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Key Factors to Consider When Choosing a Group Insurance Provider

Posted on 13 Aug, 2024
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Group health insurance is a type of medical coverage offered to a group of individuals who work for a particular employer or organisation. Typically, employer-sponsored insurance is offered to the employees of the same company. The employer may pay the entire premium or a part of it. The main advantage of such plans is that premiums are generally lower, as employer-sponsored insurance reduces the insurer’s liability since the risk gets distributed among all group members.

So, with several group insurance companies offering such plans, how do you decide which insurer to choose? Let's look at the factors we should consider before deciding to go ahead with a particular group insurance provider.

group health insurance policy

Factors to Consider When Selecting a Group Insurance Provider

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.

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.

Conclusion

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.

Help us know you better!

This contains only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale.ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025. . IRDA Reg.No.115. Toll Free 1800 2666. Fax No – 022 61961323. CIN (L67200MH2000PLC129408). customersupport@iciclombard.com. www.icicilombard.com. (Group Health Insurance,4016 , ICIHLGP21381V052021)