I am an HR Executive of a company. Our employee size is small, and we are looking for employee health insurance for the first time. Can anyone suggest the best company or TPA to proceed with?
From India, Madras
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From India, Madras
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Overview of Health Insurance Cover (Group Mediclaim)
The health insurance cover (group mediclaim) is available with standard features that can be tailor-made to suit your requirements. A typical standard cover includes:
Coverage Details
- It covers the cost of treatment for any illness, injury, or disease that requires hospitalization for a minimum of 24 hours. This requirement is waived in cases where medical technology advancements do not necessitate a 24-hour stay in the hospital, such as cataract, chemotherapy, radiotherapy, dialysis, etc.
Key Features
- Cover for all individuals between the ages of 3 months to 75 years.
- Does not cover any pre-existing disease or its complications.
- Does not cover maternity.
- Does not cover any claim arising from alcohol intake.
- Does not cover congenital ailments.
- No treatment except for those arising from accidents is covered in the first 30 days of taking the cover (for the first time, i.e., not applicable on renewal).
- Certain ailments are excluded for the first 1 year/2 years.
- Capping on room rent eligibility per day basis - typically 1% of the sum insured available as room rent per day. For ICU, it is 2%.
- Capping on treatment of certain ailments - like cataract, hernia, hysterectomy, bypass surgery, etc.
Decisions to Consider Before Initiating Health Insurance Cover
1. Coverage for Whom - Options include: Employee Only, Employee + Spouse, Employee + Spouse + 2 Children. Covering parents is possible, but since their claims often exceed those of other members, it can significantly impact renewal premiums. For SMEs, it is recommended to avoid this in the first year. Once the policy and its workings are clearer, consider including these benefits from the second year.
2. Coverage Basis - Individual or family floater basis: It is recommended to opt for insurance on a family floater basis, which is the ongoing trend and provides better coverage for employees and their families.
3. Coverage of Pre-Existing Disease - Any ailment, sign, or symptom existing before the policy date is excluded. You can waive this condition by paying an extra premium, often resulting in a 50% loading on the base premium.
4. Child Cover from Day 1 - If providing insurance on a family floater basis to immediate dependents (spouse and children), coverage typically starts from the 91st day. This can be modified to cover the child from birth.
5. First 30-Day Exclusion - For first-time policies, there is an exclusion on any claim for the first 30 days, except for accidental claims. This can be waived by paying an extra premium.
6. First 1/2-Year Exclusions - Certain ailments are not covered for the first 1/2 years, such as cataract, piles, hysterectomy, etc. This clause can be waived by paying an extra premium.
7. Maternity Benefits - A standard policy may not cover maternity and related complications. Maternity benefits can be obtained by paying an extra premium.
Basic Exclusions
- Alcohol-related treatments and cosmetic/plastic surgeries are not covered.
- The hospital should be registered with local government authorities and have a minimum of 15 beds in urban areas and 10 beds in rural areas, along with full-time qualified doctors/nurses, ICU, etc.
What I have provided above is a brief overview of the options you need to consider before initiating the insurance policy. The policy should be designed to provide relevant risk coverage and be sustainable for both the insurance company and yourself in the long term. Otherwise, premiums may rise, or insurers may refuse to continue the cover if it becomes loss-making beyond their risk appetite.
Next is to finalize the cover and compare it with multiple insurance companies.
From India, New Delhi
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5The health insurance cover (group mediclaim) is available with standard features that can be tailor-made to suit your requirements. A typical standard cover includes:
Coverage Details
- It covers the cost of treatment for any illness, injury, or disease that requires hospitalization for a minimum of 24 hours. This requirement is waived in cases where medical technology advancements do not necessitate a 24-hour stay in the hospital, such as cataract, chemotherapy, radiotherapy, dialysis, etc.
Key Features
- Cover for all individuals between the ages of 3 months to 75 years.
- Does not cover any pre-existing disease or its complications.
- Does not cover maternity.
- Does not cover any claim arising from alcohol intake.
- Does not cover congenital ailments.
- No treatment except for those arising from accidents is covered in the first 30 days of taking the cover (for the first time, i.e., not applicable on renewal).
- Certain ailments are excluded for the first 1 year/2 years.
- Capping on room rent eligibility per day basis - typically 1% of the sum insured available as room rent per day. For ICU, it is 2%.
- Capping on treatment of certain ailments - like cataract, hernia, hysterectomy, bypass surgery, etc.
Decisions to Consider Before Initiating Health Insurance Cover
1. Coverage for Whom - Options include: Employee Only, Employee + Spouse, Employee + Spouse + 2 Children. Covering parents is possible, but since their claims often exceed those of other members, it can significantly impact renewal premiums. For SMEs, it is recommended to avoid this in the first year. Once the policy and its workings are clearer, consider including these benefits from the second year.
2. Coverage Basis - Individual or family floater basis: It is recommended to opt for insurance on a family floater basis, which is the ongoing trend and provides better coverage for employees and their families.
3. Coverage of Pre-Existing Disease - Any ailment, sign, or symptom existing before the policy date is excluded. You can waive this condition by paying an extra premium, often resulting in a 50% loading on the base premium.
4. Child Cover from Day 1 - If providing insurance on a family floater basis to immediate dependents (spouse and children), coverage typically starts from the 91st day. This can be modified to cover the child from birth.
5. First 30-Day Exclusion - For first-time policies, there is an exclusion on any claim for the first 30 days, except for accidental claims. This can be waived by paying an extra premium.
6. First 1/2-Year Exclusions - Certain ailments are not covered for the first 1/2 years, such as cataract, piles, hysterectomy, etc. This clause can be waived by paying an extra premium.
7. Maternity Benefits - A standard policy may not cover maternity and related complications. Maternity benefits can be obtained by paying an extra premium.
Basic Exclusions
- Alcohol-related treatments and cosmetic/plastic surgeries are not covered.
- The hospital should be registered with local government authorities and have a minimum of 15 beds in urban areas and 10 beds in rural areas, along with full-time qualified doctors/nurses, ICU, etc.
What I have provided above is a brief overview of the options you need to consider before initiating the insurance policy. The policy should be designed to provide relevant risk coverage and be sustainable for both the insurance company and yourself in the long term. Otherwise, premiums may rise, or insurers may refuse to continue the cover if it becomes loss-making beyond their risk appetite.
Next is to finalize the cover and compare it with multiple insurance companies.
From India, New Delhi
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