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 few limitations of the group health insurance program –
- The employee has little or no control over their individual coverage. The benefit structure of the group plan is designed keeping in mind the larger audience, hence misses 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 is linked 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 are considered to be a higher risk within the group policy. The group policy does not necessitate individual medical underwriting for enrollment in the policy. Hence premium is charged basis 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 does not extend to all financially dependent family members including but not limited to parents, siblings, more than 2 kids, etc. Also, covers for OPD expenses including doctor consultations and routine medications, health check-ups, etc. have to be purchased from elsewhere.