Mediclaim Policy Lapsed: Is Our Company Liable for Employee's Emergency Surgery Costs?

Hi Seniors, I have been working in an engineering company as an HR Manager for the past 1.5 years. Our company has provided Mediclaim (both GMC & GPA) facilities to all its employees, which have lapsed due to the non-renewal of the policy (the policy ended on 3rd Dec-13). One of our employees has undergone emergency surgery after the lapse of the Mediclaim policy. Now, he cannot make a claim or get reimbursement due to the expiry of the policy. My question is whether the company has the liability to pay for his medical expenses. How can we tackle this situation?

Thanks in advance for your valuable suggestions.

Regards, Manjunath

GMC/GPA Policy Withdrawal and Employee Liability

GMC/GPA is given as a benefit from the employer's end and it's not mandatory. If the management has decided to withdraw the policy and not renew it, then you need not bear it. However, if the company policy states that all employees are covered under the mediclaim policy and renewal is not done due to the negligence of the company, then the employee cannot be penalized. It works both ways. You can inform the employee that mediclaim is not available or the management can provide the benefit and renew the policy.

The situation clearly indicates that the management has chosen to withdraw the policy for some reason, as the broking services will contact you a month before your policy expiry date. Therefore, the management is not obligated to pay if it has been communicated to the employees, nor is the decision taken by management without informing them.

Thank you.

Dear Manjunath,

The company has no liability to pay for his medical expenses. You can tackle this situation by informing your employees that if they wish to have a mediclaim policy, the company can arrange a camp or a lecture on it at its premises.

If you need further assistance on this matter, please let me know.

Regards,
Vijaya
Star Health & Allied Insurance Company Limited

The company is liable to pay the expense bill incurred by the employee. The employee was covered under GMC and GPA. Have you informed the employee that the company has withdrawn or not renewed the policy? If not, how will the employee know about it?

Secondly, nowadays employees are covered under ESIC, GMC, and GPA if their gross is more than Rs. 15,000. Employees are also covered under the Workmen's Compensation Act. The employer has to bear the medical bills.

Warm regards,
Pranab Chakraborty
[Phone Number Removed For Privacy Reasons]

Employer Responsibility for Mediclaim Premiums

Some companies extend the mediclaim facilities, and the premium is part of the CTC. If it is part of the CTC, the onus lies with the employer.

Regards,
Pon

If you have informed the employee that the company has withdrawn the policy and not renewed it, then there is no need to worry. If you have not informed them, then the liability to pay lies with the employer.