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Group Health Insurance For Employees | Pros And Cons

By January 8, 2022January 9th, 2022No Comments

Discussing The Pros And Cons of Group Healthcare Plans For Employees

One cannot deny the importance of having a healthcare plan during tough times. There is no better option than to rely on a Mediclaim during medical emergencies. Whether it is an individual Mediclaim or a group healthcare insurance program, it is highly essential for you. A Mediclaim program provides financial support when you get hospitalized. You can get a cashless treatment facility or claim for reimbursement after the treatment process is over. But how does a group healthcare plan work for the policyholder? It may provide a similar plan coverage (depends on the opted medical plan) but the procedure of continuing the healthcare facilities is different. 

How does it work for the employees?

A Group healthcare program or employer medical insurance plan is a Mediclaim provided by the employer of an organization to the employees. Since April 2020, it has become mandatory for professional organizations (businesses, enterprises, startups, etc.) to provide healthcare insurance facilities to existing employees. The employer purchases the insurance plan for the people working in the organization and pays the renewal charges to continue the plan coverage and other treatment benefits. Unlike the regular Mediclaim plans where the policyholder pays the renewal charges (premium), here the employer pays it on their behalf. It is more like a service benefit for the employees. The employees can enjoy the healthcare insurance program benefits till the last day of their service at the organization. 

Check out the pros

There are pros and cons to every insurance plan. Be it a life insurance program or a healthcare plan. When you choose a Mediclaim, you can review the features and then decide to reject it or purchase it. But in the case of group healthcare plans, an employee cannot decide the policy features or anything related to the plan coverage (unless the employer offers a customizable plan). So, there are some advantages and disadvantages attached to the policy. Read along to figure out the pros of having a group healthcare insurance plan. 

  1. Free of cost for the employees

The best part of owning a group healthcare plan is that you do not have to pay a penny to avail of the plan benefits. Why? Because it is the responsibility of the organization and the employer under whom you are working. It is a service benefit that has recently become compulsory since the lockdown in India. The employees in the organization do not have to contribute to the policy continuation. The organization’s employers pay it as a token of appreciation. Irrespective of the sum insured to your name, you do not have to pay anything for it.  

  1. Extended insurance coverage

Most organizations and businesses offer moderate plan coverage under a group healthcare plan. The medical insurance may not be able to meet all the expenses for the treatment but it can cover a major portion. The good thing about having a group healthcare plan is that you can use other insurance claims after covering the plan benefits of the insurance provided to you by your employer. For example, if you have an individual Mediclaim policy of Rs. 5lacs and a group healthcare plan are provided to you from the company, worth Rs. 2lac, you can get complete coverage of Rs.7 lac. The combined healthcare coverage helps you recover more treatment expenses compared to a single healthcare plan. So, having a group healthcare policy alongside an individual plan is a wise financial decision as you get one of the insurance free of cost.  

  1. Additional insurance benefits

If your employer offers a comprehensive healthcare program, it is a great advantage for you and your family. You get to include the names of your children, spouse, and dependent parents in the list. With more age, the premium charges increase but here you do not have to worry a bit. The employer will take care of the excess expenditure of covering your parent’s name(senior citizens) in the policy beneficiary list. Your parents can avail of plan coverage for critical ailments and pre-existing diseases. It is indeed a financial stress-reliever as the expense of treating serious illnesses is huge with the current inflation. Also, the comprehensive plans will help you meet maternity expenses. The insurances offer maternity care and childbirth coverage, including pre-and post-natal expenses. So, it is an advantage for those planning to start a family or for female employees in the organization. 

  1. Cashless treatment and easy reimbursement

With group healthcare plans, employees can enjoy a cashless treatment at the leading hospitals. The hospital should be listed under the network of cashless facilitated names with the insurance company. It is of great help during emergency medical needs when the employee can produce the policy papers and get hospitalized. The cashless approval time takes less than an hour, easing the needs during an emergency. For reimbursement procedures, the insurance companies now offer an electronic-claim process. With e-claim, the policyholder(employee) does not have to visit the insurance office or TPA center to produce the medical bills. They can submit the scanned documents online and avail themselves of the reimbursement facilities in due time. 

  1. A hassle-free option for you

With group healthcare plans, you do not have to undergo medical checkups. 

Most insurance companies approve the group healthcare plans without any prior checkups if the employees belong to the lower age band. Also, it is a hassle-free and convenient process for the employees. The employer is responsible for finding the right healthcare program and takes the necessary steps to buy it. Thus, you only have to be a part of the organization to continue the insurance coverage for yourself and your dependent family members(if included). 

Check out the cons

Now that you have understood the benefits of having the group healthcare plan, it is time to review the cons. If you consider from a financial perspective, there will be no disadvantages as such. Why? Because the plan covers you enjoy is free of cost and hassle-free. Other than a few limitations of the healthcare plan, there are no disadvantages of the insurance.

  1. Employer dependent insurance benefits

With group healthcare plans, the employees do not have much authority over the insurance selection. The employers buy the policies for the employees and decide if they want to provide them comprehensive coverage. You cannot expand or alter the policy features unless the employer has provided you with a customized healthcare program. 

Also, with group healthcare policies, there is a constant fear of insurance discontinuation. The employees can enjoy the healthcare benefits till they are serving in the organization. However, there is always an option to port the policy into an individual Mediclaim if the employer wants to discontinue the policy

  1. Lack of customization or control

An employee cannot increase the sum insured or buy add-ons. These features are possible only in the case of tailor-made healthcare programs. Most employers of small to mid-scale organizations offer insurance coverage of Rs.1lac to Rs.3lacs, which may not be sufficient for all the employees. Hence, having an option to add-on policy benefits (like coverage extension for specific diseases like Covid-care, diabetes, cardiac ailments, etc.) helps the employees in more than one way. If your group healthcare plan offers basic coverage with no scope to customize, it can be a major disadvantage. 

  1. No tax benefits for the employees

If an employer purchases a group healthcare plan for the employees, they can get a tax release. On producing premium payment receipts, they can get a tax deduction. But the employees will not get such tax cuts on their annual income tax amounts. For enjoying tax deduction on the ground of healthcare policy, an employee has to buy an individual Mediclaim. 

  1. Switching your job

Group healthcare policies are operational and beneficial till you are serving in the company. If you leave the job or the company replaces you, the policy will get canceled. Also, it is entirely dependent on the employer to continue the benefits as they are the ones to pay the renewal charges. So, an employee is always in a dilemma about the policy extension. While switching a job, the process can get troublesome. Employees may have to port the policy or lose the insurance seniority earned over all the years. So, it is good to keep a backup Mediclaim under your name even if your company provides you group healthcare plan.

What is the right thing to do?

Even if there are disadvantages of the group healthcare plan for the employees, it is better to use the plan coverage. The wise step to managing the financial needs during a medical emergency or planned treatment is to use both healthcare plans. If affordable, an employee should buy an individual Mediclaim besides having the group healthcare plan. 

PlanCover – Offering the best plans to insurance buyers.

PlanCover, the most-trusted insurance broker, brings highly customizable group healthcare plans under your budget. Employers of small to mid-size organizations can approach them to buy group policies from the leading IRDAI-approved insurance companies in India. Connect to them now to find the best group healthcare plans in the market that suits your requirements and budget. 

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