Why Corporate health Insurance Is Not Enough?

According to a recent survey conducted by insurance major Marsh India, 53% of employees rated the group medical coverage or Mediclaim provided by their employers as insufficient. Interestingly, a significant cross-section of employees surveyed said they were also looking for top-up covers and parental health insurance plans to minimise out-of-pocket expenses in an emergency.

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Why your company-funded health insurance policy may leave you vulnerable in an emergency

It is a well-known fact that most employee health insurance covers provide Rs 3 to 5 lakh of the sum insured, which may not always be sufficient, considering medical inflation is increasing twice as fast as overall inflation.

That said, group Mediclaim or employer’s health insurance policies do offer several advantages: coverage for pre-existing illnesses, no waiting period, and tax deduction under Section 80D on the premium paid for dependent senior citizens. These indemnity-based plans protect you and your dependents from medical expenses incurred if you contract any of the illnesses specified. You can either claim reimbursement or opt for cashless treatment, depending on whether the insurer approves the hospital of your choice.

In this context, the dilemma for the average working professional is threefold:

• To stay or quit the current job that offers reasonably good Mediclaim coverage • Or to find a new job that provides higher coverage • If one opts to quit, what happens in the interim

Here are a few things to consider before making a decision:

1. Is the sum insured adequate?

The rapid growth of medical inflation has increased operating costs for the healthcare industry. These are inevitably passed on to patients. Private hospitals spend up to half their budget on salaries, as revealed in a study by the Association of Healthcare Providers of India. This means that a sum insured that would have been adequate five years ago is likely to be insufficient for present-day needs.

2. What is excluded from coverage?

Coverage for dependent parents may be excluded entirely by some companies or left to the employees. Read the policy document carefully to understand the terms and conditions of pre- and post-hospitalisation coverage, room rent sub-limits, daycare treatment, daily cash allowance, expenses for organ donors etc. This will help you objectively assess whether you are getting sufficient coverage for current and future needs. To plug any gaps, you can opt for a separate family floater or an individual health insurance plan.

3. Does it provide global cover?

Global cover refers to medical expenses that are incurred outside India if the diagnosis was made in India. You need to consider if they cover only inpatient hospitalisation costs or if OPD treatment is covered too. You might also need to look at the countries that come under such a plan and the method of payment - is it cashless or on a reimbursement basis?

4. What about compassionate travellers?

While many corporate insurance plans offer coverage during the recovery/convalescence phase, travel expenses for visiting family members in a different country or state may not be included. This is especially important if you have to receive treatment in another country, where you might need someone from your family by your side.

5. Does it cover diagnostic tests?

Diagnostic tests may be subject to sub-limits, in which case an employee may have to foot the bill from their own resources. This includes common pathological tests and specialised tests such as MRI, which can prove to be an expensive proposition.

Health insurance benefits can change at any time by your employer without prior intimation. As a rule of the thumb, make sure you #ThinkAhead and also invest in a personal health insurance plan that fills in the gaps of an existing insurance policy. This can help you supplement your company-funded health insurance plan and meet health emergencies head-on and without strain on your financial situation.

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