You must keep in mind the following factors when zeroing in on an insurer:
Cost of Premium
Different group insurance providers have various premium structures. So, it is important that you acquire and compare quotes from different insurers and find the best possible plan for your requirements. However, cost should not be the only factor when choosing group insurance for employees.
Network Hospitals
Network hospitals have tie-ups with insurance providers. As a result, you can avail of cashless treatment facilities at these hospitals. Hence, the greater the number of network hospitals, the better it is. This is especially important if your business has several branches. You should ensure that there are enough network hospitals empanelled with the insurance provider in all the locations where you have branches. So, make sure you check the insurer's list of network hospitals before deciding to go ahead with them.
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Value Added Benefits
Group insurance comes with several value-added benefits, including wellness benefits and health check-up camps. Therefore, one should consider these benefits when choosing any group health insurance plan.
Exclusions & Other Clauses
Another aspect you need to look into when choosing a group insurance provider is exclusions, deductibles, sub-limits, and copayments. These can be found in the policy's terms and conditions. The higher the deductibles, the higher your out-of-pocket expenditure will be. Similarly, a greater copayment requirement will increase your burden. There can be sub-limits for pre-existing health conditions. Review the list of exclusions to avoid unpleasant surprises when you raise a claim. So, this is an important factor you should carefully evaluate while choosing a group health insurance provider.
Flexibility
Every workforce is unique, and a one-size-fits-all approach may not work well. Look for insurance providers with flexibility in plan design and customisable coverage. Ideally, group health insurance for employees should have options for adding family members and choosing add-ons like OPD coverage, depending on their specific needs. You should have the flexibility to enhance or reduce the scope of coverage as your business continues to grow or change.
Reputation
Make sure to consider the reputation of a group health insurance provider. It is important to be aware of whether they are financially stable and pay claims on time. Look for instances of unnecessary denial of insurance benefits, which will be a red flag for you. When you finally pick an insurer, review the insurance provider’s claim settlement ratio, industry ratings, financial statements, etc., to make a final decision.
Customer Service
Good customer service is paramount. Evaluate the group health insurance provider's record in offering customer service, namely the availability and responsibility of the support services. Efficient claim processing, quick issue resolution, and effective communication are all part of good customer service.
TPA or In-house Claim Processing
Third Party Administrators, or TPAs, assist in coordinating claim processing among the insurance company, the insured, and healthcare providers. Their involvement has been seen as hastening the settlement of a claim because they undertake the paperwork and communication for settlement. On the other hand, some insurance companies prefer to manage claims in-house, maintaining direct control over the settlement process. The two approaches have advantages and disadvantages, with TPAs possibly more specialised and much faster in processing, whereas in-house management can be easier to monitor and more constant.
Choosing the right group insurance provider is a crucial decision. We have discussed various factors you should keep in mind while choosing group insurance for employees. Going beyond just the cost of the premium, you should evaluate your insurance provider on parameters like the number of network hospitals, the policy’s terms and conditions, flexibility in the policy, reputation in the market, customer service experience, exclusions and inclusions, etc.