How to Compare Group Health Insurance

Group health insurance is a type of insurance that covers the medical expenses of a group of individuals, usually employees or other well-defined groups and associations. Employer-provided group health insurance, also called corporate health insurance, typically covers hospitalisation expenses, daycare treatment, doctor consultations, medicines, diagnostic tests, surgeries and more, depending on your chosen plan.

Group insurance for employees acts as an employment benefit that attracts top talent to an organisation. Some plans even allow employees to add their family members, including spouse and children, to the corporate plan. Group plans cost much less than individual health insurance. Additionally, the costs are either borne entirely by the employer or shared with the employee via a cost-sharing arrangement, making group health insurance a cost-efficient product.

The following are the main reasons why many employers opt for group insurance for employees:

• Lower Premium Costs: Group health insurance plans provide cost-effective medical coverage for employees due to their lower costs. As the risk is spread across many employees, the premium is much lower compared to individual plans. For employees, it’s a key employment benefit with little to no cost.

• Retaining and Attracting Employees: One of the biggest reasons to get group insurance for employees is that it is a key employment benefit that helps attract top talent to your organisation. By providing medical insurance coverage, you can also demonstrate care for key employees and reduce turnover.

• Access to Quality Medical Care: A group health insurance policy provides your employees access to the insurer’s network of doctors, specialists and hospitals. This provides a financial safety net for your employees and their families and helps them maintain a healthy lifestyle.

• Boost Goodwill and Productivity: Looking after employees’ health leads to a satisfied workforce, which directly benefits an organisation by boosting productivity and loyalty. A company that builds a positive reputation of caring for its employees increases the overall goodwill it receives from the wider community. This directly improves the company’s image and reputation.

Also Read: Employee Health Insurance Benefits & Coverage

Group health insurance plans can be categorised into different types depending on the group, policy coverage and contributions. A detailed employee health plan comparison will help you find the right policy type for your business.

Based on the Type of Group

• Formal Group Insurance: Also called employer-employee health insurance or corporate health insurance, these plans insure the employees of an organisation.

• Informal Group Insurance: These plans insure non-employee or informal groups, including cultural, social and welfare associations. The group must be pre-existing and not formed for the sole purpose of getting group health insurance coverage.

Based on Type of Insurance

• Group Mediclaim: This covers medical treatment and related expenses for each employee up to the specified sum insured. These plans typically cover room rent, doctors’ fees, surgeries, pre-and post-hospitalisation expenses, etc.

• Group Personal Accident Insurance: It works similar to individual personal accident insurance. These plans cover medical expenses and provide financial compensation in case of accidental injuries, disability and death.

• Group Critical Illness Insurance: These plans cover the medical expenses of treating critical illnesses, such as cancer, heart attack, stroke and kidney failure. It provides a fixed lump sum payout upon diagnosis of such illnesses.

• Workmen’s Compensation Insurance: This is an insurance cover provided under the Employee Compensation Act. It covers an employer’s liabilities, including medical expenses, from workplace-related injuries or death.

Based on Employee Contribution

• Contributory Group Insurance: In contributory plans, each employee must cover a portion of the group health insurance premium. Some employers may deduct a fixed percentage of each employee’s salary for insurance coverage.

• Non-Contributory Group Insurance: Here, the employer bears the full cost of the group health insurance policy, whereas the employee does not need to make any payments.

Also Read: Types of Group Insurance

Here are some important parameters you can use to compare the benefits of different group health insurance plans:

• Coverage Types and Limits: Check if the plan covers daycare treatments, home treatments and alternative medicine and which diseases and procedures are covered. Also, check the sum insured (maximum claim amount) and sub-limits of each coverage type.

• Network Hospitals: These are hospitals that are partnered with an insurance company to provide quick and cashless treatments to the insured employees. To compare corporate health policies, you need to look at the network size and the availability of reputable medical facilities near your location.

• Claim Settlement Ratio: The Claim Settlement Ratio (CSR) of an insurance provider is the ratio of its claims settled against the claims it has received. Generally, a CSR of 80% is recommended to choose a reliable insurer that has a good track record of fulfilling valid claims.

• Incurred Claim Ratio: The Incurred Claim Ratio (ICR) is the ratio of an insurer’s total claims paid against the total premiums it has collected. An ICR of 75% to 90% shows a good balance of fulfilling claims and maintaining financial stability.

• Additional Benefits: Nowadays, insurance companies provide many additional benefits beyond hospitalisation and treatments. This includes preventive services like health checkups and vaccinations, access to specialists, mental health services, wellness programmes and telemedicine facilities. You should do a detailed employee health benefits comparison to find a good plan.

• Customer Experience: The insurer’s service quality, including its customer support and response time, will determine your experience. You can check online reviews and customer feedback on support channels to understand how the company deals with claim requests, emergencies, queries and complaints.

Follow our step-by-step guide to compare different group health insurance policies available in the market and pick the right plan:

Step 1: Understand Your Organisation Needs: Assess the specific needs of your organisation, including the budget, company policy, size of your workforce, demographic needs, employees’ medical history and existing healthcare benefits. Knowing what your company needs will help you find the best group insurance plan. A simple survey or medical screening test gives you data about your employees’ healthcare needs.

Step 2: Research Insurance Providers: You can review insurance companies by researching them online. You can compare insurers by their Claim Settlement Ratio, Incurred Claim Ratio, turnaround time for claims, hospital network size, premium price, benefits and exclusions, etc. Also, go through customer reviews, feedback and testimonials.

Step 3: Compare Plan Parameters: Once you have shortlisted a few insurance providers, take a look at their plans and their features and exclusions. Make a note of important parameters, such as the sum insured amount, procedures covered, pre-and post-hospitalisation coverage, room rent limit, co-payment clause, and additional benefits like dental care and wellness programs. You can make a comparison table to quickly identify key benefits and features.

Step 4: Get Quotes from Different Providers: Contact your shortlisted insurance providers on their official websites and request detailed premium quotes. These quotes should contain full premium cost breakdowns, coverage options, deductible amounts, renewal premiums, discounts, and other important information. Then, compare group health insurance plans based on both the costs and benefits to find the best value.

Step 5: Read Through the Policy Document: Before you purchase a group health insurance policy, you should carefully go through the fine print to check the inclusions, coverage limits, sub-limits, deductible and co-payment clauses and exclusions. Prioritise plans with no waiting periods for pre-existing conditions and benefits like maternity coverage, newborn baby coverage, OPD coverage, etc.

Step 6: Check the Policy Add-ons: Add-ons or riders allow you to enhance the coverage and customise your plan based on your organisation’s needs. Based on the insurer, group health insurance plans may offer riders such as accidental death benefits, critical illness insurance, maternity cover extension, health insurance top-ups, and more. Check if your chosen plan has your preferred riders.

Step 7: Take Help from an Insurance Advisor: If you have a large organisation or complex employee benefit needs, you shouldn’t hesitate to seek help from a professional. Registered insurance advisors, brokers and consultants can provide expert guidance, help with selections and negotiate with multiple insurance companies to help find the right terms and prices on your behalf. They can ensure that you make an informed decision.

Also Read: How to Evaluate Your Group Medical Cover

Here are the most common mistakes you should take care to avoid when comparing group health insurance plans:

• Focusing Only on Costs: While costs are important, selecting group health plans based on only the costs can lead to compromises on coverage, claims and customer support. The chosen plan may not align with your organisation's goals.

• Not Reading the Fine Print: Many important details, such as sub-limits, co-payment clauses and exclusions, may get lost in the fine print. You should carefully go through the policy wording document and understand the limits and exclusions of your chosen plan.

• Not Waiting for Discounts: Just like any other company, insurers have offers like the No Claim Bonus for claim-free renewals and discounts on online purchases. Waiting for and fulfilling the conditions for these discounts can result in considerable savings when buying a group insurance covering many individuals.

• Ignoring Sub-Limits and Deductibles: When you compare corporate health policies, make sure to examine the sub-limits on room rent and certain procedures. Also, check if there are any deductibles or co-payment clauses which increase savings on premiums but require the employee to pay a portion of their medical expenses.

• Overlooking Wellness Benefits: Many group health insurance plans offer health checkups, fitness programs, free consultations and nutritional counselling. While these benefits may cost extra, they are worth considering as they lower the chances of diseases and health complications.

Group insurance for employees offers cost-effective medical coverage for employees and boosts productivity and retention for employers. To find the best plan for your organisation, make sure to conduct a thorough employee health plan comparison and consider the costs, benefits, value and flexibility. It’s worth considering multiple factors, such as network size, inclusions, exclusions, coverage limits, insurer’s reputation and additional benefits, before deciding on group insurance plans.

Besides employees’ well-being, businesses need to cover their assets and operations against a wide variety of risks, such as fire, theft, workplace accidents, transit losses and more. At TATA AIG, we offer a wide range of Commercial Insurance Plans, including Fire & Burglary Insurance, Workmen’s Compensation Insurance, Marine Insurance and more. Explore our options to find the right plans.