Community health insurance is one of the most competitive health insurance policies offered in the industry. Community Health Insurance accounts for more than 50 per cent of the non-government-funded health insurance industry.
As per an MHA notice, it has now become mandatory for employers to provide health insurance coverage to their employees in case they resume Well Being Programs for Employees post Covid-19 lockdowns.
In light of these, it becomes important for the employers to consider the dynamics of group health insurance programs- how the premiums are measured, terms and conditions associated with their policies and the customizations available so as to extend best possible benefits to their employees in the budget.
Here are a few realistic tips that may help you develop the right health insurance policy for your employees :
1) Select the correct Sum Insured
This is the maximum amount of money per family or individual) that will be charged by the insurer in case your employees are hospitalised. Please take note of the increasing medical inflation costs as well as the kind of hospital your employees will usually go to when determining the amount insured.
Often, additional insurance becomes cheaper as you go up. A Rs 4 lakh cover does not cost twice as much as a Rs 2 lakh cover. Calculate the premium for larger sum insured sums even and the extra money expended would certainly be worth it. Usually, go for at least Rs 3 lakh of coverage if you remain in a metro/tier-1 city and a minimum of Rs 5 lakh if you are planning to ensure your employee’s family members too.
2) Room Rent Cap
This looks easy. This is essentially the highest rent or type of room you are eligible for. Your limits can be 1 per cent of the amount insured or even up to a single private room ( irrespective of cost) ( irrespective of cost).
If your employees go to a tier-1 hospital in a tier-1 area, average room tariff is usually Rs 10000 for a single private room. Hence, if you have a Rs 5 lakh cover and room rent cap at 1 per cent of the amount insured, your employees will be covered only up to Rs 5000 for.
There is another downside with lower room rent caps which most people are unaware of. Most insurers also have a definition of proportionate deduction. In simple words – If your total bill for the hospital stay is Rs 2lakh and you stayed in a room which cost Rs 10000. If your room rent cap is Rs 5000 only, then the insurer can reimburse only 50 per cent ( 5000 divided by 10000 ) of the Rs 2 lakh bill.
Hence, your employees would lose roughly Rs 1 lakh on the treatment costs even if they remain in higher category space. In case the budget allows, it is usually advised to get a health insurance plan which at least covers up to a single private room.
3) Search the List of network hospitals
This is particularly important if your company is located in a non-metro area. Since the list of hospitals may also get updated during the policy year it is important to check whether your city’s preferred major hospitals are protected when buying the policy.
4) Waive off all waiting periods
Waiting period refers to the time your workers have to wait in order to be able to take some kind of treatment. This is usually of 3 forms
Initial Waiting Period: It is usually 30 days. For the first 30 days after the first insurance policy purchase, you can take claims only for injury-related hospitalizations. No disease/illness will be covered within the first 30 days.
Relevant Disease Waiting Period: This is usually 2 years.
Pre-Existing Disease (PED) Waiting Time – This is usually 3 to 4 years. Pre-existing disorders include specific conditions such as high blood pressure, diabetes, thyroid etc. Insurers only cover treatments during the PED waiting period for these conditions.
The value of community health insurance policies is that you will pay an extra premium to cancel any necessary waiting periods. It is highly recommended that waiting periods in community health insurance contracts be waived as a norm. This is a big advantage over the market-based conventional retail health insurance policies.
5) Coverage of pregnancy
It’s a gift for parenthood. It’s important when you have a child to be here for your stay there. If you have a relatively young team, where your workers have a high chance of starting a family, you can opt for maternity coverage when you purchase a policy. If any of the workers are unheard of or older than 35-40 you will opt out of the maternity coverage add-ons.
6) Protect families of workers
Employees love it if the health care scheme also includes their immediate family members. Maximum coverage to protect the families of your workers will cost you about twice the premium. If you want to bear this cost, make a wise decision.
In short, there are many ways of adjusting an insurance programme to the needs of the workers. You can talk with your insurance consultant thoroughly and have Health Insurance for Employees as early as possible.