• Why Employer Health Insurance is not Enough?

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    Getting a job in a good company means you’re entitled to a bunch of benefits in addition to your salary – one of the more important perks is the fact that your employer will provide you (and, in some cases, 2 members of your family) with best health insurance.

    But is it enough?

    As we all now, insurance providers will only pay out the promised amount only if they absolutely have to. They protect their money using the fine print in their offer document, and pay out what they promised only once they have no more fine print to hide behind. While getting the insurance providers to honour their agreements for regular insurance policies is hard enough, it’s even harder when claiming through an employer-group policy.

    Companies and employers, too, seek to minimize costs, by providing bare-minimum coverage insurance policies to their employees. Policies that include co-pay clauses, for example, are usually cheaper, and more attractive to companies who focus on the bottom line of the P & L account, rather than their employee’s wellbeing. Even a bare minimum insurance policy can still be used as an “insurance benefit” to lure or retain employees.

    A recent report by ICICI Lombard Insurance Company revealed that as many as 76% of insurance policies offered by employers have co-pay and room-rent limiting clauses. The fine print is a tool that insurance providers use to limit or even nullify their liability.

    Here are some things you may have overlooked in your employer’s insurance policy, and also why you may need additional cover.

    • Co-pay clauses: This means that the insurer will only cover a part of the total expenditure incurred, and the insured party will have to pay the rest. This effectively reduces the total benefit of even having insurance cover, as the financial burden is just lightened, not eliminated. Most regular insurance policies do not have co-pay clauses, and offer a higher total amount of financial aid.
    • Room-rent limiting clauses: This clause basically means that your room rent per day in the hospital will only be covered up to a certain amount, which is usually as low as half the total rent. This clause also means that the cover will only extend as far as the room rent alone, and nothing inside the room like nurse and doctors expenses – which form the major chunk of the expense.

    Clauses in the policy document are only one of the many methods which employers and insurer employ to limit their total liability. There are many other reasons that you may require additional coverage through a separate insurance policy, like:

    • Employment status: Your employer’s insurance coverage will only protect you as long as you are employed with the company. The second your employment stands terminated for whatever reason, your insurance cover stops. Between the time you have no employer insurance and find another policy, you will be out of insurance cover and liable to pay every penny for hospitalization. Having a primary insurance policy as an individual will cover you despite your employment status.
    • Number of persons covered: The health insurance policy you get from your employer may or may not cover your dependants. In India, a very important aspect of owning a health insurance policy is so that you dependant parents, or children, can be brought under the coverage of the policy. The whole point of owning insurance is so that you will have to pay little or no amount when you (or your dependants) are faced with hospitalization. Employer and company insurance policies are group policies which may only cover the employee.
    • Employer insurance is a perk, not a right: Insurance cover offered by your employer is a perk. It’s a benefit and a tool used to retain employees and sweeten the employer-employee relationship. The employer can pull the insurance cover without having to worry about any legal ramifications whatsoever. Should you be faced with hospitalization when your company decides to save money and stop paying premiums, you will be stuck in a right fix.
    • Post-retirement coverage: As mentioned earlier, you will only be covered for the duration of your employment with the company. After your retirement, which is when you’ll need insurance coverage the most, you will not have the benefit of insurance cover. Getting a policy after the age of 50 is an extremely arduous task, and requires medical tests to be undertaken. Getting a new insurance policy after the age of 50 also means that you will be signing a form that says there will be no coverage for “pre-existing medical conditions” – which effectively means that the insurance provider has no liability or responsibility towards you, should your hospitalization be due to a disease or medical condition that you’ve had before taking the policy. 80% of hospitalizations for senior citizens are for pre-existing conditions, and this does not help you at all. Getting a private insurance cover in your youth, which extends beyond your retirement age, is how you need to play this.
    • Changes in the terms and conditions of the employer policy: Employers and insurers work together to save money and limit their liability. At any time, they could change the terms and conditions in your policy to remove certain types of coverage, or include clauses that don’t cover pre-existing medical conditions, or certain types of illnesses. They could also remove your dependants from the coverage, or basically do whatever they want with the policy from cutting benefits to the bone, or even raising them (which is unlikely).
    • Total effective cover: Group policies taken by employers for their employees don’t cover too much, financially. It’s likely that the total coverage (if all terms and conditions are met) could be up to Rs.1,50,000 or Rs.2,00,000 (if you’re lucky). For serious illnesses and long hospitalizations, this amount will hardly be 20% – 30% of the total expenditure.

    It’s definitely a benefit having insurance cover from your employer, and of course, insurance providers and policies differ between companies.

    Your company could have an excellent group health insurance policy, or a really bad one – you need to analyse the policy document to know exactly how much coverage you have, and how good it is.

    It’s advisable to always treat your employer’s insurance policy as a secondary cover, should your primary policy (that you take as an individual, with no connection to your company) run out.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Why Employer Health Insurance is not Enough? Reviews

  • Page 1 of 50 1 2 3 4 5
    • Star Health Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the Star Health Insurance Company. It offer health insurance benefits for the Whole full family, I am paying premium of 6000 per year and do not have any claim experience. The service is good. They have partnered with many hospitals in my area . Based on the features it has been a god experience with them.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 21, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance policy with the Royal Sundaram. I am paying the premium for myself . I pay a premium of 2500 per years. I do not have any claim experience with the policy and th premium amount gets auto debited from my account.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 21, 2018
    • Reliance General Health Insurance
      "Hopeless Service"
      0.5 0.5/5 "Unacceptable"
      They are a joke to the insurance sector. They will never give you any claim and even if you write to them, they will never bother to reply. I took a policy medical from Reliance and trust me during the time of claim they did not pass it when we inquired they did not reply. Thief company
      Was this review helpful? 0
      , kolkata
      Reviewed on Jun 21, 2018
    • Star Health Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the Star Health. I have claimed this policy for 2 lacs. The whole claim process was easy, after discharge. The service was very good. I am really happy about the service of Star Health and it is a recommendable health insurance policy to have.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard . I pay a premium of 5500 per year for this policy. I do not have any claim experience with the policy. They offers 5 lacs coverage for the entire family and the network list of hospitals are also pretty solid with their services.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 20, 2018
    • Cigna TTK Health Insurance
      "Good Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance provided by the Employer from the Cigna TTK . I do not have any claim experience , Company is paying the premium. It offers an annually coverage of 2 lacs for me and 1 lac for my wife and 50000 for my children. So far it has been a smooth experience and I'll have to wait and see how they respond to my claim in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 20, 2018
    • HDFC Ergo Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      Got the health insurance policy from the HDFC ERGO around a year ago. The customer support service and the response is good with the HDFC ergo . This policy covers only one member in my family. I have the medical coverage up to Rs,3,00,000 and I am satisfied having the health insurance policy.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jun 20, 2018
    • Star Health Health Insurance
      "Excellent"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the Star health insurance company. Customer service is good one and their response too. Coverage value is fine one too with the Star health insurance company. I have not faced any such claims with them till now.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 20, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with MAX BUPA from last 3 years and it is one of the good policy. It is a family coverage where spouse and children are covered. I pay a premium of Rs 18000 for this health insurance. My claim experience was good and they covered 70% of the billed amount.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 19, 2018
    • Religare Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I was using health insurance policy with Religare from last 2 years, i am happy with the coverage value of this insurance policy. I am satisfied with the claim experience and it was a cashless treatment. I have a coverage value of Rs 3 lakhs for this insurance policy.
      Was this review helpful? 0
      , navi mumbai
      Reviewed on Jun 19, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Icici health insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. Pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 19, 2018
    • New India Health Insurance
      "Very good service"
      0.5 5.0/5 "Blown Away!"
      New India Assurance was the first health insurance provider with the Employer provided health insurance, They've partnered with the many hospitals in Pan India and also offered protection for the entire family. They were also offering cashless treatment facilities. Overall it has been a smooth experience.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 18, 2018
    • SBI General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with SBI general insurance from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance company. I pay a premium of Rs 50 per month for this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 18, 2018
    • Star Health Health Insurance
      "Good to have insurance policy"
      0.5 3.0/5 "Satisfactory"
      Idon't have any experience of claim hence i never get a chance to call their customer care. They used to call me for renewing the policy. I can claim about 3.5 lakhs per annum. If i use 10% or not claim the policy, they wont give additional benefits for the next year. Their is a insured amount by 10%. My premium amount will be same but the claim amount they will increase by 10% next year. Cashless treatment is available in this policy
      Was this review helpful? 0
      , noida
      Reviewed on Jun 18, 2018
    • National Insurance Health Insurance
      "Very late back policy"
      0.5 3.0/5 "Satisfactory"
      My company people have taken health insurance policy to the employees. Once i have claimed the policy for my mother. The service is not good as per experience. They have a separate hospital list, in that they have mentioned cashless facility is available but when i went for those hospital, they said their is no cashless facility for this insurance. They will not response from the National Health insurance. The number will keep on ringing. After that my company asked me to send the bill. But i never done to this company. The claim is very low which is less than 20000.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 18, 2018
    • Religare Health Insurance
      "BEST"
      0.5 4.0/5 "Great!"
      From past 7months i am using this health insurance. Documents i have done through the on line. The coverage is for 10k. Per annual i pay of rupees 7-8k. Disease coverage is there. Free medical checkup once in a year is also available in my insurance.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 17, 2018
    • New India Health Insurance
      "Chatting with customer at clamp time"
      0.5 0.5/5 "Unacceptable"
      This is a type of fraud company.This does not pass the claim.When they go to the customer to make a claim, it only rotates it, this time of direction can be more than 8 months.thay do not have any response anymore, only you have to call them these times and you have to consider the information.Out of which it does not raise your phone more than half the time. Each time they constantly ask for something new, they never tell you once and after 8 or 9 months of the final, you cancel your claim according to the new rule.They do not deliberately describe the whole processor, either by either losing the customer tired or in the last. I will request all individual personal and special corporate offices to never do any bonding with this type of company.Because the new rules which it says in 8 or 9 months, how will the customer know at first sight, they deliberately conceal the rules so that the customer does not get disturbed and do not claim.
      Was this review helpful? 0
      , neemuch
      Reviewed on Jun 16, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy from the National Insurance. I am paying the premium of 1400 per year. You can claim this policy at any network hospitals in the country. The need to nofity the customers about the partnered hospitals. If they have tie up with the a new hospital they need to send updates to the customers or publish it on their website.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 2.0/5 "Expected more"
      I'm using the Star Health insurance policy. I do not have any claim experience yet. I pay a premium of 8000 Per year. They don't send any renewal notifications. Their Service is good. The coverage is 1 lac for whole family per year. They need to improve their notifications and keep the customer posted about important dates.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've been using the health insurance policy from Royal Sundaram for a while. I am paying the premium of 8000, many of my friends recommended Royal Sundaram. I never had any claim experience with the policy. Overall it has been a smooth experience. I'll have to wait and see how they respond to my requirement in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
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