Can We Legally Add Employees' Families to Our Health Insurance Plan? Seeking Guidance

Dear Seniors,

Our company has taken a Group Health Insurance Policy (including Pre-Existing Disease, 30 days / 1 year / 2 years waiting period waiver, etc.) for the first time exclusively for our company employees. However, our employees are requesting us to extend this policy to cover their family members as well, with the entire premium for their family members being paid by the employees themselves.

In response to this request, our company is willing to accommodate their families under the policy. However, we need to ensure that there are no legal implications if the company is required to cover claims for the employees' family members in case the insurance company denies or does not accept the claim.

Therefore, I kindly request your guidance on this matter.

Thanks in advance.

Addition of Family Members in Group Mediclaim Insurance

In general, there will be no legal issues involved. However, you need to safeguard the interests of your employer. Create a policy titled "Addition of Family Members in Group Mediclaim Insurance."

The policy should include:

1) The validity of the mediclaim policy until employees are in the service of the company.
2) The employee's willingness and agreement to pay the premium for family members.
3) No addition or deletion in the middle of the policy tenure (otherwise, it would become difficult to manage).
4) The company has no liability in case of any dispute arising from non-settlement by the insurance company.

Also, please collect a self-declaration from all employees requesting the addition of their family members, including names and date of birth details. This should include an assurance to pay the premium and acceptance that the company has no responsibility in case of any dispute between them and the insurance company.

Annual Addition or Deletion

Addition or deletion can be made on a yearly basis. The company may pay the whole premium upfront and recover it in, say, 6 months EMI. In case of resignation, the balance EMI should be recovered in full and final settlement. After the cancellation of employment, the employee cannot use the mediclaim card.

Benefits and Reimbursement

All benefits, such as in mediclaim reimbursement cases, should be routed through the employer. This way, the company will have some control.

Dear Sir,

Thank you for your valuable reply and the time you spent on my question. I understand that your points are very clear and effective in this case. However, can we ask the insurance company to underwrite the same in our group health insurance policy? Is it possible for the insurance company to do so based on our request?

Kindly clarify the above doubts for me.

Thanks in advance.

Hi,

If you are covering employees under the same corporate GHI, underwriting may not be required. The crux of covering employees' family under Group GHI is that they can cover their elderly parents with existing illnesses. If you go for underwriting, the number of employees opting for the addition of parents option will go down.

Sir,

Our employees were already covered under Corporate GHI. Now, we are planning to add their family members to the same Corporate GHI policy. I don't understand your reply clearly: "If you go for underwriting, the number of employees opting for the addition of parents' options will go down."

Kindly clarify this for me again, and I apologize for any inconvenience. If possible, please provide me with notes or documents for better understanding.

Thanks in advance.

Hi,

What I meant is if you go for underwriting for Parents addition (wherein they will exclude pre-existing illness or will charge more premium), the number of employees showing interest to opt for the parents addition will come down. If the number goes down, the insurance company will charge a higher premium for the employees who are willing to add their parents.

Sir,

Thank you, sir. If we request our insurance company to incorporate these points (the above 4 points mentioned by you in your 1st reply), can they underwrite or not? Will the insurance company accept this type of request?

Thanks in advance.

Hi,

The points mentioned above are for your internal policy. Create a policy with points similar to those above and have it signed by the concerned employees. The insurance company will not impose these points; they will provide a quote based on your requirements and the number of lives to be covered. The term "underwrite" in mediclaim insurance is a different terminology.

Thank you.