If you have got a good permanent job with a renowned employer, then you must have been offered, in your pay package, a considerably good medical insurance coverage, for you as well as your immediate family members. The company itself pays the premium for this policy, and there are cashless facilities and more or less satisfactory claim settlement history. But the question is, is the insurance coverage good enough?
Insurers Not Willing To Pay Up
A big drawback of the health insurance companies, and for that matter all sorts of insurers is that they do not want to pay up. They will try to find as many loopholes as possible in the policy document to stop the payment of the claimed amount. The terms and conditions and all the minute details are brought under microscopic verification before the hospital is paid and claims are settled. This is the case even with the normal or regular insurance policies. So, it is obvious that the case is worse for the group insurance plans offered by the employers to the staff.
Employers Providing Minimum Possible Coverage
Quite naturally, the employers try to minimize the amount of premium per employee that they have to cough up every month/year. So what they opt for is the bare minimum coverage that entails the minimum premium payment obligations. The real medical well – being of the employees do not always appear as priorities to them. They know that the words “offering insurance benefits” will be enough to attract and retain employees.
There are certain clauses in some insurance policies that limit the liabilities of the employer to a great extent. Some of them are discussed hereunder:
Room – Rent Limiting Clauses in Employer Health Benefit Schemes
This clause limits the rent of the hospital room that you are admitted into. The maximum amount that the policy covers is mentioned and most often it is observed that not even 50% of the total room rent payable is covered. There are also other cleverly hidden clauses like “only and solely the room rent” and nothing else that comes with the room like the nurses, doctors or any other extra facilities given are included.
Co – Pay Clauses in Employer Health Benefit Schemes
This is also a very cleverly hidden clause which stipulates that the employer pays not the whole amount but just partially, while the rest of the tab is picked up by the patient party. Thus what it boils down to is a part coverage of medical expenses and not a total removal of worries stemming from the health point of view. Such clauses, however, do not appear in the regular medical insurance schemes.
Other Reasons Why Employer Insurance Scheme is Not Enough
Apart from the clauses that the insurer inserts into the policy document to baffle the employees, there are other reasons as well that should make you reconsider your decision to depend only on the employer-provided health scheme:
● You get to get the benefits of the health insurance only as long as you remain in service with the employer. On the very moment that you resign or your employment is terminated, you stand uninsured. The time gap between jobs is a hard time by itself, and anybody getting hospitalized without a medical insurance coverage can be disastrous. This is also true for post – retirement days when you are out of insurance.
● The employer – provided health schemes do not cover all your dependent family members. However, in most of these policies, only the employee is covered. That way, the very significance of medical insurance is lost.
● The terms of employment do not guarantee the medical insurance as your right as an employee. It is a facility provided by the employer and can be stopped at any point in time. He has no legal obligations to keep you medically covered.
Hence, it is highly advisable that you must not depend on the medical insurance provided by your employer solely and get it supplemented with some good health insurance policy for yourself and your family members.
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