Group Health Insurance

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Factors affecting the cost of a group health insurance policy

A group health insurance policy covers many individuals under a single policy. An insurer will issue a master group medical insurance policy to recognized groups. It will have the names of all insured members. When new individuals join the group, the policy covers them by default. So, there are various factors affecting the cost of a group health insurance policy

These are:

  1. Type of group being insured

Employer-employee groups, clubs, associations, etc. have members from a specific socio-economic background. They are considered low-risk. Thus, the premiums for their group mediclaim insurance policy are lower. However, members of trade unions, or farmers, or other groups are seen as having many health risks. Thus, they have a higher group medical insurance cost.

  1. Number of members covered in the policy

This is a simple equation. As the number of members covered increases, the group health insurance premium rises.

  1. Sum insured and coverage benefits of the policy

A high sum insured means the premium for group medical insurance will also be high. Similarly, a plan can offer many coverage benefits. It can also extend coverage to members’ dependents. In such cases, the premium would increase.

  1. Add-ons selected for the policy

If a group chooses optional coverage riders, the group health insurance premium increases. This is because each rider comes at an additional premium. If you opt-in for caps on common diseases like kidney stone, hernia, cataract, etc. insurers are likely to offer discounts in premium. However, ensure that the limit for each disease is sufficient for treatment. For e.g., a cap of Rs 30-35,000 per eye for cataract treatment is adequate.

Additional Read: How to customize your group health insurance policy

  1. Claims experience in the group cover

Group medical insurance plans offer discounts if the loss ratio i.e. claims/premium is less that 100%.

Compare costs and benefits for best group mediclaim policy

Different insurance companies have different pricing policies. Thus, you will find different premiums for the same coverage. So, compare plans based on coverage benefits, the sum insured, and the premium. Then, choose one that offers a competitive premium and good coverage benefits. Finally, you can add or remove optional coverage benefits. This will help you find the best group health insurance premium.

Factors influencing group health policy renewal 

At the time of renewal, the insurer revises the group health insurance premium based on:

  • The number of members
  • The increased age of each member
  • New add-ons, if any
  • The claims made in the past year

If there are only a few claims in the previous policy year, the insurer might offer discounts.

Case study: A broker can help you get the best policy

A large food company was about to finalize mediclaim for its employees. At the very last moment, a senior executive of the company called SecureNow for a second opinion.

Corporate Manager Gaurav Negi met the HR person responsible for the deal. He was shocked when he learnt the terms and conditions and the price the insurance company had offered. We analyzed their previous policy and claims and noticed that the insurer was charging a higher renewal premium for lower benefits.

Thereafter, we floated a fresh RFQ among insurers, both in the public and private sector, to generate fair renewal prices. Finally, we removed some clauses/caps and negotiated with the insurance companies.

After two days, we presented our comparative options to the client. We had managed to reduce the premium by 50%, i.e., a savings of Rs 10 lakh. We included maternity benefits with no waiting periods, removed disease-wise caps, and improved the list of network hospitals. Additionally, we provided employees with a tele-doctor facility.

Generally, people shy away from brokers over concerns that costs will increase. As this case study shows, the impact of working with a broker can be exactly the opposite — a cheap policy with excellent benefits. SecureNow made a difference because we understand the market and competitive context and our buying process forces insurers to compete with one another. The net result is that the client benefits.

How can we help?

SecureNow is an IRDA-licensed broker. We are authorized to represent the client to the insurance company and help buy the best product from any insurer. Our responsibility is to the client and not the insurer.

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