Deepakmendiratta
Health Insurance ( Mediclaim ) - Policy Design,
+1 Other

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Hi All, I need information about PF and employee Insurance process?? what are their deductions and process?? Thanks and regards Lily
From India, Bangalore
What are the processes that you are looking for in insurance ?
Do you have an existing insurance cover or are you wanting to set up a fresh cover ? IN both cases, the focus of processes changes.
With a little clarification perhaps I can help you further.
Regards, Deepak

From India, New Delhi
Hi Deepak, Thank you:) we don’t have any insurance.. we have plans to set up a fresh for all the employees.. so guide me as in what will be the premium and other process regards Lily
From India, Bangalore
Dear Lily, From ur question I believe u are looking for ESIC & PF information. Is it so? Regards, Viraj
From India, Pune
Hi Lily,

The following will be helpful for you to begin with. Post this you can provide your feedback and share your employee list. WIth the features that get decided, I can then assist you in obtaining quotes from various companies, which you can choose from.

Please note the following decisions need to be taken before you initiate the health insurance cover:

1. Coverage for Whom - The options being - Employee Only, Employee + Spouse, Employee + Spouse + 2 Children. There is a possibility of covering your parents as well but considering that almost the claims emanating from them will be more than the claims of the rest of the members, it will have a huge impact on your renewal premiums. for SME's it is recommended that this be avoided int he first year of taking the cover. Once the policy and its workings are much clearer, please get into a management huddle to consider including these benefits from the 2nd year of the policy.

2. Coverage on individual basis or a family floater basis: It is recommended that you opt for insurance on family floater basis. It is the ongiong trend now a days to do so and is a better way of providing coverage to the employee and their families

3. Coverage of Pre Existing Disease: Any ailment, its sign or symptom, if it exists before the date of taking the cover, will be excluded from the scope of the policy. So will any resultant complications. You can have this condition inthe policy waived off by paying extra premium. Often this results in loading of about 50 % onthe base premium to get this waiver.

4. Child Cover from Day 1: In case you decide to provide the insurance on a family floater baiss to the immediate dependats of hte employee ( spouse and children), the children will get covered often from 91st day onwards. This can be modified to cover the child from day 1 of birth.

5. First 30 day exclusion: When the policy is provided for the first time, ther eis an exclusion on any claim for the first 30 days except in case of an accidental claim. This can also be waived off on payment of extra premium - loading on base premium

6. First 1 / 2 year exclusions: There are certain class of ailments, whose treatment is not covered under the policy for the first 1 / 2 years. Typically these include Cataract, Piles, Hysterectomy etc. This clause can be waived off by payment of extra premium - loading on base premium

7. Maternity Benefits: A standard policy may not cover maternity and its related complications. On payment of extra premium, you can obtain maternity benefits for your employees.

There are some basic exclusions like - Alcohol related treatments are not covered, cosmetic treatments / plastic surgeries are not covered etc. The hospital where treatment is taken either should be registered with local relevant government authorities and / or should have a minimum of 15 beds in urban areas and 10 beds in rural areas. Along with full time and qualified doctors / nurse, ICU etc.

What I have provided above is the brief of the options you need to consider before initiating on the insurance policy. The policy needs to be designed in such a way that not only does it provide relevant risk coverage but should also be sustainable for the insurance company and your self in years to come. Else, the premiums will rise or the insurers will refuse to continue with the cover in case it becomes loss making beyond their risk appetite.

Next is to fix in on the cover and floater it to multiple insurance companies.

Lets communicate further to take this ahead.

Regards, Deepak

From India, New Delhi
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