You’ve been working in this organisation for years now and had been enjoying multiple corporate benefits. These benefits are tax-free meal vouchers, term insurance, group insurance health plans, internet and telephone reimbursements, etc. You knew your company has your back. Thanks to the group insurance policy your employer enrolled you in, your father’s cataract operation was cashless. Hence, when your mother needed to undergo knee replacement surgery last week, you contacted your office. But his time you were in for a shock. Upon inquiry, you found out that your group insurance policy doesn’t cover your parents anymore. Your organisation changed their group insurance T&Cs scheme recently during its renewal.
How is group medical cover (GMC) renewed?
A GMC or group insurance policy is a customized healthcare plan meant to be used collectively for the members of a group or a community. Group insurance health plans are master plans that bring all; the employees of an organization under one umbrella scheme. This includes the names of the insured employees and the sum insured. In a group insurance scheme, companies design the policy according to the requirements of their employees. A GMC often covers employees and their family members. However, it’s the employer who calls the shots.
Whereas individual health insurance plans come with lifelong renewability; group health insurance policies are required to be renewed by the organization.
Here’s how your employer deals with the entire group insurance renewal process:
- Requesting the insurer to renew the policy
- Informing the insurer about adding new members to the coverage. Also includes terminating coverage of employees who have left the organisation
- Jack up or reduce the sum insured if needed
- Communicate to the insurer of any add-ons or riders
The insurer makes required changes at the time of the policy renewal based on the information offered by your company. These factors include total claims made, changes in members and their age, the inclusion of riders or expansion of the sum insured, etc. Some of the changes you can expect at the time of group policy renewal are:
- A possible increase or decrease in the sum insured
- Inclusion or exclusion of add-ons
- Increased or discounted premium
- Changes in health coverage. Your group health coverage may not continue to include maternity or parental coverage.
- Addition or deletion of employees
Limitations of GMC
A group insurance policy offers few benefits. These are free coverage, zero waiting period, cashless hospitalisation, preventive healthcare benefits, etc. However, a group insurance policy might as well catch you off guard when you most need it. Some of the major disadvantages of a group insurance scheme are:
- Employer-controlled cover: The employer uses his/her discretion to select the insurer, determine and change the sum insured. Also, keep the total number of people covered under the policy in mind, etc. It is an all-encompassing cover and hence, there’s very little scope to address individual-specific requirements. The cover is often inadequate for an entry-level or mid-level employee. Your employer could even decide to discontinue the insurance cover. This is where you may find yourself at a loss if not for an individual health policy.
- Pay add-ons from your pocket: In case you wish to increase your coverage or include riders or add-ons based on your requirements. You will have to shell out from your pocket. Upon renewal, your group insurance policy may discontinue coverage for dependent parents or maternity coverage.
- Discontinuation: if you are laid off or leave the job, you will no longer enjoy coverage under the group health policy. When you are in between jobs, a medical emergency could be tremendously difficult to deal with. Unless, of course, you have individual health insurance.
- No tax benefit: if your company pays your a health insurance premium, you cannot avail of tax exemption. Only if you are paying for your premium partially, you are eligible for tax benefit under Section 80D.
To sum up:
As against group insurance health plans, you are in charge of individual health insurance. An individual plan is tailor-made for your requirements and enables financial management at a personal level. To get your plan check https://www.oneassure.in/