Every type of company has its own requirements when it comes to health insurance. Some companies are relatively high risk when compared to other companies. A high-risk company is a company whose employees operate under less safe working conditions when compared to other companies.
A construction company is considered to be relatively high-risk because accidents on a construction site can occur at any time. Such accidents can lead to injuries which means claims against the health insurance company.
There are certain factors that you need to consider before opting for group health insurance for construction companies. These factors will help you to determine which GMC construction company to opt for.
What’s on this page?
Are Injuries Covered Under the Plan?
A construction company will have employees that work on-site. A construction site is a high-risk area for accidents that can cause personal injury. For example, suppose a person accidentally hammers their hand while trying to hit a nail. A finger or two might break.
In such circumstances, the construction company will need a group health insurance policy that covers injuries.
Contrary to popular belief, not every health insurance covers injuries. An injury, for insurance purposes, is defined as bodily harm which has been caused by an accident. There are separate types of group health insurance policies that specifically cover such incidents.
Before opting for a group health insurance policy, the construction company needs to check whether injuries are covered by the policy. Further, they need to check whether there are any sub-limits for the treatment of injuries. Ideally, there should be no sub-limits for the treatment of injuries.
Policies that only cover accidental injuries are known as personal accident insurance policies. However, there are general health insurance policies that also offer the same coverage in addition to other types of coverage for other types of medical conditions as well.
Choosing between the two types of insurance depends on your company’s needs and requirements.
Is the Sum Insured Sufficient?
The sum insured means the maximum amount per person (or member) that can be claimed from the insurance company. A higher sum insured means a higher annual premium, hence, a construction company will need to be careful about the amount of sum insured that they opt for.
Ideally, the sum insured should be enough to cover any kind of injury that an employee can suffer at a construction site. The higher the sum insured, the more peace of mind the construction company management team can have.
Imagine a situation in which an employee suffers an accident at the construction site. The employee has broken their hand. The maximum sum insured by the policy is Rs. 3 lakhs, however, the total cost of treatment of the broken hand comes to Rs. 5 lakhs.
In such circumstances, the insurance company will only be liable for Rs. 3 lakhs. The rest of the Rs. 2 lakhs will need to be paid by the employee themselves or the construction company.
The injured employee may not have the means to cover the cost of the treatment. To avoid such scenarios, the construction company needs to avail an insurance for construction with a sufficient sum insured.
Are Network Hospitals Close to Sites of Construction?
There are two ways of making a claim against an insurance company. The claim can be a cashless claim or a reimbursement claim. In a cashless claim, the insurance company directly pays the hospital for the treatment. In a reimbursement claim, the insurance company will pay the policyholder once all the expenses have been paid for by the policyholder.
It is always better to opt for a cashless claim rather than a reimbursement claim. However, a cashless claim can only be made if the hospital at which the treatment has been done is within the “network” of the insurance company. These hospitals are called network hospitals by the insurance company.
In case of emergencies, an injured employee will need to be carried to the nearest hospital. It is better for the construction company if this hospital is a network hospital for the insurance company. This way, the policyholder can make a cashless claim and not need to pay for the treatment before getting the insurance money.
Are Pre-Hospitalization and Post-Hospitalization Costs Covered?
All the expenses related to an injury or medical condition may not occur at a hospital. There will always be some expenses that occur before the hospitalization and some expenses that occur after the patient has been discharged. These expenses are known as pre-hospitalization and post-hospitalization expenses.
Not every insurance policy covers such expenses, however, it is crucial to opt for a policy that does. Such expenses can seem little but can amount to a lot over time. The rehabilitation period after an injury can be long and expensive.
As a construction company, you need to plan for such expenses and only opt for a group plan that covers it. Even though the premium may be slightly higher for such a plan, the potential benefit outweighs the cost.
If such expenses are covered, then a claim from the insurance company can be made which may cover the actual costs of the entire treatment (depending on the particular circumstances of the case).
Hence, there may be no need for the construction company or the injured employee to pay anything (or pay a minimal amount) from their own pocket.
It is essential for a construction company to opt for a group health insurance policy. The advantages of having such a policy are far greater than the cost. Construction workers are especially prone to bodily harm and injuries, and it is the duty of the employer to protect employees from on-site injuries.
There are several factors that need to be considered when opting for any kind of insurance. The points raised in this article are specifically meant for the specific needs of construction companies, however, other general considerations should also be taken into account.