Employee Health Insurance Benefits and Coverage


4 min read

Employee-Group Health Insurance

Health is the most important thing that we have. A lot of it depends on us and the kind of lifestyle we choose to live. Whether we want to live a healthy life or not, totally depends on us. However, no matter what measures we take, we may fall sick and even may end up in a hospital bed. And at that point, along with the poor health condition, we also start getting bothered with the sky-rocketing medical bills. This is why buying a health insurance policy is so important these days.

The idea of health insurance makes so much sense that the majority of employers now include employee healthcare insurance in the package. Some employers pay the premiums while some others pay half the amount of premiums and the other half is deducted from the employees’ salary. Here are some of the things that we should know about employee medical insurance.

Employee Health Insurance – Meaning and Scope

Employee insurance policies are bought by employers to support their employees financially. The health insurance policies come with a heap of benefits for the employees. These health insurance plans are called group plans. As compared to other types of health insurance plans, the premium charged for group plans is lesser. The risks associated are distributed among the employees of an organization. In some cases, the benefits of this kind of health insurance plan are extended to the immediate family of the employees.

Lesser complications

Health insurance policies are usually found to be complex and not many people understand them properly. However, as compared to the other health insurance policies, the group health plans are much simpler in nature. These plans are generic and come for a larger group. Therefore, these plans are not customized at all. This is what makes them easier to understand than the other plans. However, the benefits are many of these policies and employees can avail themselves of all of those. For example, health check-ups and waiting periods are not there in the group health insurance policies. Once can start availing of the benefits from the first day of receiving the policy or joining the company.

Varied features and coverage

Employee health insurance policies are generic; however, the features, as well as coverage offered by the policy, may vary on the basis of the insurance company that is offering the policies. Some of the medical benefits for employees like maternity benefits, and cashless claims facilities may vary from one insurance company to the other.

Also Read: How are Term and Health Insurance Different From Each Other?

Additional cover in Group Health Insurance Policy

While you might get an employee health insurance policy when you join an organization, this should not be the only cover you should have. You must be aware of the fact that the No Claim Bonus (NCB) facility does not come with the employee health insurance policies. Therefore, if you have already bought an individual health insurance policy and an employee health insurance plan, it would be better for you to raise your claims from the employee health insurance plan, and not claim the individual health insurance plan to avail of the NCB.

Limitations of Employee Health Insurance Plan

One of the major drawbacks of an employee health insurance plan is that it will be valid for you only till the time you are associated with the specific employer. The day you leave the organization, your employee health insurance policy will be canceled. Since it is generic in nature, you may not get the coverage that you and your family may need. Apart from this, the insurance company, as well as the coverage, may even change on the basis of the requirements of the employer.

Salient features and benefits of employee health insurance

Mentioned below are some of the key features of employee health insurance policies.

  • Some policies provide coverage for boarding expenses other than anesthetist and consultant fees, surgeon, oxygen and diagnostic materials, charges for anesthesia, along with X-rays as well as dialysis expenses
  • These policies provide cashless facility as well as direct settlement of bills with the respective hospital
  • They provide coverage for pre and post-hospitalization costs for a certain period
  • Some of the policies even come with maternity benefits
  • Coverage for hospitalization less than 24 hours such as chemotherapy, tonsillectomy, eye surgery, etc.
  • Provide coverage for specific critical illnesses above hospitalization benefits
  • Some of these policies provide coverage for pre-existing illnesses after an extra premium is paid
  • Some of the policies provide coverage for domiciliary charges
  • There are some optional benefits which include first-year exclusions, reimbursement of ambulance charges, waiver of the waiting period, etc.

Why do organizations offer health insurance to their employees?

You will find almost all the companies these days offering health insurance policies to their employees. This helps them to retain the employees and as a result, it also boosts the performance of the employees. The employees feel that the company they are working so hard for is concerned about them. Some people are there who do not buy a health insurance policy at all. For them, this is a great help, especially when they or any of their core family members are hospitalized.

There are several group health insurance policies available these days that are offered by different insurance companies. The health insurance policy chosen by a particular insurance company depends totally on the number of employees they have and the benefits they want to offer to their employees.

Apr 29, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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