What is a Corporate Health Insurance: Its Working, Inclusions and Benefits
A corporate health insurance plan provides financial coverage to employees of an organisation under a specific group. This insurance is also known as group medical insurance by many and is available to employees at a lower premium. The policy brings coverage against expenses arising from Covid-19 hospitalisation, accidental hospitalisation, critical illness cover, maternity benefits and more.
Employers worldwide offer this health insurance policy to employees to support them in times of medical emergencies through financial coverage. This also builds a positive image of any employer in the minds of the employees.
Benefits of Corporate Health Insurance
With a few corporate health insurance policies, the entire premium is borne by the employer, and in other cases, a part of the amount is required to be paid by an employee.
This health insurance policy offers a range of benefits, both to an employer and an employee, as mentioned below:
1. Employee Retention
Most companies use a corporate health insurance policy as a tool to retain employees. In any company, employees are the driving force to help it achieve new goals. Providing such a health insurance policy sends a positive image of the company to its employees. It also instils a sense of belongingness among them towards their company.
2. Tax Benefits for Both Employee and Employer
Another advantage of this health policy is that companies can avail of tax benefits under India’s Income Tax Act, 1961. For example – If XYZ Company pays a premium for its employees, they will present this as a business expense in their profit and loss account. Thus, employers get tax benefits on this premium amount as per law.
Similarly, employees making part-payment of this premium amount can claim tax benefits under Section 80D of the Income Tax Act, 1961. Employees can save tax between Rs. 25,000 – Rs. 50,000 on an average.
3. Customised Plans
The plans under corporate health insurance are customisable. Hence, employers can choose any plan of their choice based on needs and requirements.
4. Coverage of Pre-existing Diseases
This is one of the most striking features of this policy. Employees will get covered against expenses resulting from the treatment of pre-existing diseases. In addition, this benefit has no waiting period.
5. Maternity Coverage
Most corporate health plans include expenses arising from both C-sections and normal deliveries. However, in some plans, there is coverage for newborn infants as well.
6. Benefits at an Affordable Cost
This insurance plan offers a spectrum of benefits at affordable premiums. For a sum insured limit of Rs. 1 lakh, one can pay a premium as low as Rs. 50.
In some cases, the premium amount can range between Rs. 100 – Rs. 120. The premium depends on the type of policy, number of employees covered, number of dependents, employee age, and location.
What Gets Covered under Corporate Health Insurance Policy?
Find the list of coverage below:
- Pre-existing diseases coverage
- Maternity benefits
- Newborn baby coverage right from day 1 of delivery
- Includes pre and post-hospitalisation charges
- Covers domiciliary expenses
- Includes daycare expenses
- Covers expenses such as – OT charges, diagnostic costs, oxygen, blood test, and many others
- Some plans cover ambulance charges, chemotherapy, radiotherapy, pacemaker cost, etc.
What gets Excluded from Corporate Medical Insurance?
Before purchasing any policy, one must be aware of exclusions as well. Following is a rundown of these:
- Coverage for the treatment of parents may not get included under this medical policy
- This policy does not include Ayurveda and Homoeopathy treatments
- Your policy expires after the termination of employment or resignation
- Congenital diseases are not part of this policy
- Does not provide financial cover to any ailments arising out of drug abuse or alcohol consumption
How to Claim Corporate Medical Insurance?
An insured must seek treatment in a network hospital to file a claim, as mentioned in this policy. The insured person’s family members must provide the policy details and TPA e-card to the hospital.
After getting discharged, the network hospital must send all expenses, and medical bills must be sent to the TPA or insurance provider. One must duly fill out the claim form and submit the same as well.
After that, the TPA will evaluate all costs and arrange for the settlement of claims.
As mentioned here, you must keep in mind a few things for an easy and smooth claim process.
- Update your family’s profile on the insurance provider portal
- Get an e-card
- Proper understanding of benefits
- Network hospital list
You must keep in mind all these above details before filing a claim.
Documents Required to File a Claim
Check the document list as mentioned below:
- Duly signed claim form with the signature of doctor or hospital
- Final investigation report
- Doctor’s prescription
- Final bill with all breakups
- Medical reports
- Police report in case of an accident
- Summary of discharge and suggested treatment
- Any other documents required by your insurer
Policyholders must make it a point to ensure that all documents being submitted are original.
Final Word
Corporate health insurance helps to safeguard employees in time of need during hospitalisation due to any illness or accident. This policy helps companies in ensuring employee welfare and inculcates a positive image about it among them.
Both employees and employers enjoy a wide range of benefits from 10,000 plus network hospitals, daycare treatment and health cover up to 1 crore. Monthly Premium starts just from INR 241. Download the Navi App to know more about corporate medical policies.
FAQs
Ans: Such a policy may come with a few limitations, such as co-pay clauses, room rent clauses, etc. However, you may need to incur additional costs for the same.
Ans: This insurance policy provides a fixed sum insured amount that covers expenses resulting from hospitalisation due to an accident or any illness. For example – If the sum insured is Rs. 1 lakh, and the overall expense is Rs. 1.5 lakh, a policyholder can claim up to Rs. 1 lakh only. The extra Rs. 50,000 will have to be paid by a policyholder.
Ans: Some of the disadvantages are employer dependent cover, inadequate coverage, room rent capping, etc.
Ans: Employees more than 18 years and less than 70 years of age are eligible to get financial cover under this policy. In addition, a policyholder can add their dependent children between 3 months to 25 years of age. Also, it is possible to add a spouse and sometimes dependent parents as well.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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