7 Important Things to Know About Employee Health Insurance Policy

Employee health insurance is an employer-provided plan that covers employees and their dependents (as per Terms and Conditions). This health insurance plan offers lower premiums, coverage for pre-existing diseases as per policy terms (often with reduced or waived waiting periods in group plans), and usually no mandatory health screening.

You should know about coverage, cashless benefits, features, eligibility, and policy exclusions of an employee health insurance policy before signing the final papers. Moreover, know why employers provide health coverage for employees.

What are the 7 Important Things to Know about Employee Health Insurance Policy?

Even when choosing the best medical insurance for employees, analyse the demographics and health history of the entire workforce to determine employees' healthcare needs. What are the important things you must know about employee health insurance? Here are the factors:

Coverage

Before finalising the health insurance, individuals must be aware of the employee health insurance coverage. Employee medical insurance covers inpatient care, post-hospitalisation expenses, and daycare treatments. It must also provide ambulance cover, domiciliary care, and efficient claim support services.

Even medical insurance for employees often provides discounts on medicines, telecommunication and annual health check-ups.

Claim Settlement

The claim-making process for a good employee health insurance plan is straightforward. You can raise a cashless claim or opt for reimbursement. Employee health insurance often offers direct settlement of hospital bills, subject to policy terms and network hospital availability. This allows employees to undergo costly treatments without immediate financial strain.

Featuring Cashless Benefits

Look for employee health insurance plans that offer access to network hospitals. Network hospitals ensure cashless treatment and hassle-free hospitalisation without upfront payments. This not only allows employees to access timely medical care at network hospitals but also takes off the stress of unexpected hospital bills.

Family Coverage

Look for the best benefit of employee health insurance, the option to include family members in the policy. Family coverage in employee health insurance offers the same financial benefit to the employee's family and helps the insured person stay stress-free.

Eligibility

There are some requirements to follow when buying employee health insurance. Check how many members your employer can add to a single policy. Members of a group health insurance policy may have a non-employer-employee relationship, or an employer-employee relationship, not just a group formed to obtain insurance benefits.

The Group Health Insurance from Bajaj General Insurance Private Limited usually require a minimum number of employees (often 7–10) and offers customisable features depending on the organisation’s needs.

Policy Exclusions

Employee health insurance plans also have exclusions, so you must read the policy terms and conditions before signing the contract. Some common exclusions include cosmetic surgeries, injuries caused by adventurous activities, infertility treatment, sterility, gender change surgeries, health problems or accidents caused while under the influence of drugs or alcohol.

Wellness Benefits

Currently, modern employee health insurance plans often offer free health examinations, gym memberships, discounts on laboratory services, nutritionist consultations, and tele-consultation. Employee health coverage also offers counselling and stress management activities to improve both physical and mental health. These are crucial for employee well-being, so check all aspects of your coverage.

Select an appropriate sum insured and decide whether your coverage should be for employees only or include family members. Bajaj General Insurance offers group health insurance solutions with optional add-ons, including critical illness and maternity benefits, helping organisations enhance coverage for employees.

Also Read: Zero Waiting Period in Health Insurance Plans - How it Works

Why Do Employers Offer Employee Medical Insurance?

According to Business Today, with medical inflation in India growing at 14-15% annually, hospitalisation and treatment are getting more expensive. Employee health insurance is a financial plan to ensure coverage for employees during emergencies.  Here is why employee health insurance is crucial

1. Attract and Retain Talent: Providing medical insurance makes your company more attractive to potential employees and helps retain existing ones.

2. Boosts Productivity: When employees know they're covered, they're more likely to focus on work rather than worrying about medical bills.

3. Tax Benefits: Employers can enjoy tax advantages when providing medical insurance to their employees.

4. Customisable Coverage: Medical insurance plans can be tailored to fit your company's specific needs and budget.

5. Comprehensive Support: Many plans include additional benefits such as maternity coverage, wellness programs, and outpatient care, which support employees' overall well-being.

6. Enhances Company Reputation: Offering medical insurance shows that your company values its employees, making it a more desirable workplace.

₹5-10 lakh in health insurance coverage was adequate in earlier years of an employee's career, but the same amount is falling short today. In metro cities, even a single hospitalisation can cost lakhs. Before opting for corporate or employee health insurance, check the coverage and the sum insured limit, as these are usually fixed under group policies.

Also Read: What is a Group Personal Accident Insurance Policy & Its Benefits

Final Statement

Offering an employee health insurance policy boosts employee morale and improves their overall medical care experience.  Individuals must check for add-on coverage and the option to add riders by paying an additional premium. Specifically, women employees can opt for maternity add-ons to better manage future medical expenses.

For employers, choosing a reliable insurer such as Bajaj General Insurance ensures access to structured group health plans, wider hospital networks, and efficient claim support, making it a practical solution for employee well-being.

Frequently Asked Questions

Is it mandatory to have employee health insurance?

Yes, in India, having employee health insurance is compulsory. Post-COVID-19 lockdown, the Ministry of Home Affairs introduced a mandate requiring companies with over 7 to 10 employees to comply. From April 2020, employers must provide health medical insurance for employees.

What are the necessary documents to file a claim for employee health insurance?

You must submit essential documents, including medical reports, a duly filled-out claim form, an incident or accident report, employment proof, and other relevant details like police reports or FIR in case of a major accident. Provide accurate documents for verification and to settle claims faster for the injured employee.

Who pays for employee health insurance coverage?

Employees do not have to pay for the medical insurance. Employers pay the premium as a prerequisite for employees in their organisation.

What happens to the employee's health insurance coverage when an employee leaves the company?

Group health insurance coverage usually ends when an employee leaves the company. However, employees may be able to convert the group policy into an individual plan, subject to the insurer’s terms and conditions.

Can I buy an individual insurance plan if I already have a group health insurance policy?

Yes, you can. If your group health insurance does not fully meet your needs, purchasing an individual plan can enhance coverage, offer a higher sum insured, and provide long-term security for you and your family.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.