This post sets out to clarify the interpretation of family in group health insurance. It also examines the implications of extending medical insurance cover to the families of employees.
Family in the group health insurance context
A group health insurance policy often extends cover to the families of group members in addition to the members themselves. In this context, family is understood to include the legal spouse, legal and dependent children and siblings, and dependent parents or in-laws.
However, different insurance providers might have different policies regarding coverage for families. For instance, some might not extend cover to elderly parents, while others might not cover siblings. It is important, therefore, to read the policy document carefully to ascertain who is covered by your policy.
Additionally, some insurance providers might charge an additional premium to provide cover to elderly parents. However, this might still be cheaper than and easier than trying to find individual health insurance policies that cover elderly parents.
Case study: Deductible for extending cover to parents
Software engineer Ravish Sharma moved from Chennai to Pune to be with his aged parents. He found a job that paid a handsome salary and offered attractive perks.
One of the benefits his employer offered was corporate health insurance. The policy covered Ravish’s medical expenses as well as those of his family. Since Ravish’s family only included his parents, the insurer agreed to cover them. However, since his parents were above 60 years of age, the insurer set a high deductible limit. In the insurance segment, deductible is the amount you have to pay before the insurer will settle the rest of the claim.
Because his parents were elderly and individual health insurance policies could prove far more costly, Ravish decided to pay the deductible. The group health insurance company then agreed to cover both Ravish and his aged parents under a single policy.
Case study: Cover for parents but not for niece
Jyoti Kumari recently joined LK Solutions. Along with her attractive salary package, her new employer offered her a group health insurance policy as well.
On her induction day, the HR manager explained that the policy covered not only Jyoti but also her family members. Jyoti lived with her husband, their two-year-old son, and a niece who was staying with them to pursue her higher education. So, when the HR executive asked her to fill in her family details in the insurance form, Jyoti included her niece as well.
However, the insurer refused to cover her niece. The insurer did not consider Jyoti’s niece part of her family, even though the girl had been staying with Jyoti for the past five years. For insurance purposes, the insurer considered only her husband and son as her family.
However, in the case of Jyoti’s colleague, Rahul, the group health insurance provider agreed to cover his parents who were dependent on him. His parents fell within the definition of family in the group mediclaim policy and were, therefore, covered.
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.
