Employee Health Insurance

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Employee health insurance is defined as a healthcare program provided to the workers in an organization by its owner. Under normal circumstances, the employers provide either some part or the entire premium amount by themselves. These plans can also be regarded as a form of agreement that the employer reaches with the employees.

At times these plans are also organized by unions that pay the premium or certain amounts of it as part of their member welfare activities. In cases where the total amount of premium is not provided by the employer there is an agreement reached as to how much will be borne by both the parties, i.e., the owner and the workers. Both reimbursement and coverage based plans are offered.

Different types of employee health insurance
The healthcare plans provided by the employers to the employees can also be broadly referred to as managed healthcare plans - these are basically medical insurance services at discounted rates.

The discounts are normally availed by bargaining for lesser charges with the doctors and the hospitals. There are three prominent types of plans in this regard - HMO, POS, and PPO.

With the HMO (Health Maintenance Organization) plans the employers can attend to the healthcare requirements of their employees through negotiations with certain doctors, clinics, and hospitals. However, the employees will not be able to venture outside this selected network if they wish to get treated for a lower fee or reduce their expenses towards the health plan in general.

By availing the POS (Point of Service) plans the employers can give employees the choice of availing a doctor who has already agreed to treat them at lesser fees. In these plans the primary care doctors serve as a sounding board before the specialists are visited.

In simple terms this means that if an insured, under this plan, falls ill, he or she will need to visit the doctor first before getting to the specialists. Otherwise, they may not get the benefits of the plan.

In case of the PPO (Preferred Provider Organization) plans the employers can arrange health treatments linked to the insurance plans at lesser costs. In these plans the insured can choose the doctor and hospital who may be out of the network but normally ones included in the plan are less expensive.

How to buy employee health insurance?
Following are some important factors that need to be kept in mind while choosing the healthcare plans for the employees:

Doctors: in certain employee health insurance policies the choice of doctors is restricted to a selected group. In case the employer wishes a certain doctor to treat the employees, he or she should make sure that the doctor is in the network.

In case they are worried about the quality of doctors on offer they can call up the hospitals where that person works or check up the internet for information on him or her.

The employer should also check out the locations of the doctors as well as the timings when they operate. Normally several doctors operate at different facilities, which means they might not be available at all times.

Specialists: there are certain conditions where specialists are an absolute must. So before availing an employee health insurance plan the employers should check the different options and conditions available in that regard.

They need to determine if the plan calls for a primary care physician to be seen every time. Besides, they also need to find out if they will be able to avail the services of their preferred specialist as part of the plan itself.

Pre-existing conditions: this is a pretty simple aspect of healthcare plans but quite often people availing such policies forget to verify if their already existing diseases and ailments shall be insured by the plan.

Hospital and emergency care: the employers need to find out the emergency care treatments and hospitals available to them as part of the plan. They should also determine what services are provided as part of emergency care. Besides, they need to find out if the recommendation of the primary care physician is needed in order to get to emergency care.

Physical and health check-ups on a regular basis: if the employers want their workers to get tested on a regular basis, it is always worthwhile to find out if such tests are covered by the plan or not.

Prescription drugs: if the employees of a company are regular users of prescription drugs then the employer can look for plans that provide good coverage on this front. They also need to find out the price for prescriptions if they are not available in the generic form.

OB-GYN: if the workers are regular visitors to gynecologists or obstetricians then the employers should find if they are covered in the plan or not. They should also determine if the plan covers critical areas like fertility treatments and pregnancy and what sort of coverage is offered in these areas.

Extra services: following are some additional services that the employers can look for in a healthcare program before availing it:

  • Alcohol and drug rehabilitation
  • Hospice
  • Mental health care
  • Experimental treatments
  • Counseling
  • Alternative treatments
  • Home health care
  • Chiropractic care
  • Nursing home care
Expenses: the following factors have to be carefully considered while determining the viability of an employee healthcare plan from the perspective of expenses:

  • Deductibles
  • Co-payments
  • Percentage of healthcare costs to be paid following deductibles
  • Limits
Exclusions: thelast, but not the least, factor is the exclusions. The employers should look very closely at what is not covered in the plan and decide if their situation allows such exclusions.

Top employee health insurance plans
Max Bupa Health Insurance: The Employee First Health Insurance plan of Max Bupa provides the following advantages for the policyholders:

  • Direct communication with service provider
  • Cashless facilities at top hospitals
  • Wide range of coverage
  • 24X7 access to helpline
  • Health profile of insured
  • Option of changing group policy to a single one when they retire or move to another company
  • Tax savings
  • Medical costs for daycare processes covered
  • Accommodation in single rooms with zero sub limits
  • Complete coverage for availing the best medical treatment and advice
The employers can access the customer page of the company and perform the following actions:

  • Review claims history
  • Manage audit policy calendars
  • Review coverage details
  • Generate reports for supervising the medical requirements of employees
Apollo Munich Health Insurance: the employee health insurance plans of Apollo Munich provide the following benefits for the policyholders:

  • Substantial coverage for treatment of accidents and illnesses that necessitate hospitalization
  • Coverage for diagnostic processes, lodging and boarding, ICU, prosthetic and surgery expenses
  • Critical illness cover
Royal Sundaram General Insurance: The employee health insurance of Royal Sundaram is referred to as Health Premium Platinum. It provides the following advantages for the policyholders:

  • Cashless facility
  • No exclusions in first year
  • Pre hospitalization cover
  • Hospital cash
  • Post hospitalization cover
  • Convalescence benefit
  • Outpatient care
  • Maternity benefits
  • 30 days waiting period waived off

Last Updated on 15/06/2011

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