Don’t just bank on group health Insurance

It’s always better to have an individual health insurance plan even if you are covered under group insurance. This is because retail health is renewable for life; even if the insurer decides to discontinue the policy it has to mandatorily port you to another. On the other hand, in group health insurance, once the relationship with the group ends—like when you quit your job—so does your health insurance cover.

Lets first understand what is Group Health Insurance is:

A group or corporate health insurance policy is purchased by an employer for eligible employees of a company. One of the key employee benefit packages provided by employers, a group health insurance plan, in some cases, may also provide cover to family members of employees.

Most of us are offered Health Insurance as a perquisite or benefit attached to our jobs. Because this insurance is built into our contract, we rarely analyze or compare it with other plans. However, just because one does not have the option of rejecting employer’s health insurance does not mean one should not analyze the pros and cons of these group plans. More often than not, these plans are limited in the cover they provide and come with problematic loopholes. So how do you ensure you are well covered? Getting a health insurance plan that requires you to pay premium regularly and in return only get reimbursement for actual expenses, can be a costly substitute. What you can opt for instead is a lump sum fixed benefit plan that gives you additional cover for hospitalization, surgeries, and critical illnesses. This plan should cover you for a range of surgeries, as these are medical procedures that cost the most. It must also provide cover for a number of critical illnesses, such as cancer, Alzheimer’s, kidney failure, etc. As these diseases are on the rise and a reimbursement based Health Insurance plan which pays for actuals will not cover all expenses- you need a lump sum pay-out that can be used to cover all costs involved - be it pre or post hospitalization. To demonstrate why and how employer’s health insurance plans may not be sufficient, we have outlined how these plans fall short, and how you can make up for their shortcomings:

• No Guaranteed Continuation of the Plan

Employers offering group cover as a perquisite or facility can always choose to discontinue the plan. Further, the coverage is linked to continuation in the job. Quit the job and the policy is automatically terminated. Unlike individual plans, a group plan cannot be extended or renewed for as long as one wants. The coverage will get terminated once the policy holder reaches the age of retirement. Moving from a group plan to an individual plan after retirement will always be costlier than renewing an existing individual plan. While you can try to port your group policy to individual, there are no guarantees. This hits senior citizens and those with pre-existing ailments the most.

Restricted Customization Options Employers negotiate all aspects of the group cover—including number of critical illnesses and diseases covered, inclusion of dependents, minimum and maximum sum assured— directly with the insurer, which means you cannot always ensure that the critical illnesses and surgeries you are prone to, given familial history, are covered

Little Scope for Planning for the Future The concept of group plans originated in an era when healthcare was not very costly and health insurance was not considered necessary. Hence, these plans focus on lowering cost of the cover even if it involves degradation of quality of the care.

Will the plan reimburse the daily expenses resulting from hospital admission, even for a short period of just 7-10 days? Can you opt for a surgery with absolutely zero worries about the cost of the procedure? Does the plan give you the confidence that no family member will lack proper care and treatment when suffering from a critical illness? Group plans are suitable for routine and ordinary health expenses. To truly plan for the future, you need a plan that offers assured lump sum benefits at very lenient terms and conditions.

Group Plans Lag behind—the Numbers Story Data obtained from a pan-India survey covering more than 3000 employees • 59% employees want coverage for general consultation as well. Only 39% enjoyed this benefit in their group plan. • 31% sought inclusion of diagnostic services, which was offered by just 20% employers. • Only 28% employers offered maternity education as a group plan benefit that was sought by 73% of all female employees. Other Issues • No option to customize plans to cover risks based on family history. • Perfunctory coverage for surgeries and critical illnesses. • High out of the pocket expenses during hospitalization. Conclusion • Premium escalation is inevitable and unavoidable in group plan as well • Gap in coverage benefits can impair the efficacy of the plan • A smart combination of fixed benefits and group cover is an effective way to minimize the negatives of group cover ..

Source: https://economictimes.indiatimes.com/wealth/insure/is-employers-health-insurance-enough/articleshow/52688277.cms