HRs often make these statements when we meet them for the first time as an Insurance Broker specializing in Employee Benefit Plans
We are spending a large portion of our HR Budget on group health insurance, but I am not happy with its impact.
This is all for 8% of your employees who actually claim benefits. Most of the remaining 92% don't even recall them.
Only 2-3% of those 6% are for emergency. The rest are for maternity and planned procedures.
In addition, the Group Health Insurance premiums keep increasing exponentially every year, which affects the HR budget for other verticals.
Providing insurance to employees' parents has always been challenging.
Despite all our efforts, employees are not happy. In spite of their claim of 99000, they complain about the 1000 which was deducted due to policy conditions.
There are times when I feel HR is such a thankless job.
Having read over the above statements, are there any of them that you can relate to?
Think about hiring an insurance broker that promises to solve all of the above problems.
" Your day could be more efficient if you didn't have to spend 90% of it following up with your insurance companies, TPAs or hospitals. "
In group health insurance, the whole employee experience is impacted by a triad that includes the insurer,
third party administrator, and hospital.
A broker is responsible for balancing TPAs' and insurance companies' customer promises and delivery standards.
Aside from just acting as a watchman, an insurance broker can add significant value to the whole experience and administration of group insurance.
Choosing the right insurance broker is crucial before learning about Insurance Premiums and Policy Benefits.
Some of these key value facets are explained herewith.
Getting Group Insurance from an insurance Broker is like “insuring the risk of insuring the risk”, as the insurance broker is legally liable for protecting your interests.
Insurance brokers represent their clients to the insurer and not the other way around.
They are bound by the Insurance Regulator to perform as per the terms laid to them.
They must protect your interest at each stage of insurance, from purchasing a policy to assisting you with a claim.
They are experienced and have worked with various clients, so they know the best practices and can set up an insurance program for your organization with ease, saving you time and effort!
Ask these 3 questions to your insurance broker.
Typically the insurance broker should offer all of the below services
Premiums in the Indian market are very competitive compared to the world market and have been driven more by prior year premiums rather than claims experience.
During the last decade, insurance companies have faced claim ratios of more than 120% due to the intense competition mostly brought on by public sector insurance companies.
As a result, organizations/employers have had a good ride, as they were able to pass the risk to insurance companies and enjoyed a great range of benefits without getting impacted by high claim ratios.
Claim Ratio: The ratio between the total claims made by the group at the end of the policy vs the premium paid by the corporate without tax.
Additionally, some of the new insurers burned money intentionally to gain market share quickly.
Government plans to divest all four public sector insurers, which could lead to the end of competitive insurance premiums.
Therefore the actual value addition of the insurance broker to get you the competitive premium will depend on how effectively he communicates with the insurer on technical grounds.
This will involve negotiating with underwriters on various parameters like
The insurers want to feel a sense of partnership between them and the customer in reducing the overall health risk of the company. If they speak to only one insurance broker who has complete information about the risk, that can be established.
A client involving more than one broker for negotiating with the insurer creates a negative impact on the negotiations. It implies that the client does not fully trust the insurance broker.
As a policy, Ethika does not work with companies that involve multiple insurance brokers. Trust and complete transparency are important to us.
Putting together a generous Benefits Program that will profoundly impact the life and loyalty of your employees requires legal and financial counsel. There is no one solution, and as any HR manager will testify, the demands of each work place are different.
During the consultation process, the following topics will be discussed.
The first step is obviously Gap Analysis, finding out the gap between what is actually covered and what you think is covered. More importantly, what should be covered?
CLAIMS CONTROL MEASURES
Control the claims without reducing the perceived benefit provided by policy to employees. Right use of Co-payments, Deductibles, Preferred provider Network, Room Rent cap, Disease wise cap, Second opinion from Specialist doctors can help in decreasing premium.
Benefits comparison of your peer group companies and best practices in the industry.
SCIENTIFIC CLAIM PROJECTIONS
Projecting next year’s claims and premiums based on the members' demography, current year claims, benefit modifications, group size changes and medical inflation.
Cost Benefit Analysis
Once the benefits are frozen, an insurance broker should float a detailed RFP with leading insurers and fetch the most competitive premium. They should then present to you the detailed cost-benefit analysis and comparison report along with recommend you at least three options.
MERGER AND ACQUISITIONS
Amalgamation of policies and employee communication.
EMPLOYEE FUNDED GROUP POLICIES
Employee’s parents health insurance with group benefits, Super Top-up Insurance to increase the coverage, Group to Retail portability of Health Insurance.
Suggesting new benefits
Like outpatient consultations, diagnostic tests, health check ups, nutrition consultations, pharmacy discounts, unlimited access to doctor on video or phone, Negotiating Discounts with preferred hospitals, long term ( more than 1 year) Group health insurance policies, Employee assistance program, Employee wellness programs, Flexi Benefits etc.,
Amalgamation of other compulsory benefits like EDLI, ESI, future service gratuity, Workmen Compensation etc.,.
Experience our inhouse Benefit Management Tool.
Customise as per your requirement.
Technology will reshape how employers select and offer employee benefits, put access to information at the fingertips of employees and create a more seamless and interactive experience. At the same time, these advances may help employers focus more on strategic tasks, focus more on their people. The tools are automating simple, repetitive tasks that don’t need to be carried out by employers or agents. The new age insurance technology is reducing risk, improving visibility, and enabling profitability. In perfect scenarios, insurance brokers would strike just the right balance between introducing new technologies and maintaining a human touch where it’s most needed.
To support employees during enrollment, employers can adopt online platforms designed to personalize and simplify the experience. All the information related to their benefits is available to them always. The platform can also offer many tools to support the well-being of employees. Most of the insurance brokers including Ethika offer you a complimentary enrollment tool so that the employer or HR can manage the enrollment period* online seamlessly and conveniently. With an online platform, the new employee can be onboarded, instantly. The additions and deletions of employees can be easily done.
The premium for additions and deletions is generally calculated on a prorated basis and the credit or debit is made in the CD balance account. This tool also helps the employer to see the balance anytime online for their policies. Online tool helps in managing the policies, adding or deleting members without any hassle, with just a click!
Employers, especially with the right employee benefits insurance, need to become experience-led and make their employees’ lives easier and better with technology. Partnering with technology is a necessity for growth.
As an employer you may have created a great employee benefits package for your employees but do your employees truly know or understand what is available to them?
Only less than 8% of employees avail the insurance benefits.
Many of them may not even be aware that such benefits are available. That's why proper employee communication is imperative.
It increases the overall perceived benefit among employees about the benefit program offered by employers.
The Importance of a well-structured and planned Employee Benefit Communication program is the “Most important part of a company’s HR function”.
The employees should be aware of the overall compensation and not just the cash value of their salary!
That’s where benefits communication plays its part by helping the employees to understand the value of their employment.
A good, thought through employee benefits communication program tells the employees what options are available to them, what to choose wisely, what mistakes to avoid, like not selecting the plans that will later lead to increased out of pocket costs putting a burden on their pockets.
Ethika also designs and implements a comprehensive and functional communication program for its clients to ensure the employees are made aware of all the benefits our clients offer to them.
With frequent communication you can ensure employees remain engaged and up-to-date about the various benefits and facilities available for them.
Structured promotional mailers and posters about all the benefits can be designed and sent to employees at well-panned intervals and pace.
The benefits should be communicated in the language that employees understand and connect with.
Choose a partner who can provide the best support to your employees during their claims settlement process which is generally an unpleasant and stressful experience. When your employee is having questions about the claims, most of the Insurance brokers direct them to contact the health insurance company’s customer service department or third-party administrators.
You should choose an insurance broker who is always working on your side, on the side of your employees to achieve the best possible outcome on their claims. The broker should provide red carpet support service to your employees, extending support to them at every step step, from medical emergencies to claims settlement. Your broker can help you understand how benefits work and will be able to suggest ways to clear up billing disputes.
Outsourcing the management of your Benefits program to an Insurance Broker has several advantages. Crucial personnel need not be burdened with additional, unfamiliar responsibilities and your employees are assured of timely, professional assistance with compassion. Most of the Insurance Brokers provide the above service
Ethika believes in 'serving to care and serving with compassion’. We are sensitive to the claimant's losses and his expectations from an insurer. Our exposure to diverse cases of claims redressal has shown us that each claim is unique in terms of conditions and requirements. We take up the responsibility to address all questions or concerns your employees may have during claims settlements therefore, we are in a better position to have control over the process.