Insurance Advisory Newsletter: Group Mediclaim Insurance Policy – March 2023

Employer/ Policyholder Perspective:

1. Low cost and affordable as risk is spread across a large pool. 
2. Retention & attraction of quality talent
3. Savings in taxes

Employee/ Insured Person Perspective:

1. Coverage for pre-existing diseases without waiting period.
2. No Medical Check-Up Is Required
3. Coverage can be extended to spouse, children and also parents.

1. Lack of Control by Insured Person on choice of applicable and necessary coverages.
2. Apprehension about continuity of insurance.
3. Insurance coverage is dependent on the Employer.
4. No tax benefits can be availed by the Insured Person.
5. Unreliable for reasons of personal financial planning.
6. Marginal increase in Premium for successive years due to claims in the preceding years.

• Flexible plans: The health insurance plan that a Policyholder chooses for its employees should offer the Policyholder the flexibility of adding or removing its employees. Moreover, the Insured Person(s) should also be able to extend coverage to their family members as per their requirements.
• Room rent limit: Room rent is the amount charged by the hospital for occupying the room on a 24-hour basis. Opting for a policy with no room rent limit or a higher one is beneficial because if the Insured Person(s) occupies a higher category room, then the additional expenses along with the associated expenses of consumables, doctor fees, etc. would be charged as per the higher room category chosen.   

• Network hospitals: the Insured Persons would be eligible to receive cashless treatment at these ‘Network Hospitals’, thereby ensuring a swift claims process.
• Maternity Coverage: If the Policyholder has a young team then it is advisable to procure and maintain a GMC as it provides coverage for maternity expenses (both normal and caesarean delivery). 
• Home healthcare: Health insurance companies offer coverage for home healthcare i.e., the treatment of a medical condition from the comfort of the Insured Person’s home. This is covered only if there are no hospital beds available or the Insured Person is in no condition to be taken to the hospital.