Is an Employer’s Health Insurance Enough to Cover All Your Health Issues?

Despite the fact that insurance companies and medical professionals have been emphasising constantly on the need of proper medical insurance, a majority of India’s population remains either uninsured or dependent on their employer’s health insurance plans.One of the probable reasons behind it might be that a major chunk of the working population has not yet experienced a medical exigency that could end up putting financial strain on them. It is assumed by many that if there were to be an emergency, their corporate health insurance plan will cover them for all the medical expenses, and that even their family members are protected thanks to the provision for dependants in such group mediclaim plans.

The Need for Separate Insurance

A corporate plan has its own benefits, but with the current state of lifestyle which most people lead, along with the constantly rising medical costs, it is not a good idea to depend solely on you corporate plan. Having an individual plan if you are single and a family health insurance plan if you are married is the need of the hour. Apart from a regular medical insurance plan, it is also a good idea to buy critical illness insurance, especially if you have a family history of a certain critical illness. Your health is probably the most precious asset you have, and doing all you can to safeguard it should be your priority.

Factors That You Don’t Generally Consider in Corporate Medical Insurance Plans

Companies and employers, if they are providing corporate health insurance for all their employees, have to consider their costs as well, and to minimize costs, they provide bare-minimum coverage policies. For example, health insurance plans that come with a co-pay clause are much cheaper than regular policies, and even bare-minimum insurance can act as an attractive benefit to lure or retain employees.

Here are the two most common factors that people tend to overlook when considering employer insurance policies:

• The co-pay clause: This clause stipulates that the insurance company will cover only a part of the total expenses incurred, and the rest will have to be paid by you. This clause effectively reduces the benefits offered by the insurance cover; even though the financial burden might be lightened, it is not eliminated. Most individual or family health insurance plans do not have this clause.
• The room-rent limiting clause: This is a clause that stipulates that the insurer will cover your room rent per day in the hospital up to a certain amount only. This amount is generally quite low, and not sufficient to cover the total expenses.

These clauses are only two of the many differences in how the policy coverage in corporate medical insurance plans differs from what’s available in individually bought health insurance plans.

Other Factors to Consider

There are many reasons why you should opt for extra medical insurance apart from your existing corporate plan. Some of these are:

• Employment status: A fact that should not really require mentioning, but you are only covered under your employer’s insurance plan as long as you are working with them. For whatever reason, if you terminate your employment with the company, your insurance cover will also lapse. You will be without coverage and liable to pay for any medical emergency till the time you find a new policy. Having an individual or family health insurance in place provides you coverage irrespective of your employment status.
• Number of persons covered: If you are a family man, married with kids, or responsible for your parents, a family floater plan is a must for you. Your corporate policy may or may not cover dependants. To be fair, your employer’s insurance might cover dependants, but the number of people covered and the total amount the insurer is liable to pay in case of a claim might not always be enough.
• Employer’s insurance is a perk and not a right: Not every company offers a corporate health insurance to its employees. Health insurance is more of an added incentive to attract and retain employees, and a company has the right to pull the insurance cover at any time without fear of legal ramifications. Moreover, if the cover is suspended for a small period of time while the company is looking for a different insurer, and you were to be hospitalized during this period, then you will be in quite a fix.
• Post-retirement coverage: Individuals are covered under corporate plans only till the time they are employed with the company. This means that after your retirement, at a time when the need of health insurance plans is at an all-time high, you will find yourself without coverage. While you might think that you can buy an individual plan later, the fact remains that after your retirement, buying health insurance might be an arduous process. You will be required to submit to a panel of medical tests to ascertain your eligibility, and a lot of policies don’t offer coverage for pre-existing diseases after a certain age. The only way to combat such a situation is to opt for a health insurance in your youth that offers lifelong renewal.
• Changes in terms and conditions of the policy: Unlike a separately bought insurance, if there are changes made in the terms and conditions of the policy, or in its clauses, you might not find out about it in time. Of course, the information will be shared with your employer, but the information being conveyed to the employees might take time.
• Total effective cover: Group policies cover a large number of individuals, which means that the cover might not be enough in case of serious illnesses or long-term hospitalization.

The intent here is not to deride the group mediclaim cover given by your employer. On the contrary, it is always a benefit to have insurance from your employer. This insurance could be excellent or it could be the bare-minimum. However, you as an individual should always treat your corporate health insurance as a secondary cover. Analyse how much coverage you are actually getting with your employer’s medical insurance, read the fine print to avoid any nasty surprises, and calculate how much your individual insurance should be for. As long as you are covered by a separate health insurance policy, you can always affect changes in the sum insured and the benefits offered at the time of renewal.