Group medical insurance is an effective tool for protecting your employees’ health and lowering your company’s attrition rate. This plan provides health care to your employees without needing them to pay anything out of pocket. However, as with any other financial resource, you must review this plan regularly to ensure it aligns with changing medical needs and rising healthcare expenditures.
Here are the parameters you should review as an entrepreneur to ensure you provide your dedicated employees with the best.
Let’s look closely at the attributes that will help you evaluate your group medical insurance plan.
1. Adequate Coverage
When purchasing a plan, ensure that the coverage is not limited to hospital expenses but includes pre-hospitalisation and post-discharge expenditures. Let us illustrate this with an example.
Suppose one of your employees develops a cardiac issue. One day, he visits the doctor, who advises a range of tests, after which he is diagnosed with a heart blockage. The doctor recommends that he be admitted to the hospital right away so that the angioplasty can begin. During the discharge procedure, the doctor advises him to visit the OPD every two weeks for a routine check-up. In this situation, if the group plan just covers hospitalisation fees, your employee has to pay for pre-hospitalisation tests, post-discharge OPD expenses, prescriptions, and screenings out of pocket. However, if the policy provides coverage for these expenses, it will ease the burden on the employee and help him focus on his recovery and get back to work sooner.
2. Flexibility
Medical inflation is soaring day by day. A few years ago, when you went to the doctor for seasonal flu, you might have paid roughly Rs 100-200 for the consultation and Rs 150-300 for the medications.
However, the consultation charge for a general practitioner in major locations today ranges between Rs 1000 and Rs 2000, and flu drugs can cost thousands. Now, consider the cost of treating a chronic condition. It would cost a few lakhs.
Considering inflation, your group medical insurance must allow you to upgrade the sum insured and augment the plan with various add-ons.
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3. Network Hospitals
These hospitals are healthcare establishments where your employees can receive treatment without opening their wallets. Insurers now have thousands of reputable hospitals in their network. However, this is not worth it if there is no tie-up medical facility in the city where the business is located.
Suppose your company is based in XYZ town and all your employees are local. You purchase a group health plan with a network of over 8000 hospitals, but none of them are situated in XYZ town. The nearest healthcare facility is 100 kilometres away from the town. In this scenario, assume one of your employees suffers a fatal injury in an accident that necessitates rapid medical attention, but he lacks the financial means to pay for his treatment. Regardless of the sum insured, your policy will be useless to him in this situation.
4. Waiting Period
This period refers to the time during which your employees cannot use the insurance coverage, regardless of how severe their medical condition is. Usually, there is no waiting period with group medical insurance, but checking the fine print for hidden terms is still crucial.
5. Room Rent Limits
During hospitalisation, patients are either admitted to the general ward, where they share a room with other patients, or to the private ward, which is basically a room in the hospital with all of the medical facilities and dedicated nursing staff.
A one-day stay in a private ward typically costs between Rs 5,000 and Rs 20,000, depending on the facility. The term "room rent limit" refers to the maximum amount an insurer will pay for the daily rent of a private ward.
Opt for a plan with no or minimum room rent caps. Otherwise, if your employee is hospitalised for a prolonged period, he/she may face significant financial hardship due to room rent.
6. Settlement Process
Examine your insurer’s claim settlement procedures and ratio. The CSR, or claim settlement ratio, displays how many claims the insurer received in a given financial year and how many were settled. Check if your insurer has a CSR of more than 90.
The next step is the settlement process. Check to see if the insurer has a specific app or portal for submitting claims. For example, if you purchase ICICI Lombard insurance, the IL Take Care app makes filing a claim easier, requiring only a few taps on your smartphone’s screen.
Insurers offer multiple products under the name of group medical cover. Each plan has distinct features. It is crucial for you as an employer to review the plan at least once a year and make changes in line with evolving medical needs. Review the inclusions and exclusions, claim settlement process, network hospitals, and a few more parameters before continuing with the same insurer.