Dear All, Please find attached a short PPT on health insurance Need and Tips on important aspects of Insurance Regards, Vishalkrips
From India, Pune
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From India, Pune
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And you should read the following too:
The health insurance cover (group mediclaim) is available with standard features that can be tailor-made to suit your requirements. A typical standard cover includes:
Coverage: It covers the cost of treatment for any illness, injury, or disease that requires hospitalization for a minimum of 24 hours. (This is waived off in cases where medical technology advancements now do not necessitate a 24-hour stay in the hospital, for example, Cataract, Chemotherapy, Radiotherapy, Dialysis, etc.)
Moreover, the following are features in the same:
- Cover for all individuals between the age groups of 3 months to 75 years of age.
- Does not cover any pre-existing disease or its complications.
- Does not cover maternity.
- Does not cover any claim arising out of alcohol intake.
- Does not cover congenital ailments.
- No treatment except arising out of accidents is covered in the first 30 days of taking the cover (for the first time, i.e., not applicable on renewal).
- Certain ailments are excluded for the first 1 year/2 years.
- Capping on room rent eligibility per day basis - typically 1% of sum insured available as room rent per day. For ICU, it is 2%.
- Capping on the treatment of certain ailments - like cataract, hernia, hysterectomy, bypass surgery, etc.
Please note the following decisions need to be taken before you initiate the health insurance cover:
1. Coverage for Whom - The options being - Employee Only, Employee + Spouse, Employee + Spouse + 2 Children. There is a possibility of covering your parents as well, but considering that almost the claims emanating from them will be more than the claims of the rest of the members, it will have a huge impact on your renewal premiums. For SMEs, it is recommended that this be avoided in the first year of taking the cover. Once the policy and its workings are much clearer, please get into a management huddle to consider including these benefits from the 2nd year of the policy.
2. Coverage on an individual basis or a family floater basis: It is recommended that you opt for insurance on a family floater basis. It is the ongoing trend nowadays to do so and is a better way of providing coverage to the employee and their families.
3. Coverage of Pre-Existing Disease: Any ailment, its sign, or symptom, if it exists before the date of taking the cover, will be excluded from the scope of the policy. So will any resultant complications. You can have this condition in the policy waived off by paying an extra premium. Often, this results in loading of about 50% on the base premium to get this waiver.
4. Child Cover from Day 1: In case you decide to provide the insurance on a family floater basis to the immediate dependents of the employee (spouse and children), the children will get covered often from the 91st day onwards. This can be modified to cover the child from day 1 of birth.
5. First 30-day exclusion: When the policy is provided for the first time, there is an exclusion on any claim for the first 30 days except in case of an accidental claim. This can also be waived off on payment of an extra premium - loading on the base premium.
6. First 1/2-year exclusions: There are certain classes of ailments whose treatment is not covered under the policy for the first 1/2 years. Typically, these include Cataract, Piles, Hysterectomy, etc. This clause can be waived off by payment of an extra premium - loading on the base premium.
7. Maternity Benefits: A standard policy may not cover maternity and its related complications. On payment of an extra premium, you can obtain maternity benefits for your employees.
There are some basic exclusions like - Alcohol-related treatments are not covered, cosmetic treatments/plastic surgeries are not covered, etc. The hospital where treatment is taken should either be registered with local relevant government authorities and/or should have a minimum of 15 beds in urban areas and 10 beds in rural areas. Along with full-time and qualified doctors/nurses, ICU, etc.
What I have provided above is a brief of the options you need to consider before initiating the insurance policy. The policy needs to be designed in such a way that not only does it provide relevant risk coverage but should also be sustainable for the insurance company and yourself in years to come. Else, the premiums will rise, or the insurers will refuse to continue with the cover in case it becomes loss-making beyond their risk appetite.
Next is to fix on the cover and floater it to multiple insurance companies.
From India, New Delhi
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5The health insurance cover (group mediclaim) is available with standard features that can be tailor-made to suit your requirements. A typical standard cover includes:
Coverage: It covers the cost of treatment for any illness, injury, or disease that requires hospitalization for a minimum of 24 hours. (This is waived off in cases where medical technology advancements now do not necessitate a 24-hour stay in the hospital, for example, Cataract, Chemotherapy, Radiotherapy, Dialysis, etc.)
Moreover, the following are features in the same:
- Cover for all individuals between the age groups of 3 months to 75 years of age.
- Does not cover any pre-existing disease or its complications.
- Does not cover maternity.
- Does not cover any claim arising out of alcohol intake.
- Does not cover congenital ailments.
- No treatment except arising out of accidents is covered in the first 30 days of taking the cover (for the first time, i.e., not applicable on renewal).
- Certain ailments are excluded for the first 1 year/2 years.
- Capping on room rent eligibility per day basis - typically 1% of sum insured available as room rent per day. For ICU, it is 2%.
- Capping on the treatment of certain ailments - like cataract, hernia, hysterectomy, bypass surgery, etc.
Please note the following decisions need to be taken before you initiate the health insurance cover:
1. Coverage for Whom - The options being - Employee Only, Employee + Spouse, Employee + Spouse + 2 Children. There is a possibility of covering your parents as well, but considering that almost the claims emanating from them will be more than the claims of the rest of the members, it will have a huge impact on your renewal premiums. For SMEs, it is recommended that this be avoided in the first year of taking the cover. Once the policy and its workings are much clearer, please get into a management huddle to consider including these benefits from the 2nd year of the policy.
2. Coverage on an individual basis or a family floater basis: It is recommended that you opt for insurance on a family floater basis. It is the ongoing trend nowadays to do so and is a better way of providing coverage to the employee and their families.
3. Coverage of Pre-Existing Disease: Any ailment, its sign, or symptom, if it exists before the date of taking the cover, will be excluded from the scope of the policy. So will any resultant complications. You can have this condition in the policy waived off by paying an extra premium. Often, this results in loading of about 50% on the base premium to get this waiver.
4. Child Cover from Day 1: In case you decide to provide the insurance on a family floater basis to the immediate dependents of the employee (spouse and children), the children will get covered often from the 91st day onwards. This can be modified to cover the child from day 1 of birth.
5. First 30-day exclusion: When the policy is provided for the first time, there is an exclusion on any claim for the first 30 days except in case of an accidental claim. This can also be waived off on payment of an extra premium - loading on the base premium.
6. First 1/2-year exclusions: There are certain classes of ailments whose treatment is not covered under the policy for the first 1/2 years. Typically, these include Cataract, Piles, Hysterectomy, etc. This clause can be waived off by payment of an extra premium - loading on the base premium.
7. Maternity Benefits: A standard policy may not cover maternity and its related complications. On payment of an extra premium, you can obtain maternity benefits for your employees.
There are some basic exclusions like - Alcohol-related treatments are not covered, cosmetic treatments/plastic surgeries are not covered, etc. The hospital where treatment is taken should either be registered with local relevant government authorities and/or should have a minimum of 15 beds in urban areas and 10 beds in rural areas. Along with full-time and qualified doctors/nurses, ICU, etc.
What I have provided above is a brief of the options you need to consider before initiating the insurance policy. The policy needs to be designed in such a way that not only does it provide relevant risk coverage but should also be sustainable for the insurance company and yourself in years to come. Else, the premiums will rise, or the insurers will refuse to continue with the cover in case it becomes loss-making beyond their risk appetite.
Next is to fix on the cover and floater it to multiple insurance companies.
From India, New Delhi
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