After collaborating with more than 200 companies and providing Group Health Insurance benefits to the firm and its employees, we came up with some common doubts, questions, and queries related to group health insurance policy which HRs generally ask. Here are some frequently asked questions:
1. What are the types of policies? I am starting fresh.
Let’s say you want to buy GHI for your employees. The first thing you would ask any insurance company would be the types of policies, right? There are 3 types of policies in group health insurance.
- Employee only policy: In this, the employer only covers the employee and no involvement of the employee’s family.
- Employee, spouse and children policy: In this case, the employer covers the employee, their spouse and their two children are covered. Anything more than two children if added to the policy naturally increases the cost of the policy. With new laws coming into the picture by the Indian Government, the definition of spouse is now changing into the term partner. There are a lot of companies that are friendly towards the LGBT community and want to provide insurance to their partner, which can also be included in this policy.
- Employee, spouse, children, parents policy: In this case, the employer covers the employee, their spouse, children and two parents or in-laws. The employee can choose between in-laws and parents.
Out of the three types of policies, the employee only policy is the most economical for the employer. And as you include more people into the policy, the coverage becomes more expensive.
All the group health insurance policies are tailor-made policies and can be customized as per the client's requirements.
2. What are some important points and inclusions to consider?
Once you get a fair idea of what type of policy you want to offer, you have to fix the coverage, inclusions and exclusions in insurance.
The type of coverage
You have to decide what type of policy and how much coverage goes with each employee.
Let’s say you are giving a cover of 5lakh rupees to an employee, if the policy is employee-only then the whole amount is for the employee. But if the policy includes family members also, then these 5lakh rupees is known as floater cover where the whole family is covered under 5lakh rather than each individual member as 5lakh.
It is astonishing that there is only a handful of countries including India that provide maternity cover. Generally, if you purchase retail policy and not Group Medical policy then the total waiting period for the maternity to be covered is 9 months. But in GHI there is no waiting period. Here, maternity is covered from the day you buy your group health insurance.
One thing to keep in mind, depending on the group you cover, when you include maternity in GHI for your employee, the cost increases substantially. Maximum coverage for maternity is Rs 75,000.
Room Rent Capital
Hospitals provide rate cards for the types of rooms which patients can choose from. Now with the inclusion of room rent in GHI, employees' room expenses are covered.
1% and 2% room rent
Suppose your company selects sum insurance of 5 lakh and on that and you have 1% and 2% room rent clause. Then the patient can select any general wardroom that cost them Rs 5000 per day or lesser as 1% of 5 lakh is Rs 5000.
If the patient has to get admitted in the ICU or ICCU then the cover for that is Rs 10,000 per day or lesser as 2% of 5 lakh is Rs 10,000.
2% and 4% room rent
Similarly, for 2% and 4%, the patient can select any general wardroom that cost them Rs 10,000 or lesser per day as 2% of 5 lakh is Rs 10,000.
If the patient has to get admitted in the ICU or ICCU then the cover for that is Rs 20,000 per day or lesser as 4% of 5 lakh is Rs 20,000.
One has to note that all these charges are only for room rent. Doctor consultation charges are covered over and above the rent.
No cap room rent
Here there is no limit or cap on room rent for the employee. It means that there is no coverage percentage limit on the room rent per day.
3. What are the things needed from the company’s side if we want to buy GHI for the first time?
While buying group health insurance for your team all you need to give is your employee’s code, their name, age, gender, email address, parents and family data. When you give this data and the type of coverage policy you need, we talk with the insurance companies and bring you the best deals.
When you buy a group health insurance policy for your team you do not need your employees to get medical check-ups.
4. What is the process for renewal?
The basic details required for renewal are similar to that when you buy a group health insurance policy for the first time like employee’s code, their name, age, gender, email address, parent and family data. Apart from these additional details like the previous GHI coverage, a number of claims used in the previous year and the insurer are required. Based on these data and current company requirements, quotes will be given to you
5. Where and how can I keep a check on my employees' insurance data?
Instead of going with the primitive method of giving calls to the insurance company and creating documents and excel sheets to add new employees, with the use of this software, HRs are provided with Pazcare employer dashboard wherein HR can come and directly put employee’s email id. New employees will get an email stating that the company is providing them with health insurance and will be requested to fill in their details. As soon as the details are filled in, the insurance policy of the new employee begins.
It’s also not feasible for HRs to add many employees on daily basis on the website, so if the company has an HRMS solution system, we get our systems integrated into that HRMS solution system so that whenever the employee fills in their details in the HRMS system it gets reflected on our system and their insurance policy starts.
6. Do you provide technical and claim support?
Although most of the process is automated, it is very easy for HRs to use our software. “10X easier than the HRMS Softwares” as said by our experts. You will be given a walkthrough of the whole application. If you face any difficulty or need support, we have instant human chat support which is a 24x7 human-assisted chat support on WhatsApp/email (firstname.lastname@example.org) and on calls (+91-7829111300). We provide employees with end-to-end support for anything related to the cashless claim.
You can check out the employer experience for more details.
7. How is Pazcare different from traditional insurers?
The whole insurance company has been manual for the last 20 years. Covid-19 has made us realize that we need insurance digitally as the millennials want everything quick and ASAP.
Pazcare is a new-age technology insurance broker and IRDAI regulated company. As per your requirement, we provide you with the best policies. We are catering insurance to corporate, SMEs and startups with as low as 2 employees digitally. We provide a very convenient and easy-to-use insurance platform for your company. With the help of a dedicated dashboard, HRs can easily add and remove employees. They will have all the administrative access within the dashboard. They can get a clear understanding of how their employees are making use of the healthcare benefits through the analytics dashboard. Also, check how many claims are in process and have been settled. Automate your entire policy management process through your native HRMS platforms.
Design the perfect healthcare benefits for your employees and get started with Pazcare now.