Covered for life?

It's a good idea to read the fineprint carefully before signing on the dotted line for employee insurance cover.

India's healthcare industry is going great guns with corporate hospitals mushrooming across the country and the pharma industry growing at a phenomenal rate of 7.2 per cent, year-over-year. But quality comes at a price and the rising cost of quality healthcare may be a worry for many.

Most professionals though find relief in the form of the Employee Group Health Insurance "" a benefit offered to employees by a company. The pitfall comes to the fore, however, only when it's time to claim the insurance cover, especially, if you haven't read the fineprint.

The importance of group health insurance can be understood from the fact that it has now become almost a norm for employee welfare and increasingly more and more corporates are realising its worth in curbing attrition.

The problem occurs if an employee overlooks the terms and conditions of the health cover, thus having to pay for all the hospitalisation expenses through his own pocket.

Pavanjit Singh Dhingra, vice president, Prudent Insurance Brokers says, "Employees don't bother to read the insurance terms until they fall sick. We come across almost four cases every month where people incur expenses only to realise later that those expenses are not covered under the policy."

Agrees Kartik Jain, head marketing, ICICI Lombard, "The percentage of inadmissible claims would reduce with increased awareness of the policy purchased by the insured."

It, thus, becomes very important for employees to understand their company's insurance cover fully before opting for a hospital treatment.

Moreover, now following de-tariffing (that is, the removal of tariffs allowing insurance companies to set the premium for a product based on its risk profile), with the increasing premium on health insurance, it is likely that corporates cut down on the health insurance benefits in order to cut costs.

Common mistakes employees make are in the following areas: in choosing a hospital/room, first year diseases, pre existing diseases, maternity and hospitalisation resulting in no treatment.

Says Dhingra: "Employees must be careful while choosing a hospital and a room. They must find out which hospitals fall under their insurance cover and what kind of room they are allowed to book."

In fact, a large percentage of the hospital bill is room rent and not the actual treatment. And while such claims may be honoured, they may eat into the employee's total sum insured that includes his family's cover too.

Treatment for pre-existing diseases like cancer and heart aliments had begun to enter the health insurance cover but it may now, once again, take a backseat with increasing premiums.

"Covering pre-existing diseases in the insurance policy involves the payment of a higher premium by the company. But these days most large corporates tend to cover most health risks except those that are not medically required," says Shreeraj Deshpandey, head, health and travel, Bajaj Allianz General Insurance.

He also suggests that an employee with an employee health cover need not go for an individual insurance if he isn't planning to take up a job that offers no cover.

Normally, group health insurances are more exhaustive and lenient than individual ones. With a normal limit of Rs 5 lakh per employee, health insurance covers have become the need of the hour for most corporates.

However, this may not remain hunky-dory with de-tariffing setting in. So, before you get hospitalised, give your insurance policy a good read.