What Is Employee Health Insurance Coverage | Types & Benefits

By Okbima 03 May 2023 83
Employee Health Insurance Coverage - Okbima


Typically, employees value the benefits of their employer-provided health insurance. The employee views it as the next best thing to financial payments, and it gives the company the advantage of having the ability to hire and keep the top employees in the industry. Okbima assists you in locating a health insurance plan for your employees at a reasonable cost. 

In the event of hospitalisation, disability, or even the terrible death brought on by accidents, these policies are of considerable assistance. Moreover, it doesn't incur significant expenses for your business but significantly strengthens their trust in you. 

The insurance coverage provided by an employee health insurance policy, also called a commercial health insurance policy, typically consists of accidental hospitalisation COVID insurance, daily hospitalisation benefit, critical illness coverage, maternity coverage, etc.


Group Or Employee Health Insurance Policies Have Advantages

Any organisation values its employees greatly. As a result, employee health insurance has evolved as one of the most popular perks to entice fresh talent in today's more employee-centric businesses.

It plays a critical role in improving an employee's attitude towards the firm, reducing employee attrition, raising productivity, and extending coverage to members of the family of the employees, making the corporate or group health insurance plan a decisive victory for both the staff and the company.


Group Health Insurance Benefits For Employers Include

Here are some benefits that employee health insurance provides to the company

Help with Employee Retention

Helps with Employee Retention: Retaining employees has become challenging in the present era because there are so many jobs available in various industries. Yet, offering employees and their dependents perks like health insurance boosts employee retention rates.

Tax Benefits

As previously indicated, a group health insurance plan includes both employers and employees as beneficiaries; as a result, the company receives tax advantages for offering such plans to its staff.

Superior Advantages at a Cheap Cost

Employee health insurance offers superior advantages at an affordable price.


Advantages from Employee Group Health Insurance

Here are some benefits that employee health insurance provides to the employee

The First Day Covers Pre-Existing Disease

Unlike an individual health care plan, a group insurance policy begins to cover pre-existing conditions the moment an employee starts working for the company. It eliminates the need for any waiting period for existing diseases.

A Broad Spectrum of Cover with No Disease Limit

A workplace health insurance policy for workers covers pre-existing conditions and offers broader coverage that is disease-neutral.

Extended Maternity Coverage 

One of the best benefits to young workers is broader maternity coverage. The majority of these policies generally cover both C-sections and regular deliveries. Some plans also include coverage for newborn children without the usual 90-day maternity period.


Key Elements of Employee Health Insurance

  1. Health insurance plans for groups or corporations are offered in the market. The following features are found in all employee health insurance plans:
  2. Health benefits an employer provides are frequently extended to the insured (themselves), spouse, dependent children, and parents.
  3. Some health insurance companies also cover pre-existing illnesses and pregnancy.
  4. Hospital treatment at network hospitals is cashless with employee health insurance.
  5. Auxiliary expenses like ambulance costs may also be covered by group health insurance.
  6. Some health insurance plans for employees reimburse specialists' and other doctors' fees for subsequent checkups.
  7. With the group health plan, no medical examination is necessary.
  8. Compared to individual health policies, workplace health insurance is more affordable.
  9. It aids in lowering risk and responsibility for the business arising from employee behaviour.


Exactly Why Is Workplace Health Insurance Necessary?

Organisations today are more employee-focused than ever before, thus, they provide health insurance programmes to their staff members. The following are a few factors that make employee health insurance programmes necessary and advantageous for both workers and their employers:

Greater Benefits And Extensive Coverage

Most group health insurance policies offer their clients comprehensive coverage and superior benefits.

The Choice To Tailor Coverage

Group and corporate health insurance policies offer the choice to alter the policy terms. For instance, an employer may select an OPD or maternity care plan.

Inexpensive Premiums

Group health insurance is demonstrated to be more cost-effective when comparing premium costs to individual health insurance policies.


Points To Be Consider While Purchasing Employee Health Insurance

It must be employee-centric for your company's health insurance to guarantee that its employees benefit. Consider the following when purchasing employee health insurance coverage for your staff

Know The Prerequisites

Before purchasing any good or service, you should determine what you need. As the policy's primary beneficiary, the employees, it is crucial to know their needs, even though preserving the premium amount may be one of your requirements. Yet at the same time, you must consider the costs realistically.

The Policy's Coverage

The amount of insurance supplied by the insurer to each employee under the Workplace Health Insurance Plan is called coverage. You can require or not need specific insurance covers based on the company's scope and the employees' age range.

The Ratio Of Claims Resolved

The claim settlement ratio is the percentage of claims settled by the insurer to all claims made during the year. A claim resolution ratio of 90 or greater is generally seen as a positive ratio because it means your claim is more likely to be approved.

Hospital Networks

The insurer lists health centres when purchasing a health insurance policy. In addition, the insurance has partnerships with these hospitals to provide cashless hospitalisation. The primary advantage of receiving treatment at a clinical facility is that the policyholder—in this case, the employee—does not have to make accommodations to pay hospital expenses and then wait for reimbursement since the patient pays nothing for a cash-free service.

Health Advantages

Due to greater awareness of it following the COVID-19 pandemic, people are now focusing more and more on their psychological well-being and health. As a result, several insurers provide pro-active health insurance plans that provide financial aid when an employee is treated and assist in enabling a lifestyle that can help them avoid being hospitalised in the first place.

Waiting Intervals

The waiting time is the time your staff must wait before starting specific therapies. But, you can pay an additional premium under an employee health insurance plan and forego each of these waiting periods.

Legal Consequences

If insurance is required for your company, and if so, what kind should be discussed with your legal team? For instance, if your company is in the manufacturing sector, you may be required to cover your staff, including industrial workers, in accordance with the 1948 Employee State Insurance Act.

Details Of The Insurance Plan

Each insurance contract has a unique set of includes and exclusions. Conditions and diseases that are covered by the policy are considered inclusions. The conditions and diseases the policy does not cover are exclusions. Also, there are insurance exclusions and circumstances that the policy doesn't protect.


Included and Excluded Benefits of Group Health Insurance

The typical inclusions that the majority of employee health insurance policies offer to their insured are as follows:

What Does It Cover?

  1. Diseases that existed before coverage began are covered.
  2. All corporate health insurance plans provide maternity coverage. However, some have waiting periods that last nine months, while others don't.
  3. Beginning with the day of delivery, the child is protected.
  4. A few policies also pay ambulance fees.
  5. Hospitalisation costs both before and after.
  6. Household and daycare costs.
  7. Fees that doctors and experts charge.
  8. Rent for the room and nursing costs.
  9. Anaesthetic, oxygen, plasma, OT fees, medications, prescriptions, and the price of diagnostic tests like x-rays, among other things.
  10. Some plans additionally pay for pacemaker costs, chemotherapy, and radiotherapy.


What Does Not Come Under These Plans?

The following exclusions were shared by all of the plans in this category:

Certain policies exclude coverage for the employee's parents.

Other non-allopathic treatments like homoeopathy and ayurveda are not covered.

A employee health insurance plan for staff is always time-limited and only good while employed by the company.

Congenital disorders and all associated costs for treating AIDS and related conditions.

A condition or side effect of excessive alcohol or drug use.



Considering the abovementioned ideas when purchasing workplace health insurance will guarantee that you give your workers the most advantages while paying less for the premium. In addition, comparing insurance companies is a good idea in terms of price, client feedback, claim settlement percentage, client service, etc.

Employees love the advantages of group health insurance, which is no secret. However, employee health insurance has turned into a tightrope act in India due to rising premium costs and onerous claim procedures. Okbima provides a comprehensive range of group medical insurance solutions available to assist you in selecting the best employee insurance plans which will benefit both employers and employees. 

The goal of insurers is to make the insurance procedure simple and convenient by combining the complete service—from expert counsel to purchase support to policy renewal—into a single package.

Leave a Reply