Group health insurance is a health insurance policy taken by the employer for their employees and families. The premium under the group health insurance is paid by the employer and in certain cases, the employees also pay a part or full premium. The coverage under the group health insurance policy would be decided by the employer or the organization and the employee would have no role or say in deciding the coverage or sum insured under the policy.
There are certain things that your boss expects you to know about the group health insurance policy which is mentioned below:-
- Coverage: The coverage or sum insured under the group health insurance policy should be known to the employees. It is also important to know whether the group health insurance policy covers dependents or not. If the policy covers dependents then it would mostly be a floater sum insured in which the coverage can be utilized by any member of the family. Most organizations decide the coverage for their employees on the basis of the grades or designation of employees. It is also important to know the room rent limit under the group health insurance policy without which the employee may take higher rooms that are permitted and end up with a proportionate deduction in the claim amount.
- Additions/ Deletions: The addition and deletions of members are permitted under the group health insurance policy. But the additions and deletions can only take place within 45 days of the occurrence of the event. For example, if an employee is married then he/she needs to include their spouse within 45 days of the marriage date. The same goes with childbirth, where the intimation has to be given to the insurance company within 45 days. If the additions and deletions intimation is not given within the stipulated time, then the same would not be considered by the insurance company.
- Inclusion of Parents: Most organizations do not include the parents of employees as this would increase the premium to be paid by the organizations. Certain organizations permit their employees to add their parents to the group health policy on payment of additional premium. The additional premium would be paid by the organization and deducted from the salary of the employees in easy installments. This option would be available only in certain organizations and your boss expects you to know about this option. It is very important to know whether your parents can be covered under the basic group health insurance policy or any additional premium is to be paid for availing the coverage.
- Claim procedure: The claim process in group health insurance can be either cashless or reimbursement. A cashless reimbursement facility would be available in all the network hospitals where the insurance company has a tie-up. It is important to note that there would be a copay if the employee wants to avail reimbursement facility from a cashless hospital. The reimbursement claim settlement option is available on the production of original claim-related documents to the insurance company. It is important to know the network hospital list of every employee before going for a claim
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