Group health insurance, often known as corporate health insurance, is medical coverage employers provide to employees regardless of age, job profile, or gender.
This insurance is substantially less expensive than individual plans since the risk is spread among a large number of employees. Employees benefit from this policy because they do not need to undergo any medical screening to be covered. Furthermore, even if the employee has a pre-existing condition, it will not affect the coverage or policy terms.
You need to review the following parameters to decide whether your plan is worthy for your employees.
Our healthcare system is under immense burden, and medical inflation is rising to accommodate the growing population.
Let’s assume you choose an insurer that offers an insured sum of Rs 1.5 lakh per covered employee. After a few days, one of your employees is diagnosed with a cardiac condition and requires angioplasty, which costs roughly Rs 2 lakh. In this instance, the insured must pay 25% of the cost out of pocket. When an employee has to shell out a considerable sum of money, a group health insurance policy may not be of much use to him/her.
When selecting a group health insurer, contrast the sum insured to inflation and ensure that the insurer covers all common diseases and many chronic conditions.
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TPAs refer to third-party administrators. They act as mediators between the insured and the insurer. Their responsibilities include assisting with filing claims, following their progress, and giving the insured accurate information about the policy and claim status. However, some insurance companies have an extensive in-house claim settlement department and do not rely on TPAs.
This point is crucial since TPAs make things easier for you and your covered employees.
These are hospitals that the insurer has empanelled with. Your employees can receive free treatment here up to the sum insured limit. But let’s look at why this aspect is so crucial.
Suppose you run a small business in Gandhinagar. The majority of your employees are native to this city. You choose an insurer with no empanelled hospitals outside of major cities. In this situation, the insurance may be worthless since, in the event of a medical emergency, your employees will have to pay out of pocket and wait days for payment, which may disrupt their monthly budget or cause them to be unable to meet their other responsibilities.
This ratio informs the public about how many claims an insurance provider settles each year. In general, anything above 80% is considered favourable because you have a better possibility of receiving reimbursement for your bill, but some insurers have this ratio exceeding 95%.
You will find information on Claim Settlement Ratio on the IRDAI’s website and each insurer portal. The formula for computing this ratio is:
Claim Settlement Ratio = (Claims Settled Annually ÷ Claims Received Annually) × 100
This ratio is of utmost importance. It shows how much money the insurer has paid out in claims compared to the amount received in policy premiums in a given year.
If this ratio is poor, it indicates that the company is not profitable enough, and there is a considerable risk that your employees’ claims may be rejected in the future.
Like the Claim Settlement Ratio, information on this ratio is published on the IRDAI website. The formula for calculating this ratio is:
Incurred Claim Ratio = (Net Amount Settled as Claims ÷ Amount Collected as Premiums)
Most organisations compare insurers based solely on Claim Settlement Ratio, coverage, and network hospitals, but customer experience is also an important factor to consider. Search for reviews on Google and social media platforms. It will allow you to evaluate the insurance company beyond these figures.
Parenthood is the most treasured moment in one’s life. However, it is also the moment when one’s finances turn short. In India, C-sections can cost anywhere from Rs 40,000 to Rs 5 lakh in standard facilities. In addition, there are many significant expenses associated with pre- and post-delivery procedures and medications. Therefore, consider this coverage when reviewing plans to ensure your employees feel valued.
Most insurance providers offer customisation options when you buy group medical insurance from them. This allows your employees to increase coverage scope by choosing from riders such as critical illness cover. However, you can pass the cost on to your employees rather than paying for riders yourself.
Opting for the right group medical coverage is essential for retaining talent and providing these talents with peace of mind. The best way to compare this plan is by evaluating the sum insured, Claim Settlement Ratio, network hospitals, availability of TPAs, and other factors.