Providing a group health insurance policy for your employees is a significant decision. It demonstrates your commitment to their well-being and can be a major factor in attracting and retaining top talent.

However, with numerous options available, choosing the right policy can feel overwhelming. This guide will help you with all the knowledge to confidently select the ideal group health insurance policy for your workforce.

Let’s get started with the basics.

Understanding Your Workforce Needs

The first step to getting the best employee group insurance scheme is to gain a clear understanding of your employees' healthcare needs. Consider factors like:

Age Demographics

Younger employees might prioritise preventive care (e.g., vaccinations, annual check-ups) and mental health coverage, while older employees may require more comprehensive coverage for potential chronic conditions (e.g., diabetes, heart disease).

Family Coverage

The number of dependents significantly impacts plan costs. Explore offering tiered coverage options to cater to employee needs, such as employee-only, employee + spouse, and employee + family plans.

Industry-Specific Needs

Certain industries have higher health risks. Tailor the plan accordingly. For example, vision coverage should be included for employees who work extensively at computer screens, and physical therapy coverage should be included for employees in physically demanding jobs.

Key Considerations for Choosing a Group Health Insurance Policy

Once you understand your employees' needs, evaluate the various employees group insurance schemes based on the following key criteria:

1. Scope of Coverage

Hospitalisation

Look for a plan that covers in-patient hospital stays for accidents, illnesses, and surgeries. Ideally, the plan should cover a significant portion of the room and board charges with minimal limitations. Some plans may have daily or per-stay maximums for room rent.

Outpatient Care

A comprehensive plan should cover doctor visits for preventive care (annual check-ups) and treatment of illness or injury. It should also encompass diagnostic tests (X-rays, blood tests) needed for diagnosis. Look for coverage for other non-hospitalized medical services relevant to your workforce, such as physical therapy for musculoskeletal issues or specialist consultations for specific health concerns.

Maternity & Child Care

Ideally, the plan should include maternity coverage, encompassing prenatal care (doctor visits, ultrasounds), labour and delivery costs (including hospital stay and birthing centre options), and post-partum care (check-ups for both mother and baby). Consider plans that offer benefits for newborns, such as well-child visits for monitoring growth and development and immunisations to prevent childhood diseases.

Pre-Existing Conditions

Be wary of plans with long waiting periods for coverage of pre-existing conditions. Ideally, the plan should offer coverage for pre-existing conditions after a reasonable waiting period, if at all.

2. Network of Hospitals and Providers

Accessibility

The plan should have a wide network of hospitals and clinics conveniently located for your employees. This ensures they have access to quality care providers without excessive travel times or wait times for appointments.

Quality 

Look for a network that includes reputable hospitals with a good track record for patient care and experienced providers with strong qualifications. Consider accreditations and patient satisfaction ratings when evaluating the quality of the network.

3. Cost Sharing

Premiums

The monthly premium cost for the employer (group rate) and for employees (if applicable) will vary depending on the plan's features and deductible level. Consider offering different contribution structures to balance affordability for the company and employees. You might explore a fixed employer percentage contribution or tiered structures based on salary.

Deductibles

The deductible is the amount employees must pay out-of-pocket before the insurance kicks in for covered services. A higher deductible lowers the premium but can lead to higher upfront costs for employees. Choose a deductible level that balances affordability with adequate coverage.

Copays

Copays are fixed fees paid for certain services like doctor visits or prescriptions. Copays can encourage preventive care by lowering the out-of-pocket cost for routine check-ups. However, be mindful that high copays may create a barrier for some employees seeking necessary medical attention.

Out-of-pocket Maximums

This sets a limit on the amount an employee would have to pay out-of-pocket for covered services in a year. This helps employees budget for healthcare expenses and provides peace of mind, knowing there's a cap on their potential costs.

4. Claim Settlement Process

Efficiency

Look for plans with a user-friendly online claim submission process and clear instructions for filing claims. This minimises hassle for employees and ensures they receive timely reimbursements.

Transparency

Clearly outlined claim settlement procedures, readily available in writing and online, foster trust and reduce confusion for employees. The plan should provide details on what documentation is required for claims and estimated processing timelines.

Online Access

An online portal from the insurer empowers employees to manage their healthcare. They should be able to track claims, access benefits information (including coverage details and limitations), and download forms for filing claims or requesting pre-approvals.

5. Additional Features

Wellness Programs

These programs incentivise healthy habits and can reduce healthcare costs in the long term. Look for plans that offer wellness programs with features like gym membership discounts, smoking cessation programs, or health risk assessments.

Telemedicine

Telemedicine services allow employees to consult doctors remotely for minor illnesses or consultations. This saves time and money by eliminating the need for travel and in-person appointments for non-critical health concerns.

Employee Assistance Programs (EAPs)

EAPs support employees with mental health or personal challenges that can impact their well-being and productivity. Look for plans that offer EAPs to provide confidential counselling, resources, and referrals for employees dealing with issues like childcare, stress management, financial difficulties, or substance abuse.

Getting Employee Input and Communication

Involving your employees throughout the selection process demonstrates your commitment to their well-being and helps you choose a plan that aligns with their needs. Here are some effective ways to gather input:

Employee Surveys

Conduct anonymous surveys to understand their healthcare priorities and preferences. Ask questions about their preferred level of coverage (e.g., preventive care, hospitalisation, specialist access), budget considerations, and any specific concerns they might have. This allows you to tailor the plan selection process accordingly.

Benefits Fairs

Organise benefits fairs to present different plan options in a clear and concise manner. Have representatives from insurance companies available to answer employee questions in a face-to-face setting. This fosters a sense of transparency and allows for real-time feedback from your employees.

Open Communication

Maintain open communication channels with your employees throughout the process. Address their concerns about the new plan and provide clear explanations about plan features, costs, and enrollment procedures.

Also Read: 5 Important Things to Know About Group Employee Health Insurance Policy

Making the Final Decision

After careful consideration of all the factors, compare shortlisted plans based on their strengths and weaknesses. Weigh the plan's features against your budget and employee needs.

Remember, the ideal plan offers a balance of comprehensive coverage, affordability, and a user-friendly experience for both the employer and employees. Niva Bupa, a leading health insurance provider in India, offers a comprehensive suite of group health coverage plans designed to cater to the diverse needs of businesses and their employees.

Their extensive network of providers ensures convenient access to quality care, while their customisable plans cater to your budget and employee needs. With a focus on preventive care and technology-driven solutions for claims and information access, Niva Bupa prioritises both employee well-being and a streamlined experience. Plus, their dedicated customer support ensures you have a reliable partner throughout the entire process.