Struggling with High Claim Ratios in Group Mediclaim? Seeking Urgent Advice on Alternatives

Respected Seniors,

My query is regarding the employee group mediclaim policy. Following are the details:

Ours is a 10-year-old company, and we currently have about 500 employees. We have had a group mediclaim policy with United India Insurance for the past 10 years. The insured sum amount is 1 lakh, and it is a floater policy where an employee plus 5 dependents are covered. In the last financial year, we had a claim ratio of around 225%. This high ratio is resulting in a major problem, as at the time of renewal, the loading on the premium is becoming very high. For a sum insured of 1 lakh, we have to pay a premium of Rs. 7000 per annum for each employee.

Since we have a policy of sharing the insurance amount equally between the employer and employee, it is becoming increasingly difficult to sustain this.

Is there any alternative for this situation? Please advise me urgently.

Given the high claim ratio and increasing premium costs for the group mediclaim policy, there are several strategies you can consider to address this situation effectively:

1. Review Current Policy: Evaluate the existing policy terms, coverage, and benefits to identify areas where costs can be optimized without compromising employee health coverage.

2. Negotiate with Insurer: Engage in discussions with United India Insurance to renegotiate the premium rates based on the claim history and explore options for reducing the loading on the premium.

3. Employee Wellness Programs: Implement wellness initiatives to promote a healthier workforce, which can lead to reduced claims over time. Consider offering health screenings, fitness programs, or mental health support.

4. Risk Management: Conduct a thorough risk assessment to identify common health issues among employees and tailor the policy to address specific needs, potentially reducing claims.

5. Alternative Insurance Providers: Explore other insurance providers in the market to compare quotes and find a policy that offers competitive rates without compromising coverage.

6. Policy Restructuring: Consider adjusting the coverage limits, co-payment requirements, or deductible amounts to manage premium costs while ensuring adequate protection for employees.

7. Employee Contribution: Reassess the split of insurance costs between the employer and employees. You may need to adjust the contribution percentages to alleviate the financial burden on the company.

8. Seek Professional Advice: Consult with HR consultants or insurance experts who specialize in employee benefits to gain insights into cost-effective solutions tailored to your company's needs.

By implementing a combination of these strategies and customizing the group mediclaim policy to better suit your company's requirements, you can effectively manage the high claim ratio and premium costs while ensuring comprehensive health coverage for your employees.