MEDICAL COVERAGE FOR EMPLOYEES DRAWING SALARY GREATER THAN CEILING

Hello,

We are a small-scale engineering industry with 30 employees covered under ESI. Recently, most of the employees have crossed the Rs 15,000 ceiling, due to which they do not enjoy ESI benefits. Kindly advise on how to cover these employees for medical insurance. What is the standard procedure followed by most companies?

Thanks,
Raghuvir

Dear Raghuvir,

Employees who are not covered by the ESIC need to be covered by the Mediclaim policy for themselves and their families. You can approach the Mediclaim companies within your area and obtain quotes. While opting for the minimum is a standard practice, you will need to consider the coverage amount, the illnesses covered, and ensure that the maximum is applicable to the employees.

There are also policies available where normal doctor visits for minor illnesses like coughs and colds are covered. Try to provide these benefits to your employees as well; it will greatly assist them.

Regards,
Ashutosh Thakre

Dear Ashutosh,

Many thanks for your reply. As suggested by you, I was trying to find a mediclaim policy covering outpatient treatments, but could not find one. It seems all mediclaim policies require hospitalization. Can you provide me with some information on this aspect?

Thanks again,
Raghuvir

Dear Mr. Raghuvir,

Recently, some Mediclaim companies have started covering certain diseases for which hospitalization is not mandatory. Daycare treatment is also included in the coverage. There are numerous schemes available. You can opt for a corporate scheme that covers you, your spouse, and two children. Additionally, you may also include your parents in the coverage. To optimize costs, you can consider adopting a co-payment system for your parents. Reputed companies can offer you a customized plan tailored to your requirements. However, it is essential to thoroughly review all aspects such as reimbursement of pre and post-hospitalization expenses, cashless panel availability, approval procedures, etc. It is advisable to obtain a detailed plan in writing from the company to be aware of any hidden costs that could potentially impact employee benefits.

Considering your description of your engineering company, where employees often undertake hazardous jobs, I recommend considering a Workers' Compensation Policy as well. This policy would provide compensation in case of any unforeseen challenges.

Thank you.

Dear friends,

If an employee is not covered under ESI, is it compulsory to cover the employee with a medical insurance policy? Please provide the legal requirements, if any, for the same.

Thank you.

Dear friend,

At the shop floor, workers do get hurt or fall ill. Previously, they were covered under ESI and used to go to the ESI dispensary/hospital for treatment. ESI provides medical treatment as well as salary reimbursement for the days of absence due to health reasons.

Now, these benefits are lost, and they have to spend from their pockets for every visit to the doctor. They come and ask management for support in some cases, which we provide. If they are covered under some medical insurance, their burden will be reduced.