Group Health Insurance or Group Mediclaim is an Medical Insurance for a Group of people.
Primarily, these are taken by employers for their employees as a part of the bouquet of Employee Benefits.
Health Insurance being very sensitive and subjective [when it comes to claims] requires special care when taking a decision. The right expert/advisor who is experienced on the claims side is key to making the entire perquisite work for your employees.
An Insurance Broker like Bonsai Insurance has rich expertise in devising the right insurance plan for you, as per your requirements, size of your company, industry your belong to and ofcourse your budget.
Some points to note [Courtesy Bonsai Insurance/http://www.InsuranceBrokerIndia.com]
1. Dont get excited by low prices:
Some companies would provide low price to enter into the market or your company, you need to assess carefully whether the company would actually be able to justify the services you are expecting at the low cost of premium. Some companies have cancelled group programs in Health Insurance, due to losses mounting.
Advise on the Selection of the Insurance Company should be taken from Corporate Insurance Experts like Bonsai Insurance, who have daily claims and service experience with varied Insurance Companies, and are responsible to provide you claims assistance would be very valuable in the long-run.
2. Dont get excited by super features:
If you are a company with less than 50 employees, taking cover for employee parents and maternity benefit may excite you in the first year, but you will eventually make the portfolio unprofitable for the Insurance Company. This would result in either your costs rising every year, without control.
Think what would be the average claims that would take place with the policy you are buying. If you have an opinion that you would claim more than the premium you are paying - cut some features, which are sure-shot claims.
3. Look at the Maximum Room Rent Limit
This is a real catch, which causes good amount of stress to the HR/ADMIN/FINANCE, who handle this portfolio for the company. Room Rents are often limited to 1% of the Sum Assured. So if your Sum Assured per employee is Rs. 2 Lakhs, your employees can go for rooms which cost only Rs. 2000/-
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4. Co-Payment Clauses for Senior Citizen Parents
If you have finally decided to cover parents, then in case of Senior Citizen members, you need to check on co-payment clauses. There are policies which have a co-payment clause for Senior Citizen, where every claim has to be borne at 20% proportion by the employee, and rest 80% is paid by the Insurance Company. Though, this could be a good way to cut claims in the long run, it needs to be effectively communicated to the group members.
5. Hospital List and TPA Background:
Remember, most of the Public Sector and some Private Sector Insurance Companies, have the silent option of choosing your TPA. Check the TPA’s background and the Hospital List. The Hospital List should be checked whether important and crucial hospitals are covered under the Network for Cashless Facilities.
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6. Sub-limits on certain large ailments
There are limits on large ailments like a Bypass Surgery or Angioplasty to a smaller sub-limit than the total one. This again to help control your claims ratio, but communication of features to the group members is a must.
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