Seeking Advice on Choosing the Right Mediclaim and Group Insurance for Our Team

Dear All,

Can anyone suggest about the mediclaim policy of a group insurance scheme for our employees? Also, what are all the things we need to take care of when buying mediclaim and group insurance for our employees?

Awaiting your response.

With Regards,
Sujeet S Rajawat

1. In a group health policy, you can decide what benefits to opt for within the framework of the policy.

2. The choices you make should depend on the employee population mix (married/unmarried, male/female) and who you wish to cover.

3. Typically, the practice is to cover employees if the group size is small and for the group size of employee, spouse, and 2 kids. This premium is paid by the company.

4. As far as the insurance companies are concerned, if a fair premium is paid, then the risk can be placed with any insurer. You can also contact Devarajan at [Login to view] who may be helpful to get more details about group mediclaim policy.

Well,

Today, Group Medi-Claim policies are very helpful to employees to cover their vital expenses on medical benefits and also helpful to employers by providing a major benefit. Below are the key aspects one should ask from insurance companies:

1. Coverage of employees may include (self + Spouse + Two Kids + Parents - optional).
2. You can define the coverage of sum assured to 1 L, 2 L, 3 L, 4 L, and above as per hierarchy in your company for GMC, while for GPA, sum assured may be doubled or tripled.
3. Benefit coverages you can opt for include:
a. Pre & Post Hospitalization of 30 to 60 Days
b. Maternity Benefit Cover
c. Infant Baby cover from Day One
d. Pre-Existing Diseases etc.

When approaching a Group insurance service provider, directly approach the company, not the broker; this may benefit you to choose your TPA of your choice for getting hassle-free services from the insurance company.

Service Providers like National Insurance Co., Reliance, United Insurance, Cholamandalam are the best in terms of services (based on my personal experience with them).

While taking a fresh policy, one can negotiate up to 30-40% of the premium quoted by the service providers, and if such a policy already exists, factors like claim ratio matter a lot, as well as further loadings on premium.

If you require any further assistance or information, feel free to call or email me.

Pramod S. Bhadauriya
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Voice - 9811449000 (M)

Dear,

My experience with both has shown that it is better to have an association with the Nationalized one. However, it all depends upon your leverage/exposure to the insurance schemes. It's better to associate with the insurance company that offers other schemes with your organization, such as fire, burglary, personal accident insurance, etc., which would give you the flexibility to flex your muscles. Please remember that at the time of pitching for your account, they may make many promises while collecting the premium, but during claims processing, they may sing a different tune altogether! Please note that the claims are processed – not by the insurance company, but by the TPA – Third Party Administrators. Please also check on their reputation.

To start – give them a call and ask them to send their representatives.

Documents – Name, Age, Date of birth, Limit of insurance amount.

From my experience, I would recommend that it is better to take a floating cover, say Rs. One Lac, for the person and their family than Rs. One Lac for the individual.

Please note, whichever party you choose – please stick with them for at least 4 years to avail the following advantages, namely:

1. Pre-existing diseases are covered only after 4 continuous and claim-free renewals.
2. Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of an additional premium.

Regards,
Vipin:icon1:

Dear All, very good discussion. One circular from the Finance Ministry regarding loading the premium at the time of renewing the policy is being shared. Attached herewith is a ready reference that will be useful to all concerned.

Regards, J.L. Trivedi

Our management has decided to introduce Group Insurance for all employees who are not covered under ESI. We have 150+ employees. Kindly suggest the best policy and cost per employee.

Thank you.

Regards,

Can you please clarify what a co-payment is? Is it based on the bill amount or the sum insured?

Example:

Sum insured is 2.25 Lakhs. Co-payment is 25%. My bill amount is 4 Lakhs. If I apply for a claim, 25% of 4 Lakhs, i.e., 1 Lakh, I have to bear, and the remaining 3 Lakhs the insurance has to bear. However, 3 Lakhs is more than the sum insured, so I should get the full sum insured amount. But the insurance company is saying they pay the sum insured amount minus 25% of the sum insured amount, i.e., 168,750. Is this correct?

Hi Seniors,

Kindly advise if, in any particular factory, ESIC is not applicable, is it legal for the factory to provide group insurance to its employees. Please clarify if under what law.

Thank you.

Regards,
Smita

I need a little more clarity on Anony's query.

Switching from One Company to Another

1. What do you want to know about switching from one company to another? I presume that your company obtained the existing Group Insurance policy from Company 'A' and is considering switching to Company 'B' for the next year. Am I correct?

Yes, you are free to do so. However, before making the switch, you should be aware of at least two consequences:

i) I believe that if you switch to Company 'B', there may be a disadvantage. Starting fresh with them means that some of the medical benefits for your staff may only be accessible after the 2nd or 3rd year, whereas if you continue with Company 'A', your staff will be eligible after the first year.

ii) There is a provision for a 'No Claim Bonus'. If some insured staff members do not claim any insurance benefits, the insurance premium for renewing the existing policy for the next year will be lower due to the application of the 'No Claim Bonus'.

Considerations Before Changing Insurance Provider

Therefore, before changing to a new insurance provider, you should carefully consider the advantages and disadvantages and make a decision. Additionally, you should consider the "cashless hospitalization" option, which is a desirable feature for any group insurance or mediclaim policy. This feature ensures that the cost of treatment is covered, alleviating the burden on both the employer and employees.