Though group health insurance policies are extremely flexible by design in terms of enrollment and operability, they come with their own set of limitations. Below we highlight a few limitations of the group health insurance program –
- The employee has little or no control over their individual coverage. Designed the benefit structure of the group plan keeping in mind the larger audience. Hence, missing out on specific and more particular coverage that might be of interest to an individual member. Typically group policies have restricted sum insured, room-rent, and disease-wise limits.
- Coverage in the group health insurance policy links to employment. The policy ceases as soon as the employee leaves the job. All accrued tenure-linked benefits, including pre-existing and disease-wise waiting periods, end then and there. On the other hand, individual health insurance policies have lifetime renewability and preserve waiting periods.
- Healthier individuals pay the same premiums as those who consider being at higher risk within the group policy. The group insurance policy does not necessitate individual medical underwriting for enrollment in the policy. Hence premium is charged basis of the member’s age and sum insured, disregarding present health condition which should be the most important factor to be considered.
- Most people need additional coverage not included in their company’s group health Typically coverage definitions in a group policy do not extend to all financially dependent family members including but not limited to parents, siblings, more than 2 kids, etc. Also, covers OPD expenses including doctor consultations and routine medications, health check-ups, etc. need to purchase from elsewhere.
Written By-
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.
