India has the largest number of life insurance policies in the world with 33.8 crores in force in 2020, as per the Insurance Regulatory and Development Authority of India (IRDAI). This is a testament to the growing importance of insurance in India and the need for individuals to protect themselves and their families from unforeseen events.
Health insurance has become an integral part of employee benefits. With mounting healthcare costs, the importance of having Corporate Health Insurance coverage cannot be overstated. However, it's essential to be aware of any gaps in your coverage. Think of it as a safety net for both you and your employees, covering a variety of medical expenses and services, such as hospitalisation and outpatient services. By understanding the limitations and exclusions of your policy, you can make informed decisions about your healthcare needs.
In general, limitations refer to conditions or procedures covered under a policy but at a lower benefit level than usual. Conversely, exclusions refer to conditions or procedures that are entirely omitted from coverage.
Let’s explore how this policy works for you and your team.
What Are Some Common Limitations And Exclusions?
The limitations and exclusions included in a policy can vary depending on the insurance provider. Here are some typical limitations and exclusions that a standard policy might include.
- Geographic limitations: Some corporate health insurance policies may have geographic limitations. This means that the policy may only provide coverage for medical treatment received in certain geographic locations. If an employee requires medical treatment outside the covered area, they may need to pay for it out of pocket. It is important to review the policy terms and conditions to understand any geographic limitations.
Here’s an alternative: Employees can opt for policies that provide coverage for medical treatment received in a wider range of geographic locations or purchase a travel insurance policy that covers medical expenses incurred outside the covered area.
- Limits on coverage: Corporate health insurance policies may also have limits on coverage. For example, there may be a limit on the number of hospital days covered or the amount of coverage provided for certain treatments.
Here’s an alternative: Employees can opt for policies that offer higher coverage or purchase add-on riders that cover specific treatments or extend the coverage for a particular treatment.
- Maternity-related expenses: Most health insurance policies exclude coverage for maternity-related expenses, including childbirth, prenatal and postnatal care, and infertility treatments.
Here’s an alternative: An alternative is to opt for a policy that covers maternity-related expenses including delivery costs, prenatal, postnatal, and newborn care or purchase add-on riders that cover these expenses. These policies may have a waiting period of a few months, and the premium is usually higher. Employees can also consider opting for employee wellness packages that cover these expenses.
- Limited coverage for mental illness, substance abuse, and chronic conditions: Some corporate health insurance policies may have limited coverage for certain illnesses such as mental health, substance abuse, and chronic conditions. This means that while the policy may provide some coverage for these illnesses, it may not cover all the costs associated with the treatment.
Here’s an alternative: Employees can opt for policies that offer comprehensive coverage for mental illness, substance abuse, and chronic conditions or purchase add-on riders that cover these illnesses.
- Waiting period clause: This is the period of time during which the policyholder cannot make any claims. The duration of the waiting period can vary depending on the insurer and the policy.
Here’s an alternative: Employees can opt for policies that offer a zero waiting period or reduced waiting period for certain illnesses or procedures. They can also consider purchasing policies with a buy-out option that allows them to pay an additional premium to avoid the waiting period.
- Pre-existing conditions: One of the most common limitations of corporate health insurance policies is pre-existing conditions. These are health conditions that an employee has been diagnosed with or has received treatment for before enrolling in the policy. In most cases, pre-existing conditions are not covered by the policy for a certain period of time. This waiting period can vary from a few months to a few years depending on the policy. It is important to check the policy terms and conditions to understand the waiting period for pre-existing conditions.
Here’s an alternative: Employees with pre-existing conditions can look for policies that offer coverage for such conditions after a shorter waiting period or opt for policies that cover pre-existing conditions from day one. They can also explore alternative policies such as critical illness plans that specifically cover pre-existing conditions.
- Cosmetic surgery and alternative treatments: Corporate health insurance policies may exclude coverage for certain treatments such as cosmetic surgery, plastic surgery, infertility treatments, and alternative therapies like acupuncture or naturopathy. These exclusions are usually listed in the policy document and should be reviewed carefully. If an employee requires coverage for a treatment that is excluded by the policy, they may need to pay for it out of pocket.
Here’s an alternative: Employees who require coverage for these treatments can opt for policies that specifically cover them or look for add-on riders that provide coverage for these treatments. They can also explore wellness plans that cover alternative therapies like acupuncture or naturopathy.
- Permanent exclusions: Health insurance policies permanently exclude congenital diseases or damages resulting from war and nuclear weapons.
Here’s an alternative: For congenital diseases, employees can opt for specific policies that cover these conditions. For damages resulting from war and nuclear weapons, employees can explore government-sponsored insurance policies that offer coverage for such events.
- Deliberate Injuries: Health insurance does not cover deliberate injuries, including self-inflicted injuries and illnesses resulting from attempted suicide.
Here’s an alternative: Employees can look for policies that provide coverage for self-inflicted injuries or consider purchasing accidental death and disability insurance to cover any potential accidents or injuries.
- Dental care: Dental procedures are typically not covered under most health insurance plans, except when they are necessary due to accidental injuries.
Here’s an alternative: To ensure coverage for routine dental care, employees can consider purchasing a separate dental insurance policy or add-on riders that cover dental care expenses. Another alternative is employee wellness packages, which can offer coverage for dental care and other health services not covered under the corporate health insurance policy.
- HIV/AIDS: Sexually transmitted diseases, including HIV/AIDS, are not covered under health insurance policies.
Here’s an alternative: Employees can explore specific policies that offer coverage for HIV/AIDS or consider critical illness policies that cover major illnesses, including HIV/AIDS. They can also look for policies that cover preventive care and testing for sexually transmitted diseases.
It's important to carefully review the limitations and exclusions of any corporate health insurance policy before making a decision. Knowing what is covered and what isn't can help you choose the best plan for your organisation's needs.
How can Nova Benefits help you with Corporate Health Insurance?
If you're feeling overwhelmed by the prospect of finding the right Corporate Health Insurance for your business, don't worry - Nova Benefits has got your back!
We partner with various insurers to provide customised insurance plans that fit your business's unique needs.
Not only that, our team of experts can guide you through the process and help you find the coverage options that are right for your business.
With Nova Benefits, you can rest easy knowing your employee benefits are in good hands.
To learn more about how we can help you find the best corporate health insurance policy for your company, book a free consultation call today by clicking on the button below.
- Is corporate health insurance mandatory for employers to provide?
Corporate health insurance is not mandatory for employers to provide, but many companies choose to offer it as a benefit to attract and retain employees.
- Who is eligible for corporate health insurance?
Eligibility for corporate health insurance depends on the specific policy and the terms offered by the employer. Generally, full-time employees and their dependents are eligible for coverage.
- What types of coverage are typically included in a corporate health insurance plan?
Corporate health insurance plans typically include coverage for hospitalisation, doctor visits, diagnostic tests, prescription drugs, and preventive care.
- Can employees choose their own healthcare providers with a corporate health insurance plan?
This depends on the specific policy and the terms offered by the employer. Some plans may require employees to use in-network providers, while others may allow for out-of-network care.
- Can employees add their family members to their corporate health insurance plan?
Yes, most corporate health insurance plans allow employees to add their family members as dependents.
- What happens if an employee leaves the company? Do they lose their health insurance coverage?
When an employee leaves a company, they may be eligible for COBRA coverage, which allows them to continue their health insurance coverage for a limited time. However, they will typically be responsible for paying the full premium cost.
- Can employees change their coverage options during open enrollment?
Yes, open enrollment is a period during which employees can make changes to their coverage options.
- Are premiums for corporate health insurance plans tax-deductible?
Yes, premiums for corporate health insurance plans are generally tax-deductible for the employer.
- Can employers customise their corporate health insurance plans?
Yes, employers can customise their corporate health insurance plans to meet the specific needs of their employees.
- How does a group health plan differ from individual health insurance?
Group health plans typically have lower premiums and broader coverage than individual health insurance plans. They also often require a larger network of healthcare providers.
- Are group health plans regulated by the government?
Yes, group health plans are regulated by the government, specifically the Department of Labor, the Department of Health and Human Services, and the Treasury Department.
- Can employers offer multiple health insurance plans to their employees?
Yes, employers can offer multiple health insurance plans to their employees to provide more options and better meet the diverse needs of their workforce.
- What is a self-funded health insurance plan?
A self-funded health insurance plan is a type of plan in which the employer assumes the financial risk of providing healthcare coverage to its employees. Instead of paying a premium to an insurance company, the employer pays for claims directly.
- How can you find out your coverage?
You can find out your coverage details by reading your policy carefully. It will provide information on what is covered, what isn't, and any limitations that may apply. For additional support or questions, you can contact your insurer or benefits provider.
- Who can buy Corporate Health Insurance?
Corporate Health Insurance is available for businesses of all sizes, including small companies and non-profit organisations.