baby care. |
| Accident Protection | Hospitalization only. | Riders for death, disability, fractures, or burns. |
How can SecureNow help you customize your group health insurance policy?
You can choose the right group medical insurance policy for your company with the help of SecureNow, a reliable insurance advisor. All you need to do is provide some basic details like the number of employees, riders, etc. We will then get you group health insurance premium quotes from leading insurers. Thereafter, we can help you compare these and choose the right one. If you would like, we can also help you in customizing your group health insurance plan.
Frequently Asked Questions (FAQs)
1. How can we afford to cover parents up to age 80 without the premium skyrocketing?
A) To manage costs while offering high-age coverage, you can introduce a co-payment (e.g., 20%) or a deductible. This shares the risk with the employee and prevents the filing of minor or unnecessary claims while still protecting them from major expenses.
2. What is the difference between standard hospitalization and a “Critical Illness Rider”?
A) Standard hospitalization pays the hospital bills for any illness. A Critical Illness Rider pays a fixed lump sum upon the diagnosis of a major disease (like kidney failure or cancer), regardless of the actual hospital bill. This helps the employee manage lifestyle changes or lost wages.
3. Why should I include daycare treatments if they don’t require an overnight stay?
A) Many expensive and life-essential procedures, such as dialysis, chemotherapy, and cataract surgery, are now completed in a few hours. Without a specific daycare clause, the insurer might reject the claim because the patient wasn’t admitted for 24 hours.
4. Does an “Accidental Death Rider” only pay out in case of a fatality?
A) No. Most accident riders are comprehensive and cover Total or Partial Permanent Disability as well. You can also customize them to cover “Outpatient” accident costs, such as stiches for a deep cut or plaster for a fracture that doesn’t require a hospital bed.
5. How does location (Metro vs. Tier 2 city) affect policy customization?
A) Medical costs and room rents are significantly higher in metros like Delhi or Mumbai. If your office is in a metro, removing “Room Rent Caps” is more critical than it might be for a company based in a smaller town where hospital rates are lower.
About The Author
Mayank Sharma
MBA Finance
He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.
