Is it necessary to have a comprehensive health insurance policy if you are already covered under a corporate group health insurance scheme? Experts think it is wise to have a separate policy to avoid any hassles during hospitalization.
Let’s take the hypothetical case of Gupta, a 35-year-old employee with a renowned firm. Gupta faced a big predicament when his wife had to be hospitalized. He was asked to submit a copy of the health policy at the time of admission but realized that his group health plan had expired and his employer hadn’t renewed it. The employer told him that renewing a group health policy takes time and that he could seek reimbursement later on. Gupta was denied cashless facility and had to fall back on his savings for the hospital admission and other expenses.
Unlike Gupta, many people facing the same situation find themselves in dire straits because they do not have immediate access to cash. Thus, depending solely on corporate health policy plans can lead to problems. Here’s how an individual health policy helps address those gaps.
Necessity: If you decide to change your career, retire, or start your own business, you will not get corporate health plan coverage. And in case you or any of your family members are hospitalized, you can be exposed to massive medical bills. Hence, it is critical to buy an individual policy, regardless of your employment status.
Low sum insured: The sum insured—the primary component of any health insurance policy—is critical when selecting a policy. Amit Chhabra, head of health and travel insurance at Policybazaar.com, said, “The scope of coverage provided by corporate insurance can frequently fall short of adequately protecting you. The average sum insured can range between ₹1 lakh and ₹3 lakh. This is significantly low, especially given the spiralling medical inflation and intermittent covid waves.”
Limitations: Corporate group health plans frequently include a limit on either the sum insured or the extent of hospital room rent coverage. In a policy, these are known as sub-limits and co-payment clauses. While co-payment requires the policyholder to pay a portion of the total hospital bill, sub-limit clauses require the policyholder to pay a portion of the room rent. For instance, if your co-payment clause states that you must bear 20% of the hospital bill, you will end up paying ₹1 lakh if the bill is around ₹5 lakh.
Pooja Yadav, chief product officer of Edelweiss General Insurance, said, “Corporate health plans usually link the sum insured to the employee’s grade and may have elements of co-pay, exclusions, waiting period, room rent capping, etc. which restrict access to quality health care. Employers may choose to restrict cover for elderly parents or not cover them at all. Hence, having an individual health plan along with the corporate plan will act as a cushion if your medical emergency goes over the corporate plan limits.”