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Structuring the Group Health Insurance plan


Hospitalization is one of the most basic and expensive employee benefits that an employer can offer to its employees and the majority of employers fund the hospitalization through an insurance policy, which is primarily an indemnity policy!

The health coverage may cover just the employee or the spouse and children. Some firms cover the employee’s parents as well.

Self
Self+ spouse
Self+ Spouse + Children
Self+ Spouse + Children+ parents ( or/and parents in laws)

While taking the policy one must ensure with its broker or insurer that the below covers are provided:

  • 30 Days waiting period is waived off
  • 1,2,3 years waiting period is waived.
  • Pre-existing disease waiting period is waived
  • 90 days new born baby waiting period is waived
  • 9 months maternity waiting period is waived
  • Pre and post hospitalisation cover is provided
  • Maternity is covered
  • Corporate Buffer
  • Domiciliary Treatment ( It became the most essential cover during covid times)
  • Organ donor
  • Modern Treatments Cover
  • Room Rent Limits to be waived.

As with all things, Indian employer health benefit is shifting from that usual traditional all-expenses paid inpatient indemnity to other ways of risk or cost sharing, like high deductible plans or co-pay insurance plans.

The sum assured varies amongst employers but usually, a minimum sum assured is above Rs 200,000 for each employee. The average Sum Insured is 3,00,00 and a good sum insured means 5,00,000 per family.

Some corporations keep a provision for a corporate buffer amount for discretionary coverage if an employee exhausts the sum assured. The corporate buffer should not have any family incidence sub-limits.

Various combinations of benefit limits and privileges in room types are available at various levels of staff. You can also plan to offer a higher sum insured to employees completing certain years of service