Group Health Insurance FAQ part 1


Sat 17 Nov 2018 00:00:00 UTC

Group Health Insurance FAQ part 1

Group Health Insurance FAQ part 1


In this post, we answer a few questions that we are frequently asked, about group health insurance or employee mediclaim insurance. If you have any questions that you want answered, leave them in the comments or contact us below.

When should a business consider offering group health insurance

There are many reasons for a business to offer health insurance, and many people understand WHY it is necessary. But what a lot of SMEs ask us is when should they offer health insurance. This is a tricky question as it is an expense and company finances need to be managed.

The answer depends on the company directors of course, but a simple rule of thumb is once a company has 7 or more employees, and has been in operations for a year, its time to consider a group health insurance cover.

Now you can choose to have limited covers for employees alone, and pass the premiums on to them(the cheapest option with no spend on company), or you can cover all dependants including parents, and bear the premiums as a company(costliest option with full spend by the company). There are a variety of options and customization in between, and we help companies by helping them figure out the best plan and roadmap for them, and also help manage their policy.

Are all group health policies the same?

No. In fact, even if you had 2 companies(company A and company B), both with 20 employees, both with the same insurer, and the same sum insured per employee, the premiums could still be drastically different.

The benefits, such as waiting period, disease-wise sublimits, maternity limits, and more can be customized in a group health cover. The dependants covered(employees only, spouses also, spouses and kids, and employees+spouses+kids+parents) will also affect the premiums payable.

Previous claims experience is also a major factor in pricing of a policy. Higher loss ratios(claims paid out/premiums, expressed as a %age) will result in higher premiums.

What are the common group health benefits

To simplify, health insurance covers hospitalization costs; if you are hospitalized for more than 24 hours, your costs are covered. It also covers pre and post hospitalization costs, and day care procedures.

There are generally disease specific waiting periods, and all pre existing conditions are not covered in individual health policies(for 4 years). Group health insurance allows you to remove these waiting periods, to ensure everything is covered from day one.

There are many customizable benefits in group health insurance, which you can see here. We have also written about the differences between retail(individual) and group health, which can be read here.

Where can a small business get group insurance

As long as you have 6 or more employees, you can get group health insurance. The best way is to talk to an insurance broker to help you figure out the best benefits to go for, and set a road map of how you want the benefits plan to scale with your company.

Of course, you can always talk to us!

Do I have to cover all my employees?

Yes, you do. For employees who earn below INR 7000 a month, ESIC(Employee State Insurance Corporation) has a plan that covers a basic set of benefits for a nominal premium. You are allowed to leave ESIC covered employees out of the group health cover; but everyone else must be covered.

What is the minimum requirement for group health insurance?

Minimum requirement is to be an incorporated concern(partnership, private limited company, etc) and have 6 employees on your payroll. It is possible to take insurance for smaller firms as well but it isn’t advisable.

It is important that employees must be on your payroll officially, and that every employee be covered. You can vary the coverage by designation.

Are medical check-ups covered in group health insurance?

Your employee health insurance policy will generally NOT cover medical check-ups, however you can ask for it to be covered under your policy. We at Perilwise have a tie up with many other partners and hospital networks, who provide the check up at a lower cost than most insurance companies.

Can I add employees who join after the policy?

Yes you can, and you’ll have to pay a pro-rata premium for him/her and family(if covered).

For example, if your policy starts in march, and new employee joins in september, for the first year you pay premiums only till next march; at which point new employee is renewed along with the others in the policy.

Can dependants be added after I take the policy?

This depends on the type of dependent family member. New born children can be added when they are born(provided your policy doesn’t have a 9-month waiting period). Similarly, Spouses of those employees who get married after inception of policy can be added as and when the marriage happens.

Parents and existing dependants can only be added upon renewal of the policy. To put it simply, existing dependants cannot be added after the policy has begun, but new ones can.

This marks the end of FAQ part 1, if you have any more queries, ask us on social media, or contact us directly, and we'll help you out!(all details are in the footer of this webpage)