Why employer health insurance is not enough?

  • postauthorTripti Rai Tripti
  • postdateFebruary 7, 2024
  • postreadtime4 min read
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In 2020, the government made it mandatory for employers to provide medical insurance to employees. Between then and now, on one hand, employers across a range of industry types and sizes have doubled down their efforts to extend health insurance to their teams. Meanwhile, on the other hand, employees have started basing their job change decision on the best employer health insurance plans.  

Group health insurance has undoubtedly become extremely important in today’s day and age. Employees have started relying on it as the only mode of security of great health. But is it enough?  

Although corporates have upped their health insurance game, but are they enough for employees to ditch personal insurance. We say not. Employers still have a long way to go when it comes to offering a comprehensive employee benefits plan that takes care of employees’ end-to-end healthcare needs.  

In this article, we are going to look into the reasons why employer-sponsored health insurance is not enough. But before we do that, let us look at the perks of employer health insurance plans.  

The pros of employer health insurance plan  

  1. Waiting period
    The waiting period for health insurance in an individual plan setup can be anywhere between 2 and 4 years, depending on the pre-existing illnesses. However, in the case of corporate insurance, the employees get coverage right from the inception of the policy.  
  1. Pre-existing diseases
    In the corporate plans, there is hardly any list of diseases not covered under health insurance. This becomes a favorable situation for the employees who don’t have to enter into a waiting period clause to get claims for their pre-existing diseases.  
  1. Zero medical checkup
    The employer’s health insurance plan is issued without undergoing any pre-medical screening. In individual health plans, the coverage is dependent on age, pre-existing medical conditions, etc. This makes it a good option for the employees in the senior age bracket, as they get access to health benefits without any waiting period for the same coverage as other employees.  
  1. Premium is handled
    The premium part of the insurance is handled by the employer. Unless you upgrade your plan to one that answers: is there a health insurance that covers everything, your premium for a basic insurance plan will be handled by the employers.  

The perks make it seem like employer health insurance is the way to go. But there are some limitations that remain. Let us look into them in the next section.  

Reasons that highlight why employer health insurance is not enough 

Standardized sum insured  

A majority of the group policies come with limited sum insured, which is rarely sufficient to cover expensive medical treatments. Additionally, employer health insurance policy comes with a standardized sum insured for all the employees and their families – one that does not consider individual employee’s life stage, age, family history, medical history, etc.  

This, in turn, means that employees won’t get a plan that is based on their individual requirements, while also meaning that the list of what risks are not covered by health insurance policies runs fairly long.  

Dependent on active employment status  

The employer health insurance benefits are only valid till the employee is a part of the organization. So, if they go on a sabbatical or lose their job, they will be left unprotected with no health insurance.  

Limited dependents’ coverage 

A majority of employers offer health plans that can be extended to the spouse and children. The ones offering the health benefits to parents, siblings, and in-laws are next to none. This makes it extremely difficult for employees to manage the health and wellbeing of their parents, in-laws, and children through their salaries.  

In order to accommodate the family, the employees will have to buy individual plans with family coverage – something that cannot be availed with the employer insurance.  

No tax benefits  

The limit of tax deductions for health insurance has been increased to Rs. 25,000 by the Indian government. However, this deduction is something that can only be availed by employees who have individual health insurance.  

The employer health insurance plan, irrespective of how extensive doesn’t offer any tax benefits.  

Sudden changes in T&C  

The decision of which element to add to the group cover is entirely at the employer’s discretion. They can discontinue or modify the plan whenever they feel like it. The employers can change the terms and conditions of the plan by removing some coverages or including clauses which do not cover pre-existing diseases, they can even remove the dependents from the plan – all as per their business requirement and financial limitations. 

Limited customization options 

Employers tend to negotiate on every element of the group cover which includes critical illnesses, the addition of dependents, sum assured, etc. Directly with the insurer. This means that you have no control over the addition of critical illnesses and surgeries you are prone to, considering your family history in the group health insurance.  

If you are seeking flexible benefits like complete hospital admission, specific surgeries, and the illnesses that run in your family, your best bet would be to go with an individual plan.  

What if we told you there’s a solution to every limitation mentioned here? There is a plan which is not just affordable but also offers high flexibility, accommodates changes in terms and conditions without affecting the employee experience? 

This is where Onsurity comes in. We have created a one-stop plan having group health insurance with added benefits like discounted medicines, teleconsultations etc.
Reach out to us at partners@onsurity.com to know more about the plan offers.  

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