Should You Rely On Group Health Insurance Or Purchase A More Extensive Cover?

Most people do not purchase mediclaim because they rely heavily on employer-provided health insurance plans. But with healthcare inflation rising at an alarming rate, the question is whether an individual can afford to forego it. Here’s what you should know.

How Does Corporate Health Insurance Work?

It is a health insurance policy that the employer provides to the employee. It provides them with the optimal health coverage they need. 

Typically, it consists of your spouse and children, while some plans also give parents coverage.

The Benefits of an Employee Health Plan:

• Waiting Period

Waiver of the waiting time is one of its most significant benefits. Typically, a 2- to 4-year waiting period applies to pre-existing diseases, some defined medical problems, and maternity benefits. In this instance, the employee is covered from the policy’s start. *

• Pre-Existing Conditions

Most claims for corporate health plans are accepted regardless of any pre-existing conditions. Many insurers may deny claims or coverage or include a waiting period restriction in such situations. You can always ask your employer for confirmation. *

No Medical Examination

Even for older citizens, the policy is given without having a pre-medical examination. Other health plans may need a pre-medical exam based on your age and pre-existing diseases.

Premium is Taken Care of

Your employer pays the premium. Only if you intend to increase the sum assured or add another health plan would you be required to pay the difference. *

Cons of an Organizational Health Plan:

Now that you know some health insurance benefits, know why you need additional coverage.

• Coverage Quantity

The majority of employer-sponsored group medical insurance has a limited sum assured. The maximum coverage could reach Rs 5,000,000. And if we consider the expense of medical treatment for a major sickness, this amount would only account for 25% to 35% of the full cost. Therefore, why pay out of cash if you have insurance? *

• Co-Payment Clause

It means that the policyholder is responsible for a certain percentage of the medical expense. In this situation, the insurance company will only pay a portion of the total insured. For instance, the insurer will cover 80% of the total expenses, and you will be responsible for the remaining 20%, which in some situations can reach 40%. Most insurance policies, save those for senior citizens, do not have a co-payment clause and allow you the option to waive it. You can always choose a health plan without a co-payment or minimum co-payment. * ##

• Room Rent Capping

It is sometimes referred to as a hospital room rent sub-limit. In a corporate health plan, the maximum allowable room rent is predefined. And if you choose a room with a higher rate, you will be responsible for the difference. *

• Policy Tenure

Your group health insurance will provide coverage for your employment with the firm. After your employment, the policy will expire. You will be without insurance coverage once you find a new job. *

• Number of Insured Individuals

Not all employer-sponsored health insurance plans provide coverage for your dependents. It is one of the plan’s most significant flaws. The purpose of purchasing health insurance is to protect your family if you are hospitalised. Moreover, if your spouse, children, or elderly parents are dependent on you, corporate health plans may not be sufficient. *

Conclusion:

The advantages of corporate health insurance include minimal waiting periods, decreased premium costs, and no pre-medical screening. Still, more than the supplied amount is needed to cover the total cost of hospitalisation in India.

If you wish to plan for your future, treat your employer’s insurance policy as a secondary alternative to an individual health insurance plan that provides comprehensive coverage according to your medical needs.

* Standard T&C Apply

## All savings are provided by the insurer as per the IRDAI-approved insurance plan. Standard T&C apply

‘Insurance is the subject matter of solicitation.’ For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.‘