Quick Summary
All the group health insurance policies are tailor-made policies and can be customized as per the client's requirements, but there are some important questions HRs should ask before taking lunge.
After collaborating with more than 800 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.
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 (ESC): 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 (ESCP): Here, 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. However ESC is the most common policy opted by companies.
All the group health insurance policies are tailor-made policies and can be customized as per the client's requirements.
To understand what is group health insurance, you can check the video below
2. What are some of the important variables/cappings to decide before buying a policy?
Once you get a fair idea of what type of policy you want to offer, you have to decide on the policy coverage you want to offer.
Sum Insured ✅
Sum insured is the amount of monetary coverage each member in the policy gets. 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 becomes a floater cover where the whole family is covered under 5lakh and not individually.
Ask your insurer/vendor about the inclusions and exclusions in the policy.
Maternity Cover 🤰
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 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.
Maximum coverage for maternity is Rs 75,000. So you can dedice how much percentage of sum-insured can be used towards maternity with the upper limit being 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
Let's assume you choose sum insurance of 5 lakh and on that and you have 1% and 2% room rent clause. Then the employees, when hospitalized, can select any general wardroom that cost them Rs 5000 per day or lesser as 1% of 5 lakh is Rs 5000.
If the employee 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%, employees 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 employee 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. Policyholders are free to choose any available room in the hospital.
3. What are the things needed from the company’s side when buying group medical insurance for the first time?
While buying group health insurance for your team all you need to give is your active employee data that comprises of the below 📃
- Employee’s code
- Name
- Age
- Gender
- E-mail 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 group medical insurance renewal? 🔁
The active employee data mentioned in question 3 is required for renewal as well. Apart from that, additional details like the previous
- GHI coverage
- Name of the insurer
- Number of claims raised
- Amount of claims raised
- Policy details
You can ask your previous insurer to share the claim dump details and policy details. so you can share it with your new insurer or vendor. 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? 🤯
HRs and admins are always handful. Keeping a tab on insurance data shouldn't be an added burden. So ask regarding how your vendor can help reducing your manual work. Some of it include keeping a check on claims data, CD balance, no. of employees added and removed (endorsements).
At Pazcare, we have a sophisticated dashboard that gives an overview of all the insurance data. You can also download these as reports as per your requirement. With our dashboard reports, HRs can have more clarity on the insurance data.
6. Do you provide technical and claim support?🦾
A great insurance experience pretty much boils down to claim experience. It is important to know if you and your team will have timely support throughout. Don't shy away from asking your vendor's TAT, NPS score and claim settlement ratio.
Although Pazcare's insurance process is automated and digitized for better accessbility and visibility, we offer 24/7 customer support. 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 (support@getpaz.com) 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 industry has been manual for the last 20 years. Pazcare is revolutionizing the employee insurance and benefits space with technology. Check the below image to understand how Pazcare is different from traditional brokers.
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Along with group health insurance, we provide other employee benefits like group personal accident insurance, group term life insurance, health and wellness .
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From coverage to claims; a smooth group insurance experience
No hiccups in buying, issuing and managing insurance. Pazcare makes employee insurance effortless for you.
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Key takeaways
- Choose the type of policy, coverage and inclusions that suits your company's requirements
- Wellness benefits along with a group medical insurance policy are more impactful among employees
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