How To Get The Best From Your Employers’ Health Insurance Cover?

Employees’ insurance benefits plans are offered by most employers to reduce the possible financial and mental burden on employees. Although corporate insurance plans are decided based on the employer’s available budget, the size of the organisation, and internal employee policies, the employees have a say in the selection of the coverage and insurance provider, through their feedback after weighing the benefits.

Employees should get the maximum benefit from the insurance plans offered to them and their family members. Some of the key considerations for getting the best out of these corporate insurance plans are as under: 

• Gain a thorough understanding of all the benefits extended under the cover and figure out the processes that need to be followed to avail of these benefits 
• Ensure inclusion of all family members who can be included as per the definition of ‘family’ in the policy. Many employer-employee insurance policies provide options to cover extended family members such as siblings and in-laws 
• Double-check to ensure that the right details are updated. These include the date of birth, existing health conditions, and nominee details 
• Familiarise yourself with the process of availing the benefits and claims  
• Avail reimbursement of annual health check-ups, OPD, dental, and wearables, if these are part of the cover 
• Download the claims app of the third-party administrator (TPA) or insurer and save the claims helpline number on your phone for when you need it 

Types of Employee Benefit Insurance Plans 

Corporate employee benefit plans include health insurance for the family, accidental death and disability benefits, life insurance and wellness plans to monitor the existing health conditions of members and take necessary precautions. 

There has been significant improvement in the way the employee benefit plans are designed for employees. Insurers, brokers and other intermediaries have been analysing the claims experience and recommending those covers for renewal that are optimal for employee consumption and also within an employer’s budget. 

In addition to insurance covers, many health and wellness benefits are extended to the employees in the corporate insurance ecosystem. The range is very wide—from basic health check camps, vouchers, yoga and zumba sessions and behaviour therapy assistance to pregnancy care plans for all trimesters. 

The main focus has always been to analyse the existing health conditions of the group. This allows insurers to offer the best prevention and wellness plans to employees to ensure improvement in the risk score of each member of the group. 

Why Employees Want Health Insurance from Their Employers 

Employer-employee health insurance provides peace of mind to employees and enables them to do their jobs without the added worry of a financial hit during uncertainties related to health. This is used effectively as a tool to attract and retain talent. 

• Employees get comprehensive coverage from the employer-employee insurance plan. These are usually superior to health insurance plans that can be purchased directly by the employee. 
• Standard waiting periods are waived for the most probable claim scenarios, which makes these plans more efficient  
• Making a claim helps to take advantage of the cumulative bonus available in a self-purchased policy for not availing claims. The resulting increase in the sum insured through cumulative bonus helps the employee after retirement or in scenarios when the hospital expenses are more than the limit provided by the employer. 

Challenges For Employees 

Employee benefit plans are broadly perceived as a great benefit to the employees due to their high usability in real life scenarios, especially at no additional cost to them. However, the following challenges must not be ignored by employees.  

• The plan’s benefits and limits are not decided by the employees. Employees have minimal control over the details of the policy and hence the policy might not always cover them adequately. For example, if the plan does not extend to dependent parents, the employees remain exposed to that vulnerability  
• If an employee switches companies or leaves the current employer, he/she is forfeiting cover until a new cover from the new employer begins 
• After retirement, the employee will remain uncovered if he/she hasn’t taken a personal cover. It is difficult to get an individual health plan at the retirement age 

Tackling The Challenges 

To address these risks, an employee should buy an individual family health floater policy to provide coverage to all family members. Few employers also negotiate with the existing insurance carrier to provide the continuity benefit to the employees after retirement, if they wish to insure with the same insurer for the rest of their life. 

The author is Co-founder and Director, Riskcovry