Covering Employees’ Parents under group health insurance- 3 different cases
The premium payable is decided based on many factors and the most important among those is the previous year’s claims. With people who are aged and with a pre-existing disease it is very natural that the frequency of claims will be high and most of the time-intensity, in other words, the amount of claims is also high.
So, should the employer forget about including parental insurance as part of employee benefits? The answer is “No”.
A strategic approach towards designing the group policy will help in bringing down premium costs and, at the same time, extend the benefit of group insurance to the parents of the employee.
Following are configurations and scenarios to be considered while designing the structure of a group insurance policy to minimize the premium cost while you plan to invest:
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Case 1: The employer bears the cost of the premium and is not collecting any amount from the employees.
Employers who are including the parents of the employees in group insurance and pay premiums from their pockets shall take the following steps while designing the policy. They must focus on ensuring the claims are not very high in the current year so that next year the premium will not be high.
• Exercising sub-limits on employee cover: The employer must work with its broker to design the policy in such a way that the employees should take standard/benchmark benefits and not luxury benefits from the policy.
The policy must contain in-built limits with respect to diseases. It should include the most common ailments like cataract surgery, piles surgery, hernia surgery, hysterectomy, Hydrocele correction, Joint Replacements, Gall bladder stone surgery, appendicitis surgery, etc which are not costly. Also, the insertion of a clause that only average standard cost is allowed, and anything above that will not be allowed will help reduce the premium and also the claim liability.
Example: For daycare/ short stay procedures, like cataracts, or BPH surgery, for an employee or the dependents, it is important to consider that the treatment cost can vary significantly depending on the facility where it is undertaken.
Due to the lack of standardization of cost across hospitals, cataract surgery in a private hospital will cost around 10,000, however, the same procedure will cost 20,000 in a multispeciality hospital. So, in this case, only 10,000 will be allowed on the submission of actual bills!
• Setting a lower limit on claims: The policy must be structured in a way where employees can claim expenses that are painful to the pocket and not for the sake of claiming. The employer must set a minimum limit for seeking a claim say 3,500/- this way all small claims below 3,500/- will be curbed and employees will not be visiting as inpatients just for the sake of claiming.
• Hospitalization in preferred hospitals: Just setting up of minimum limit of claims is not enough. There can be a possibility that hospitals will misrepresent and join hands with employees to fetch money. Therefore, it’s important to include a clause that encourages employees to avail of services in preferred hospitals.
A clause stating that employees who are availing services in preferred hospitals will get a 100% claim and those who are availing at other hospitals will be getting only a partial claim to say 70% of the bill amount. It will encourage employees to avail themselves of services in preferred hospitals and if an employee chooses other hospitals, it will reduce the claim to 30%.
Preferred hospitals are those hospitals that do not have the tendency to overcharge or inflate the bills or misguide the patients to draw money. Employers as a company can also work with different hospitals to get a discounted rate of consultation in return for adding their hospital to the preferred list. A list of preferred hospitals must be added to the policy.
Case 2: Employee bears the cost of premium fully or partially
In a scenario where the employer does not want to bear the cost of premium fully or partially, it can act as a facilitating vehicle.
• Run an effective campaign to enroll: The company as an employer must run a campaign to encourage most of its employees if not all, to enroll for group health insurance with parental insurance. The campaign must be driven to inform the benefits of such enrolment and how the company is supported by choosing the best broker, including appropriate clauses and dealing with the best insurance provider. Such a campaign is led by the CEO or HR head will have a more positive impact on the employees. Certain insurance brokers also create and run a campaign for their clients.
• Ensure portability of policy: Employer while negotiating with the insurance providers must ensure that an employee who is paying the premium must be allowed to carry forward the policy when he is moving to another company. This facility of carrying forward is called the portability of policy.
Case 3: When neither case 1 nor case 2 is possible:
• Facilitate senior citizen health insurance:
In case an employer chooses not to spend any amount on the medical expenses of an employee’s parents, it can at least encourage its employees to take senior citizen health insurance policy for their parents. An employer on behalf of its employees seeks quotes for such policy and with the help of its insurance broker, supports its employees to get the best insurance plan.
Employers who can’t afford to support financially at least can support their employees by arranging for the facility to take the right decision. If the parents’ health is taken care of, the employee will be relieved of a huge burden that he may be otherwise unable to bear independently.
There are various plans and benefits offered by many insurers. Some of the plans are specially designed for people suffering from ailments like high blood pressure, diabetes, obesity, etc.,
The main challenge is that individual Health insurance is only for healthy people. One must declare family history and current health conditions while taking the policy. The insurer then decides whether to cover or reject the proposal. Even if they decide to cover the existing ailments, they will only cover them after a certain waiting period. This makes it tough for senior citizens to get the appropriate health coverage. But with the right guidance, it will be possible to find an appropriate plan that provides adequate coverage.
So now that you know how to cover parents, hope this might help you choose the best approach! In case you need any more clarity and you have any question that needs to be answered, feels free to reach us at Ethika.co.in!