An Employer health insurance policy is beneficial for both employers and employees. These are necessary for employees as they cover hospital-related expenses in case of emergencies and come with a low-cost premium. Since the onset of COVID-19, the Indian Government has made it compulsory for companies to provide health plans for employees.
However, is an employer provided health policy sufficient enough for your healthcare needs? Let’s dig a little deeper.
The employer-provided health insurance can be private or government. If it is private, these are generally group health insurance policies. However, if it is a government-offered policy, the employee must be registered under the ESI Act.
Different employee health insurance plans in India offer diverse features and benefits. Given are some of the significant features and benefits of these policies.
Here is a list of common diseases for which treatments are covered by most employer-provided health insurance policies:
Additionally, some employer health insurance policies provide treatment coverage for critical illnesses like Parkinson’s disease, paralysis, etc. Some policies cover injuries caused at a workplace which lead to temporary or permanent disabilities.
Besides Government mandate, the following are some of the reasons why employers may want to buy a health insurance policy:
Here are some of the top benefits you can get from employer-provided insurance:
Depending on the insurance company and specific policy, employer policies will usually cover the following:
Though group health insurance policy comes with its share of benefits, it has a few drawbacks. Let’s understand them.
Other than these pitfalls, group insurance policies usually have a cap on the number of dependants. For instance, some policies may allow you to add your spouse and children but not your parents as dependants.
Considering all these factors, it’s best that you sign-up for a comprehensive health insurance policy separately. You can extend the coverage to your dependents, stay protected against multiple health-related conditions, and simultaneously enjoy tax benefits under Section 80D.
With this facility, one can get admitted to a network hospital and have the insurer deal directly with the hospital.
To make a cashless medical claim, one will need to follow these steps:
You can also pay the medical expenses out of your own pocket and request reimbursement later. One should use this facility with hospitals that are a part of the insurance company’s network.
To file for claims, follow the given steps:
The following are some of the original documents you will need to carry to raise claims:
Salaried individuals can choose an employer health insurance policy to get basic and essential financial cover for medical emergencies. However, if you can afford it, choosing an individual health insurance policy would be an ideal solution as it usually provides more coverage.
For instance, with the Navi app you can get financial cover ranging from Rs. 2 lakh to Rs. 1 crore. Navi offers a Claim Settlement Ratio of 97% for cashless claims, and a network of 10,000+ cashless hospitals across 400+ locations.
Ans: An employer can choose Employee State Insurance (ESI) available from the ESIC or a separate Group Medical Cover (GMC) from an insurance company for his/her employees.
Ans: Yes, one can add family members to their employer-provided health insurance plans.
Ans: Yes, the Ministry of Home Affairs (MHA) made it mandatory for all offices and workplaces to provide medical insurance for workers as per an order dated April 15 2021.
Ans: For companies to resume functioning as before the COVID-19 pandemic, they have to stick to certain rules. The Government of India has made it mandatory for all employers to provide health insurance and COVID-19 coverage to their entire workforce.
Thus, every company needs to offer health insurance plans for their employees in accordance with IRDA’s Order No. 40-3/2020-DM-I (A).
Ans: In the case of a co-pay clause in an employer’s health insurance policy, the employee must pay a percentage of the mediclaim out of his/her own pocket. Typically, co-pay ranges from 10%-20% for most employer-provided health plans.
Ans: Yes, most group insurance policies provided by employers cover many diseases. This includes diseases like:
– Critical illnesses such as cancer, Parkinson’s disease, paralysis, etc.
– Heart diseases, including cardiomyopathy, heart failure, etc.
– High blood pressure
– HIV AIDS
Ans: A critical illness insurance policy offers more leverage and flexibility to an individual regarding the sum insured and the duration of the policy. As the costs of treating critical illnesses are very high, many experts suggest having separate critical health insurance plans for additional coverage.
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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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