what are the practice in covering the mediclaim policies to an industrial employees? Whether we have to cover mediclaim to the employee, spouse and upto two children?
From India, Selam
3From India, Selam
It depends upon the size of the employee group. If the group is more we can cover their spouse/children. For a smaller group you can cover only the employees. for help regarding group mediclaim can i suggest devarajan 98401 77017 
who may be guiding you properly
From India, Pune
From India, Pune
Mediclaim differs from company to company. There are a number of policies which differ in respect of coverage and amount of premium. But it is not statutory that a company should provide for mediclaim. Normally, those who are covered by ESI get medical facility from the ESI hospitals. The facility is available for family of the employee also. Moreover, the medical facilitiy being provided by ESI Corporation is at par with, perhaps better than, any health care policies which are maily serviced by private agencies.Therefore, it is better to exclude employees covered by ESI from mediclaim policy being implemented by the establishment. Regards, Madhu.T.K
From India, Kannur
From India, Kannur
Hi Ram: THe following will help you clarify: Do let me know if you need any further assistance:
The health insurance cover ( group mediclaim) is available with standard features which can be tailor made to suit your requirements. A typical standard cover includes:
Coverage: it covers the cost of treatment of any illness, injury or disease which requires hospitalization for a minimum of 24 hours. ( This is waived off in such cases where the medical technology advancements now do not necessitate a 24 hours stay in hospital example Cataract, Chemotherapy, Radio therapy, Dialysis etc)
Moreso, the following are features in the same:
Cover for all between the age groups of 3 months to 75 years of age
Does not cover any pre existing disease or its complication
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 are covered in the first 30 days of taking the cover ( for the first time ie is not applicable on renewal)
Certain ailments are excluded for 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 treatment of certain ailments - like cataract, hernia, hysterectomy, by pass 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 SME's it is recommended that this be avoided int he 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 individual basis or a family floater basis: It is recommended that you opt for insurance on family floater basis. It is the ongiong trend now a days 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 inthe policy waived off by paying extra premium. Often this results in loading of about 50 % onthe base premium to get this waiver.
4. Child Cover from Day 1: In case you decide to provide the insurance on a family floater baiss to the immediate dependats of hte employee ( spouse and children), the children will get covered often from 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, ther eis 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 extra premium - loading on base premium
6. First 1 / 2 year exclusions: There are certain class 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 extra premium - loading on base premium
7. Maternity Benefits: A standard policy may not cover maternity and its related complications. On payment of 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 either should 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 / nurse, ICU etc.
What I have provided above is the brief of the options you need to consider before initiating on 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 your self 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 in on the cover and floater it to multiple insurance companies.
From India, New Delhi
The health insurance cover ( group mediclaim) is available with standard features which can be tailor made to suit your requirements. A typical standard cover includes:
Coverage: it covers the cost of treatment of any illness, injury or disease which requires hospitalization for a minimum of 24 hours. ( This is waived off in such cases where the medical technology advancements now do not necessitate a 24 hours stay in hospital example Cataract, Chemotherapy, Radio therapy, Dialysis etc)
Moreso, the following are features in the same:
Cover for all between the age groups of 3 months to 75 years of age
Does not cover any pre existing disease or its complication
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 are covered in the first 30 days of taking the cover ( for the first time ie is not applicable on renewal)
Certain ailments are excluded for 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 treatment of certain ailments - like cataract, hernia, hysterectomy, by pass 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 SME's it is recommended that this be avoided int he 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 individual basis or a family floater basis: It is recommended that you opt for insurance on family floater basis. It is the ongiong trend now a days 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 inthe policy waived off by paying extra premium. Often this results in loading of about 50 % onthe base premium to get this waiver.
4. Child Cover from Day 1: In case you decide to provide the insurance on a family floater baiss to the immediate dependats of hte employee ( spouse and children), the children will get covered often from 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, ther eis 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 extra premium - loading on base premium
6. First 1 / 2 year exclusions: There are certain class 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 extra premium - loading on base premium
7. Maternity Benefits: A standard policy may not cover maternity and its related complications. On payment of 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 either should 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 / nurse, ICU etc.
What I have provided above is the brief of the options you need to consider before initiating on 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 your self 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 in on the cover and floater it to multiple insurance companies.
From India, New Delhi
Hello Deepak :
Your inputs were really useful. Thanks for it.
I am also working on introducing mediclaim benefit to employees. Our is a startup IT company of approx 80 employees - Pune based. Can you guide me what are the features we should take in the first year which will be kind of a Employee friendly policy. Also if possible please suggest some good Insurance Service providers. I am evaluating Bharti AXA, Max Bhupa and Star Insurance.... how are they?
From India, Pune
Your inputs were really useful. Thanks for it.
I am also working on introducing mediclaim benefit to employees. Our is a startup IT company of approx 80 employees - Pune based. Can you guide me what are the features we should take in the first year which will be kind of a Employee friendly policy. Also if possible please suggest some good Insurance Service providers. I am evaluating Bharti AXA, Max Bhupa and Star Insurance.... how are they?
From India, Pune
Hi,
In a start up environment, a lot depends on the constraints that you may have financially as well as the competitive landscape from where you are hiring employees ( and their expectations to continue with same benefits)
I would suggest that you start with a standard health insurance cover, run it for a year and then look at changing any benefits. The intention is to provide for a basic risk cover and the bells & whistles can be added later.
Do call me or mail me in case you need any further specifics.
Regards,Deepak
From India, New Delhi
In a start up environment, a lot depends on the constraints that you may have financially as well as the competitive landscape from where you are hiring employees ( and their expectations to continue with same benefits)
I would suggest that you start with a standard health insurance cover, run it for a year and then look at changing any benefits. The intention is to provide for a basic risk cover and the bells & whistles can be added later.
Do call me or mail me in case you need any further specifics.
Regards,Deepak
From India, New Delhi
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