Group medical insurance policies, also known as group mediclaim policies, offer a range of benefits that protect employees and their families from healthcare expenses. However, choosing the right group medical insurance policy requires careful consideration of several key features. According to a recent survey by the Society for Human Resource Management (SHRM), 88% of employers ranked health-related benefits as “very important” or “extremely important,” prioritising it above retirement savings, leave, family care, education, and transportation benefits.
In this blog, we wіll explore the ten essential features that employers should evaluate before insuring their employees with a group medical insurance policy.
The first and foremost consideration when selecting a group medical insurance policy is the coverage options it offers. Employers must review the policy to ensure that it provides benefits, including inpatient and outpatient care, specialist consultations, diagnostic tests, medicines, and surgical expenses. It is also crucial to check if the policy covers pre-existing conditions and maternity-related expenses.
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An extensive network of hospitals and medical providers is essential to accessing quality healthcare services. Employers should carefully evaluate the network coverage offered by the insurance policy to ensure that it includes reputable hospitals and clinics in the desired geographic area. This ensures that employees can receive treatment from healthcare providers of their choice without any inconvenience
1.Pre-Authorisation Process
Understanding the pré-authorisation process is vital to streamline the claims settlement procedure. Employers must check if the group medical insurance policy requires pre-authorisation for certain treatments, procedures, or hospitalisation. A straightforward and efficient pre-authorisation process helps employees avoid unnecessary delays and ensures smoother claim settlements.
2.Pricing and Affordability
While quality is a crucial consideration, pricing and affordability cannot be overlooked. Employers should compare the premiums and overall cost of the group medical insurance policy with the coverage and features offered. Striking a balance between affordability and coverage is essential to ensure that the policy is sustainable for the organisation.
3.Cost-Sharing Mechanism
Employers should carefully examine the cost-sharing mechanism of the group medical insurance policy. This involves evaluating the percentage of healthcare expenses that the employer and employees are required to bear. Factors such as co-pays, deductibles, and co-insurance should be considered to understand the financial implications for both parties involved.
4.Employee Assistance Programs
Employee Assistance Programs (EAPs) are additional support services that employers can offer with their group medical insurance policy. It is essential to check if the policy includes EAPs, as these programs may encompass counselling services, mental health support, and wellness initiatives. Including EAPs can promote employee well-being and enhance overall health care coverage.
5.Wellness Benefits
Another crucial feature to consider is whether the group medical insurance policy provides wellness benefits. These benefits focus on preventive healthcare measures and may include health check-ups, vaccinations, nutrition counseling, and fitness programs. Prioritising wellness benefits can lead to healthier employees and reduced healthcare costs in the long run.
6.Coverage Limit and Renewability
While selecting a group medical insurance policy, it is necessary to assess the coverage limit it offers. Employers should ensure that the limit is sufficient to cover potential medical expenses for employees and their dependents. Additionally, it is advisable to verify the renewal terms of the policy to avoid any surprises or coverage gaps in the future.
7.Claims Process and Customer Support
Having a smooth and efficient claims process is essential to provide a satisfactory insurance experience to employees. It is crucial to review the claims settlement procedures of the group medical insurance policy and assess the ease of filing claims. Additionally, consider the quality of customer support provided by the insurer to address any queries or concerns regarding the policy.
8.Additional Benefits and Riders
Some group medical insurance policies offer additional benefits and optional riders that can enhance coverage. It is important for employers to explore these options and check if the policy offers additional benefits such as maternity coverage, dental and vision care, international emergency coverage, and critical illness riders. This allows customisation of the policy based on the specific needs of the employees.
Employers must carefully evaluate these ten essential features before selecting a group medical insurance policy for their employees. Prioritising these considerations will not only provide employees with access to the healthcare they require but also contribute to their overall well-being and job satisfaction. Ultimately, selecting the right group medical insurance demonstrates a commitment to the health and welfare of employees, fostering a positive work environment and promoting the success of the organisation as a whole.
- GHI Insurance
- Product Code: 4016
- Product UIN: ICIHLGP21381V052021