An organization plans to have an insurance policy to take care of the employees in case of any emergency hospitalization takes place. It will be very unfortunate for an organization to know that a claim is rejected on the basis of coverages not incorporated in the policy. Group Health Insurance is one such policy which can be customized as per the requirement of the organization hence enabling in fewer rejections of claims. Here is the list of some of the coverages and their explanations which will help in understanding the criticality of the cover and their limitations.
Group Health Insurance (GHI) covers i.e. diseases contracted before the inception of the policy.
It also covers maternity benefits which are usually excluded under the individual policy with Pre and Post Hospitalization coverages.
Room Rent charges:
Room rent charges are the maximum per day charges of the room when you are admitted to the hospital.
In Corporate Group Mediclaim Insurance the standard condition for room rent is 1% of the Sum Insured for the normal room and 2% for ICU per day. In this scenario, a person having the sum insured of 2Lacs is entitled to take a room of INR 2,000/- for normal and INR 4,000/- for ICU these charges are the per day limit charges. For example, A person entitles for INR 2,000/- per day room ask to opt for INR 4,000/- per day and total bill comes to 80,000/- the settled claim amount will be INR 40,000/-
Reason: In the hospitalization, every expense of your treatment are based on the basis of room you opt for such as Room charges, doctor visit charges, Operation theatre (OT) charges, Surgery charges, and very general expenses like diagnostic also. On the basis of the same if you opt for higher category room charges the proportionate deduction will be applicable on all the charges on the basis of the room rent limit.
Co-pay refers to the part of the claim payable to the insured. For eg. The Co-pay ratio is 10% then for every claim of INR 100 made the insured will have to bear INR 10. This is usually done to reduce the claim made by insured which could have been avoidable otherwise. Most of the senior citizen’s policies have this clause.
For treatment, there is an amount decide over which the insured can’t claim. Eg. In Maternity Benefit there is sub-limit for Normal 20-25K and for Caesarian 40-50K over this amount the insured will have to bear the expenses.
It also provides the option to cover parents under the policy without the medical checkup.
Day one cover:
New employees need not wait for the existing policy to expiry to get themselves covered under the policy. With this cover, they are covered from Day one under the policy.
A fixed Sum Insured is taken for the employees who can be for the employees or floating sum insured for the entire family. Due to critical illness, the existing sum insured gets exhausted corporate buffer triggers when sum insured is exhausted due to critical illness or accidental hospitalization.
Top up their health insurance:
With increasing cost of medical expenses, it will not be sufficient to continue with the existing sum insured so there a benefit to top up your health insurance rather than paying from your pocket.