What’s should be your strategy for primary market in FY25?

The alarming second wave of the Covid-19 pandemic has left a trail of devastation since the mid of April this year. More than four lakh people have died due to the deadly coronavirus since the beginning of the pandemic in India. Currently, even though the number of cases are decreasing, the threat of a third wave has already started emerging. Moreover, even after taking proper precautions, people are still falling prey to the virus. During such times, it is important to make sure that you are financially protected against unforeseen medical emergencies.

The best way to do so is get yourself and your family members covered under health insurance. Your health insurance plan will cover you for every healthcare cost by paying for your hospital bill. While you must do your best, it is equally important for the employers too to make sure that their employees are at utmost peace. One important way to do so during such challenging times is covering them under a corporate health insurance plan. A corporate or group health insurance plan is a health cover provided by the employer to the employees. A group health plan usually covers employees and their immediate family members like spouses, kids and dependent parents. Providing group health cover to the employees ensures that you care for your employees and it is one of the most efficient employee retention tools.

Though, it is important to note that it is not just about buying any health cover for your employees in fact it is all about buying the right plan so that the actual purpose is met. In addition, having an extensive group health plan will help them keep motivated and productive. When buying a group health cover for your employees, there are numerous things that must be considered for the welfare of the employees. Here are some of the important points that must be kept in mind while making a purchase.

1.Getting the right sum insured

Sum insured is the maximum value that the insurer will pay in a year for your employees in case of hospitalization. The coverage is provided to the group members and their family members such as dependent parents, spouses, and children. Any amount beyond the sum insured is paid by the employee himself.

While buying a group health insurance for your employees the most important factor that one should look for is the ‘sum insured.’ Especially, when the virus is spreading like wildfire and the cost of hospitalization is skyrocketing. An employer should go for a high sum insured cover which will enable his employees to avoid large medical bills that can cause financial hardships.

Also, remember that most of your employees might solely rely on the health insurance provided by you. Hence, the employer needs to do proper research and make sure the coverage is adequate.

2. Check the list of network hospitals

One of the biggest advantages of getting treatment from a network hospital is that one doesn’t have to worry about making arrangements for money at the last moment. The health insurer settles the hospital bills directly, thereby taking the burden off your employees’ shoulders and he/she doesn’t have to suffer. Especially, if a person tests positive for Covid and requires hospitalization the primary focus should be on saving time and effort to have more and more efficiency. Hence, the employer should check the list of the cashless network hospitals for better convenience and treatment while selecting a group health insurance. Also, this should be taken into serious consideration when your company is operating in a non-metro city.

3. Claim settlement ratio

One of the most important factors while picking insurance for your employees is to choose the insurance company with a high claim settlement ratio. Given that, your employees will have a higher probability of getting their claims settled. Moreover, the process of the claim settlement should not be tedious and your employees should have a hassle-free experience. The claim settlement ratio also helps in understanding the overall performance of the company. It may otherwise be really hard for your employees to get on-time approval for a claim request at the time of emergency.

4. Waiting Periods

A waiting period is a specific time limit that you must pass before your actual health insurance coverage begins. For instance, there is an initial waiting period of 30 days, before this, you can’t avail any benefits. Other than this, there’s a waiting period of 3-4 years for a person who has any pre-existing diseases.

To waive off this waiting period the employer might have to pay an extra premium. But, one of the benefits of getting group health insurance is that your employees are covered from day one, as long as there is no delay in paying the premiums.

5. Room rent limit

Room rent limit refers to the maximum rent or category of room you are entitled to based on your health insurance cover. Which generally is 1% of your sum insured.

For instance, Suppose you have a cover of Rs 5 lakhs. Now, typically the room rent in a metro city is almost Rs 10,000 per day. Let’s say your employee gets hospitalized for two days, i.e. Rs 20,000. And the total hospitalization bill is Rs 1 lakh i.e. ( Rs 20,000 for room rent and 80,000 for treatment, tests, doctor’s fees, pharmacy, etc).

But, in this situation, if the room rent limit is Rs 5000 per day then the employee will only be getting paid for that Rs 5000. The additional amount will be paid from the employee’s pocket.

Therefore, getting the highest room limit available will save the employees from paying any extra money in case of hospitalization.

6. Co-payments and Sub-limits

While picking up a policy for your employees pay attention to clauses like co-payments and sub-limits. As per the co-payment clause, the insured has to pay some portion of the total hospital bill and the rest is paid by the insurer. For instance, if the policy comes with a clause of 10% copay, your employee will pay 10% of the claim amount while your insurer will pay the remaining 90% of it. Meaning if the claim amount is Rs. 50,000 then Rs. 5,000 will be paid by the employee and the remaining 45,000 will be paid by the insurer. Such policies typically have lower premiums but, at the time of hospitalization, paying even a certain amount may not be easy for your employees. Thus, selecting a policy with no co-payment feature is preferable.

Further, In case your policy has a sub-limit clause of 50% on a specific medical procedure and your total sum insured is 5lakhs you cannot claim more than 2.5 lakhs for that treatment due to the sub-limit clause. Therefore, for hassle-free hospitalization and claim procedure of your employees, it is important to opt for policies without any sub-limits clause on treatments.

7. Wellness benefits

Nowadays, many insurance companies offer benefits through wellness programs. Under this, the insurers offer reward points and incentives to the policyholders who comply with the set criteria of wellness and preventative features. Insurers can keep track of how well you manage your well-being with various smartphone applications that come with the tracking feature like steps taken in a day, sleep patterns, and so on. The criteria to earn wellness points differs from insurer to insurer. Thus, opting for a plan which offers wellness benefits will push your employees to be healthy and fit. Further look for policies that offer free yearly medical check ups such as blood count, ECG, thyroid test, etc.

To conclude

The employer should take into consideration the needs of his employees and customize the policy accordingly. Ideally, to get the best options, getting help from a licensed insurance broker or any other trustworthy source is highly recommended.

(The author is business head, corporate insurance at Policybazaar. Views expressed are personal.)