Taking care of your employees’ health should begin with the correct medical coverage


We are all going through some of the most difficult periods we have ever experienced in our lives. COVID has been eye-opening in many ways. But the most striking realisation in the last 15 months for everyone has been the necessity for proper health coverage to help us finance the treatment we require.

The year 2021 has been designated as the Year of Mass Vaccination, and practically all employers are planning vaccination efforts for their employees and families, in addition to other COVID prevention measures. However, the loss of precious lives and growing hospital expenditures that many couldn’t afford made us understand that employees demand and deserve a more comprehensive health plan.

The ever-increasing necessity for appropriate health insurance
Medical insurance is provided by most firms of a certain size for employees and their dependents, and it is frequently discovered that this is an employee’s only health coverage.

Without diminishing the value of obtaining personal health insurance, reliance on group medical insurance should be accompanied by an understanding of its limitations. Many people learned this the hard way during the pandemic, when we were fighting a sickness with no treatment standards in place, pushing up expenditures.

On the other hand, many people put off elective procedures that would aggravate their pre-existing diseases out of concern of jeopardising their health and because of treatment expenses. One reason for this is that, despite hospitalisation, specific treatment treatments are not covered by most insurance policies and would have to be paid for out of pocket – a cost and risk not regarded worth incurring during a pandemic, even if it meant diminishing quality of life.

Choosing the best group medical insurance for your employees
As medical developments bring additional treatment alternatives to the fore, it’s important to make sure that the employer’s group health insurance coverage is up to date to cover the most recent procedures, allowing the user to get the most benefit with the least amount of out-of-pocket costs. Some things to think about when considering the policy are:

Obtaining the Correct Amount is Guaranteed:
A typical group medical insurance policy covers INR 5 lakhs per year in coverage (plus or minus 1 or 2 lakhs). It covers four members of the immediate family as well as two elders (Parents or In-laws). As we’ve seen in the last two waves of the pandemic, once one family member is infected with Covid-19, there’s a good chance that others in the family will become infected as well. Add in any other medical intervention that occurs throughout the year, and the medical insurance coverage becomes insufficient to cover the treatment costs.

The importance of having a top-up option
Most insurance companies also offer the option of adding a top-up to the base policy. Employees can be given with additional coverage for an additional charge. Employees should be encouraged to invest in such supplementary coverage because it requires no prior medical exams, is available at low premium rates, and provides additional coverage for dependents such as parents.

Advanced therapy procedures are included:
Employers should make an effort to cover the most up-to-date treatment choices, such as Robotic-Assisted Surgery (RAS), which is currently not covered by an employee’s basic plan. These treatments reduce the overall cost of care by reducing hospital stays and associated costs. It also allows employees to return to improved health and productivity more quickly.

Although most insurance companies pay advanced therapeutic methods, they may not fund RAS or less invasive therapies. As a result, it’s critical to choose a policy that incorporates practises that benefit both employees and companies.

Deduction in proportion:
Sub-limits are common in health insurance policies. This is the most the insurer can pay in the event of a claim for room rent, doctor’s fees, surgical costs, and so on. This means that the remaining insurance funds will be accessible for ‘associate medical expenses,’ such as pharmacy charges, implant costs, medical device prices, and diagnostic costs. As a result, this area must be thoroughly examined in order to obtain additional benefits from the insurer in support of the employee.

Waiting period:
Some insurance companies have a waiting time before you may use their services; for example, the service is only available 30 days after the first instalment is paid or the employee is confirmed in the company. Other benefits, such as chronic disease and related ailments, are only available when an employee has worked for the company for two years or more. Clauses like these should be revised.

Digital access:
On-demand access to digital records of employee insurance information is not available from all insurers. This is critical to supporting any employee in the event of a medical emergency, and the employer should choose an insurance carrier that offers this service. Such records can help evaluate a patient’s health state rapidly in an emergency and reduce the time it takes for insurers to issue mandated approvals. Furthermore, because the patient’s medical history has already been documented, the quality of digital data will be correct.

The Room Rent Limit:
The hospital room rent cap is usually set at 1% of the total sum insured. Many insured people are unaware of this restriction and wind up paying a significant sum out of pocket because they chose higher-priced hospital rooms. As a result, employees should be aware of the benefits they are entitled to under their health insurance policy.

Maternity cover:
With most organisations employing roughly 50% of women between the ages of 25 and 40, maternity coverage becomes a necessary aspect of the insurance package. Furthermore, most businesses now provide group health insurance plans that include maternity coverage.

Network hospitals:
If the company operates in a Tier 2 or above market, examining the network hospitals is crucial to ensuring that employees have a positive experience while using the insurance facility.

Employers can also invest in preventive health initiatives, such as offering access to wellness sessions, health monitoring applications, teleconsulting, exercise awards, and so on, to give employees a sense of control over their health. While advancements in the medical sector are occurring, adopting more validated treatments into health insurance policies can enhance outcomes for both employees and employers significantly.


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