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Employee Benefits Insurance

An Employee Benefits Package has slowly yet surely evolved into more of a strategic tool to attract and retain quality talent in an organisation. Typically, an Employee Benefits package comprises 2 primary insurance covers – Group Health Insurance and Group Personal Accident

Group Health Insurance Policy

Under a group health insurance plan, the organisation usually purchases a plan to cover its employees and splits the premium payable between themselves and their employees. This means every employee is eligible to avail a basic health insurance plan from the employer providing a group mediclaim policy. Each party will pay a specified premium amount and both can claim tax benefits on the same.

Coverage

Most mid to large scale organisations offer group health insurance coverage to their employees and might extend that coverage to one or more dependents. Employees might be able to provide health cover up to a specified amount to their spouse or parents or even in-laws and children under a group health insurance plan.

Add on coverage

Employees might be able to opt for accident cover and critical illness cover in case their job demands travelling or their parents or spouse’s parents have a history of critical illness.

Benefits

  • One of the key benefits under a group health insurance policy is that the employee receives health coverage under a reduced cost in comparison to an individual health insurance policy.
  • The premium amount doesn't have to be paid by the employee alone - the company chips into to pay part of the premium
  • While pre-medical screening is a mandatory requirement for individual health cover, this is not a requirement under a group health policy.
  • The claim process for a group health insurance policy is very easy and hassle free - most organisations offer their employees a health card that can be presented at the time of hospitalisation to avail cash free hospitalisation and other benefits.
  • Employees can choose how the premium term and money will be deducted from their salary on an annual, bi-annual or monthly basis.
  • Employees can even claim for exemptions under income tax and thereby avail of tax benefits while filing their returns.

Exclusions

A group health insurance policy may not cover every aspect of health care as it is not tailored for an individual. Some of its exclusions include -

  • Limited or no dental cover
  • Medical cover required because of self-harm.
  • Injuries caused due to any involvement in criminal activity.
  • Injury incurred due to being victim of a criminal act.
  • Treatment for AIDS or HIV
  • Cosmetic and plastic surgery

Sum assured and premium

The sum assured and premium under a group medical insurance policy is dependent on the kind of plan chosen by the employee - a specified sum and premium will be determined by the organisation to offer basic health cover. If the employee wishes to opt for additional coverage or add on coverage, they can do so - this will obviously increase the sum assured as well as the premium amount.

Group Personal Accident Policy

A Group Personal Accident (GPA) policy helps an organisation protect their employees from the expense of injuries sustained in an accident and subsequent monetary issues that will follow. This policy can ensure that an organisation’s employees are offered comprehensive medical cover and financial protection against long term expenses occurring due to disablement or death of an employee.

Coverage

A comprehensive group personal accident insurance policy will protect the employees at an organisation (and might even cover their families) in the following scenarios -

  • Accidents leading to death or permanent disability. A group personal accident cover will need to provide a payout in case of death of an employee or permanent disability of an employee. In case of a fatal accident, the policy can cover the expenses of transporting the remains of the insured employee. Additionally, funeral expenses are also covered under this insurance policy.
  • Partial or permanent disability Irreversible damage to eyesight, limbs, spine etc. that lead to permanent disability and subsequent loss of income are covered under a group personal accident cover. Partial disability expenses caused due to loss of limbs, any sensory organs etc are also covered under a group personal accident policy.
  • Medical expenses Employees are eligible to claim reimbursements under a group personal accident insurance policy to cover the cost of medical expenses and hospitalisation.

Add-on Covers

  • Certain add on covers can extend the coverage of a group personal accident insurance policy to employees that might work on an on-duty or off-duty basis i.e. in shifts.
  • Add on coverage can also extend already available medical facilities and add other facilities like emergency medical transport. In case of death of an employee, the cost of transporting the employee’s remains is also covered at a nominal additional premium.

Benefits

A group personal accident cover is highly beneficial to employees at an organisation because of the comprehensive nature of coverage. Some of the benefits include -

  • Worldwide cover
    If a job involves travelling, this policy can be claimed in any part of the world to pay for medical expenses.
  • Making a claim
    As the policy is designed for a group, employees don't have to worry about documentation and claim process is generally hassle free.
  • Sum assured and premium
    The sum assured and premium for a group personal accident scheme depends upon the total number of employees, the coverage assured for each employee, variables like add on coverage, extension of coverage to spouses or family of employees etc.

Exclusions

While group personal accident is an exhaustive and comprehensive insurance policy, it has some limitations and does not cover the following scenarios -

  • Death of an employee by suicide or due to any acts of terrorism
  • Natural death
  • Medical expenses to treat HIV/AIDS
  • Medical expenses incurred during pregnancy, childbirth, miscarriage, abortions etc.

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