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Group Health Insurance

What Is a Tailor-Made Group Mediclaim Policy?

By December 16, 2021January 23rd, 2022No Comments
What is a tailor made Group Mediclaim Policy

Group healthcare insurances fall under employee-welfare schemes that most organizations offer. It is a Mediclaim policy where the employer buys it for the employees. The employer pays the premium for the annual renewal of the insurance. It is a service benefit that stays valid till the employee works under the organization and the employer continues to clear the renewal charges. The sum insured by the employer decides the coverage amount for the policyholder(employee). 

There are different types of group healthcare plans depending on the features and coverage limitations. Generally, most employers pick a general healthcare plan that covers basic medical needs. The average sum that most employers insure for the employees is between Rs. 1lac to Rs.3 lacs. The sum and the plan feature depend on the employer’s capacity to bear the premium expense and the associated organization. 

Difference between a tailor-made and a general group healthcare plan

A tailor-made plan is also a group healthcare plan with flexible policy benefits. Customizable insurance plans are termed tailor-made insurances. The customizing offers depend on the insurance company and their norms related to group health insurances. All IRDAI-approved insurance companies in India offer a varied range of insurance plans for the employer. Thus, an employer can review more than one option and pick the one that suits their needs. Read along to know what can be the possible features that comprise a tailor-made group health plan. It will ease the selection process for you as an employer to offer nothing but the best to your employees. 

Who can buy the tailor-made policy?

As per the IRDAI regulations, any organization or business with more than 7 employees can purchase group healthcare plans. A group may or may not have an existing relationship of employer-employee among the members. It can also be an association where all the members have the same interest (informal groups – a group of credit cardholders, cultural association, etc.). They can purchase the group policy and pick an option to customize it by paying extra for the added benefits. The option of picking the customizable plan depends on the employer and partly on the employees. Most employers pick a tailor-made plan when the employees agree upon paying the extra add-on charges. So, this article will help those employers confused between the different insurance alternatives. 

Regular benefits of group health insurance

If you consider the basic features, you will not find any difference in the plan coverage. In a regular and customizable policy, you get all the elementary features like – 

  • Cashless hospitalization in the network of hospitals approved under the insurance company
  • Cashless treatment of various ailments and medical emergencies
  • In-patient hospitalization treatment expense coverage
  • Plan coverage for doctor’s fee, surgery fee, medicinal expenses, etc.
  • Plan coverage for pre-and post-hospitalization expenses

Tailor-made plan features

What features comprise a tailor-made group health insurance plan? The plan benefits are the defining factors of a customized group healthcare policy. The insurance company offers the score for adding benefits to make it more convenient for the policyholder. The following features are the most commonly customized aspects in a tailor-made policy

Add-on benefits

Additional insurance benefits like coverage expansion for treatments and therapies are a part of the customized plans. Usually, the regular group insurances do not cover any OPD treatment expense or daily cash allowance. With add-on features, the policyholder can include these in the plan coverage. Also, there are options to top-up the insurance to increase the sum insured. The top-up helps in meeting the expenses that go past the base plan. Usually, the employees pay for these additional top-ups or features to make them convenient and more useful. 

Expenses apart from treatment

When a patient gets hospitalized, there are several other expenses that tag along with the treatment bill. It includes the room rent, room facilities, nursing charges, and many more. The regular group health insurances do not cover all these and only pay a part of the treatment expense. But with tailor-made insurances, you can now waive off the limitations. There are addable options like the room rent waiver scheme with which, the policyholder can select a room of any higher rent in the hospital and get insurance support for the same. Under the tailor-made plans, the patient can also enjoy consumables coverage where the insurance company pays for items like masks, gloves, cotton, bandages, etc. These are expenses that do not fall under basic plan coverage unless you pick a customizable plan. 

Alternate treatment facilities

In the regular base healthcare plans, you will not get any insurance support for treatment under alternate medicines like homeopathy, Ayurveda, etc. With tailor-made plans, there are scopes of reimbursement of such expenses. Some insurance companies pay for the expenses if you opt for a customizable plan that allows such coverage. 

Grace period for treatments

Grace period or waiting period for plan coverage is the time when the policyholder cannot get any treatment coverage for a disease. These diseases are usually pre-existing or critical ones. The waiting time can be 2year or 3years depending on the norms of the insurance company. But with tailor-made plans, you can select certain add-on packages for specific diseases. For example, if the policyholder has diabetes, then they can pick the additional top-up for diabetes care to support the causes. By choosing these customizable packs, the policyholder can eliminate the waiting period and increase the treatment coverage.  

Covid care plans

Currently, covid care plans are the most common part of tailor-made plans. There are home-quarantine covid care plans, in-hospital covid treatment plans, and many more which you can add with the base plan. The customizing factor allows you to manage the expenses easily without financial distress. Any employer who wishes to provide tailor-made insurance to their employees must include the covid care treatment benefit alongside the base plan. 

Who can help you with tailor-made insurance plans?

Now that you know what a tailor-made plan is, it is time to know who can offer such plans. There are two ways to buy such customizable plans. You can select any insurance company and approach their sales department. They can guide you with the different and versatile group healthcare plans under their company. They will present the most suited options available in their company that match your premium estimate. 

Another way to find the most appropriate tailor-made group policy is by connecting to an insurance broker. Who are these insurance brokers? They sell insurance from the leading insurance companies in India. All you require is to specify the features you want and, they will present to you the best alternatives under your budget. Going for a reliable insurance seller is the best way to find a customized plan for your employees. 

Finding the right insurance broker

You should evaluate the qualities of an insurance broker before approaching them There are many insurance sellers in the market who sell non-life insurance. As you are searching for group healthcare policies, it is better to approach an insurance broker who specializes in the field. They know the best plans in the market and thus present the best policies among the many options. 

PlanCover – Presenting the most suitable solution for you.

PlanCover, a trustworthy name when it comes to insurance. They are your one-stop solution for buying group health policies. They have years of experience in bringing customized group healthcare policies for employers in different professional fields. They sell group insurances to organizations having employee strength between 7 to 450. If yours is a small or medium enterprise, PlanCover is the right plan to bring the most appropriate plan. Connect to their team now. 

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