Right Employee Health Insurance

How to Choose the Right Employee Health Insurance

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Health insurance coverage is an important benefit that an employer can give to the employees. Group health insurance plans are affordable and constitute 50% of the non-govt-sponsored health insurance market. From increasing employee retention to enhancing productivity, employee health insurance has a plethora of benefits for the employer. Moreover, health insurance coverage is beneficial for the employees as it enables them to get high-quality medical facilities without paying hefty premiums.

In the aftermath of the covid pandemic, companies have become mandatory to provide group or employee health insurance to their employees. In this scenario, employers need to select the correct plans which provide comprehensive coverages to their employees without being too hard on the pocket.

How to Select the Right Employee Health Insurance Plan?

Some of the points to consider to select a good employee health insurance plan have been discussed here.

Right Sum Insured for An Employee Health Insurance Policy

Sum Insured in Employee Health Insurance

The sum insured under your employee health insurance policy is the maximum amount that would be paid to any of your employees or his/her family in case of hospitalization for more than 24 hours. The sum insured should be decided after taking the medical inflation and the kinds of medical facilities that will suit your employees into consideration.

The rule of the thumb is to opt for an employee health insurance policy assuring Rs. 3 lakhs if you are situated in a metro or Tier-1 city. The sum insured can be increased to Rs. 5 lakhs if you want to extend the coverage to the family members of your employees as well.

Employee Health Insurance Coverage

Employee Health Insurance Coverage

The importance of the coverage provided by an employee health insurance plan cannot be ignored. Thus, it is important to read the details of the group health insurance policy thoroughly. You need to get a clear picture of the coverage offered by the plan, such as conditions covered and excluded, restrictions, if any, additional benefits, and much more. It is important to ensure that the pre and post-hospitalization expenses are covered under the plan.

Room rent limit is an important aspect of coverage provided by the employee health insurance plan. It is the maximum allowed room rent or category of room that is covered by the policy. Plans which offer 1% of the total sum insured for room rent can prove to be disadvantageous. For example, if the sum insured is Rs. 5 lakhs, the 1% limit means the beneficiary will not get more than Rs. 5000 for room rent. In a metro city, the room rent of a private room is usually Rs. 10,000. Thus, it’s better to opt for a policy that covers at least 1 private room regardless of the tariff.

Apart from reading the fine print of the employee health insurance plan, it is also recommended to talk with the insurance consultant of the insurer to be clear about its coverage.

Waiting Period of The Employee Health Insurance Plan

Waiting Period in The Employee Health Insurance

Check the waiting period of the employee health insurance plan you are looking to purchase for your employees. The waiting period refers to the time from the date of issuance of the policy. Your employees cannot claim compensation for medical expenses except for accidental injuries requiring hospitalization.

The initial waiting period runs for 30 days from the date of issuance of the policy. The waiting period for pre-existing diseases such as diabetes, thyroid, high blood pressure, and other serious ailments, which were diagnosed at least 48 months before purchasing the policy, usually for 3-4 years. The waiting period for specific diseases listed by the insurer is usually 2 years.

Employee health insurance policies provide the option of waiving off the waiting periods by paying extra premiums. It is recommended that the employers get rid of waiting periods by adding a little more to the premium. This way, the employees get instant coverage, and the employees suffering from pre-existing diseases are benefited immensely.

Coverage for Employees’ Family Members

Employee Health Insurance Policy Cover Employees' Family Members

Comprehensive coverage means the employee health insurance policy covers the employees and their immediate family members. Extending coverage to the family members of your employees increases their loyalty and helps immensely in employee retention.

However, including the family members of the employees in the group health insurance increases the premium to about twice the premium of standard group health insurance. Hence, it is up to you as the employer to decide to bear the extra cost of providing benefits to the family members of your employees or not.

Maternity Cover Benefits in Employee Health Insurance

Maternity Cover Benefits in Employee Health Insurance

Maternity coverage is offered as an add-on to the employee health insurance plan. If a significant number of your employees are young and married and likely to start their families, then opting for maternity coverage as a part of the employee health insurance coverage is recommended.

There is no need to select maternity coverage if most of your employees are unmarried or in the age bracket of 35-40 or above.

Network Hospitals List by Employee Health Insurance Provider

Network Hospital in Employee Health Insurance

Network hospitals of an insurer are those hospitals that have a tie-up with the insurer for providing cashless treatment. The beneficiary availing treatment in a network hospital of his/her health insurance provider is not required to pay anything to the hospital. The insurer settles the bill of the hospital directly.

Thus, checking the list of network hospitals of the insurer offering employee health insurance is important to ensure that the employees get cashless treatment instead of reimbursement. Check the list to ensure that your city’s big and best hospitals are a part of the insurer’s network.

Cost of The Employee Health Insurance Premium

Calculate the Cost of The Employee Health  Insurance Premium

The cost of the employee health insurance policy is an important factor. Whether you as the employer shall bear the entire cost of the premium or require the employees to pay a certain percentage of the premium, a policy that does not exceed your budget and does not put a financial burden on your employees must be selected.

A cheap employee health insurance plan which offers very limited benefits and services is not suitable. Thus, you need to ensure that the plan provides adequate coverage at a reasonable price.


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