You are on a school picnic at an amusement park. You are not carrying lunch with you, as you were informed that your school will provide you with sandwiches. You think it will be enough, and since you were promised you didn’t give it a second thought to carrying something of your own, you do not carry any pocket money with you. But your hunger doesn’t go with the sandwiches served. If only you had carried some money along, you could have bought something for yourself to eat.

Have you ever heard the term “covering all fronts”, well while living in Pakistan and being middle-class individuals or professionals, we are constantly worried about even the smallest thing? We try to cover everything and anything that can be a sign of any pertaining worrisome thing. We tend to buy covers for anything we might feel that would provide us with a financial cushion and emotional peace.
Many companies are providing health benefits considering a number of benefits to retain employees, loyalty and increasing productivity. Keeping that in view many employers offer this benefit but sadly this benefit ends once an employee leaves the job and the workplace. One needs to have a sound health plan for its self and their families.

One question that many people have and it’s usually one of the things that matters the most is is it possible for an individual to have more than one health plan to cover the medical expenses that may arise.
When someone talks to us and tells us about investments and finances, we have our answers ready! We have done our research on what is best for us and how to select the right avenues, all done and prepared. But when it comes to choosing the best health insurance plans for family or yourself, to protect your savings and someone questions us on it, often our answer is “Why do I need one? My company covers and provides me with the needed of me and my family under their corporate health insurance policy.

Most of us can relate to this situation of having a corporate health insurance plan. And you might give it a thought on what’s wrong with it? Well, in principle, nothing. However, the essential question that remains unanswered is “Is it enough to cover your family’s health or do they need another health insurance policy?”. And that is exactly what we will be speaking about here in this article, in our simplification drive.
A corporate health insurance policy is definitely a great health benefit. Why? Simply because it offers a certain level of protection and coverage for you and your family, at the expense of your employer (happiness indeed ) and the company makes sure that this added benefit of an employer’s health insurance, will lead to better retention in the company and create loyalty.

But, the problem with depending on only a corporate health insurance plan.

Firstly, the business’s health insurance policy has a standardized Sum Insured for all employees and their families.
However, your needs and requirements might differ from the other workers. The right Sum Insured should ideally be based on your age, life stage, family arrangement, lifestyle, medical history, etc. Depending on your and your family’s requirements, a standard employer’s health insurance policy may not protect the employee completely when they actually need it.

Suppose, your Sum Insured is 2 lakhs and unfortunately, you face a sickness that necessitates hospitalization and the bill comes up to 3 lakhs. The extra 1 lakh after your employer health insurance claim to be paid, has to be borne by the employee if they don’t have an additional individual health insurance policy.

Now, you might have your savings to rely upon. But in case (God forbid), someone in your family suffers from a Life-threatening Illness and the treatment cost shoots up to more than 10 lakhs, can you still rely on your savings? And even if you can, exhausting all your savings leaves you money-wise unprotected for the future, esp. in a time which is otherwise also very mentally straining.

Secondly, an employer’s health insurance policy is applied and available till you are employed. When you leave your job or tend to switch it, the corporate health insurance cover ceases to exist immediately. So, the time when you are in between jobs or on a time off, you are basically without any health insurance policy. If anything ill-fated does happen during this period, you are left completely unprotected and vulnerable.

And the most imperative purpose is your family. Though some corporate health insurance policies cover your dependents in your plan but again that coverage which ranges from PKR2 lacs to PKR5 lacs is not enough. And given the healthcare conditions, coupled with inflation is 20% as compared to 8% overall, it is important to evaluate your health insurance protection.

So, what is the solution?

Simple, procure a personal health insurance plan parallels with the right Sum Insured that fits all your needs, so even if your corporate health insurance plan cannot cover your health expenses completely, you always have your individual health insurance policy to make an insurance claim with. And if 2 health insurance policies are becoming a pain to maintain, stick to your corporate health insurance plan and take a top-up plan on it. This way, even insurance claims needs that are over and above your corporate plan, are taken care of.

Note- In case you leave your job, the amount of coverage that was borne by your employer earlier will have to be paid from your pocket since you would lose the cushion of coverage provided by the employer.

Let us clarify this with an example

Suppose, Rasheed has corporate health insurance of PKR2 lakhs. He takes a personal health insurance plan of PKR5 lakhs, making the total Sum Insured as PKR7 lakhs. Now, he had to leave the job due to a particular reason and regrettably, has to be hospitalized for treatment, and the bill comes to PKR7 lakhs. As he also has his personal health insurance plan, at the time of claims, it will only come into action after the company pays the initial PKR2 lakhs. Given that the employer is no longer responsible for Rasheed’s health insurance claim, that amount will have to be paid by Rasheed himself, as an added amount that is above his personal health insurance coverage limit.

Can We Claim Health Insurance from Two Companies?

One reason to buy additional health insurance could be that one has availed of additional coverage over and above the group insurance offered by the company. Alternatively, that the employer might offer an old policy that means with limited coverages and to procure higher coverage one might choose a second insurance plan for better coverage. A third reason may be that an individual has two policies; one that covers your parents and the other covering their spouse and children.
The procurement of policies and coverage entirely depends on the need of the family, the number of family members and the kind of coverage desired (meaning the frills that you may need to get covered).

The process to make multiple claims

The important part is to know, understand and learn the steps involved to get the claim, if an individual understands the do’s and don’ts beforehand one can easily get the claim without further hassles and delays.
the Insurance Regulatory and Development body in Pakistan security exchange commission Pakistan has been making and proposing changes in the framework and regulations to serve people better.

The modifications have made the procedure easier and simpler. Now, if the claim amount is less than the sum assured, the insurance provider will provide the claim without any hick-ups or issues. However, for claims exceeding the sum assured, the insurance provider might add some terms and conditions but, you may choose the insurance company from whom you want to make the first claim.

1. Cashless claims

For such cashless claims, you make the claim from one insurance company and procure the settlement summary from that provider. On completion, you will need appropriate copies of all the bills. If the bills exceed the sum assured by one insurance provider an individual may then approach the second company for claiming compensation of the balance amount from the other provider.

2. Reimbursement claims

Cashless claims are appropriate because the insurance providers settle the hospital bills directly with the hospital. Nonetheless, there are some hospitals that do not follow such procedures means they might not be on the panel of the network hospitals of the insurance provider. In this situation, the individual needs to first pay the amount from their own pockets and then follow the HEALTH INSURANCE CLAIM PROCESS designed by the insurance provider for compensation. The policyholders need to submit all original documents (that are retained by the insurance provider) along with the claim application form.

Documents needed to make reimbursement claims

When you plan to make claims under multiple health insurance policies, the individual must intimate and initiate requests with all the insurance companies at the time of hospitalization. After this, the policyholder may choose the company from where they wish to make the first claim. Here is the list of original documents that must be attached with the claims form.

1. Bills and receipts
2. Discharge forms
3. Diagnostic tests
4. Prescriptions
5. Films and slides, if any required or undertaken at the time of diagnosis or treatment

When you make a HEALTH INSURANCE CLAIM, it is recommended you choose your employer’s insurer as the process will be quicker. It is important you procure multiple attested copies of the aforementioned documents from the hospital. The first company will provide a claim settlement summary, which must be submitted to the next insurer to file the claim for the balance amount.
There is always a possibility that your health insurance claim is denied (due to any reason). This may happen because the policyholder did not inform the insurance provider about existing policies at the time of buying the plan. Alternatively, the claim may exceed the amount assured as per each individual. Having adequate health coverage is fundamental as medical expenses are constantly rising. However, it is worthwhile to obtain higher coverage under a single plan instead of purchasing a smaller sum assured under multiple policies.

How to claim health insurance from your employer?

In Pakistan, amid the pandemic, many companies have given out suitable group health insurance policies for their personnel. While most companies cover employees under group health insurance, there are a few formalities and profiles to be completed before the insurance starts working. If not filled in time or in the approved manner, the employer may not pay the claim if and when needed. Hence, to make things easier, policyholders must follow these four steps before filing for a group health insurance claim.

1. Update the family’s profile: The first thing an employee should do after receiving their employee ID or confirmation letter is to update your family’s information on the company’s portal. According to a head- corporate business, of an insurance integrated platform, said, “You will not make claims if you have not entered the necessary information into the insurance portal. Prioritise this step.”
2. Get an E-card or Health insurance card: The employer will give you a third-party administrator (TPA) for instance TPL, Jubilee or IGI whoever insurance your employer procures. A card once your health insurance policy is issued. If you intend to use a cashless facility at a hospital, this card will come in handy. Also, remember to bring the employer’s E-card because if it is misplaced or forgotten the physical copy of your TPA card while in the hospital, one can always submit the e-card. It is also pertinent to mention that it is also a must to submit an ID proof in addition to the E-card.
3. Understand the benefits offered in the plan: Always read the policy document carefully and exhaustively when purchasing any policy, not just health, but the car, travel or life insurance. To avoid last-minute complications, one should first learn what is covered and what is not. “Corporate health insurance policies frequently include restrictions, such as the number of family members covered, different exclusions and room-rent limitations,” said HR Head of a reputed firm.
4. List of network hospitals: By and large, insurance companies have an agreement with a selected group of hospitals (the larger the better) to provide cashless services to their customers. These hospitals are referred to as on-panel network hospitals. While going through the policy document, make a list of these hospitals.

How to file a claim

The policyholder should try to get treatment in a network hospital of the insurance provider. At the same time, the policyholder family members should provide details of the health insurance policy and the policy card to the hospital.
An expert of corporate health insurance believes that “the Policyholder family should be well-versed in the provided employee’s healthcare policy. Keep them up to date on all of the lists that have been created and keep the policy documents in an easily accessible location.”
Usually what happens is once you get discharged from a network hospital, all expenses related to medical bills are sent to the insurance provider by the hospital. The insurance provider then evaluates the costs and gets the claim settled with the due course of action.
A corporate health expert said, “In the case of company insurance, the employee should inform the dedicated department of the organization who can help in the claim process, approval and settlement altogether.”

4 Reasons Why the Health Insurance Claim could be rejected

Many of us have the habit of not paying attention to the fine print of a health insurance policy. This mostly happens due to a lack of seriousness and awareness of the consequences. The carelessness towards health insurance can be one of the main reasons the claim is rejected. This might sound less severe for those who don’t really understand the gravity of the situation. However, the people, whose claims have been denied, would find the experience quite exhaustive and retributive.
So, it is fundamental to know the reasons for which a claim can be overruled. At the same time, it is also important to understand the precautionary measures one needs to undertake. There is a popular saying that “prevention is better than cure”. Similarly, in the insurance segment, it is better to avoid rejection than taking corrective measures later on.

An insurance company can divert your claim after rejection, provided that the policyholder is able to convince the insurance provider that the claim initiated is genuine. However, the policyholder first needs to know why it was forbidden and then take corrective measures. There are many reasons for denying your claim. These could be due to getting admitted to a non-network hospital, ignoring exclusions and putting forward them to the insurance providers, etc. So, let us elaborate on the 4 reasons because of which your claim can be rejected.

1. Going beyond the Sum Insured
Have you heard about a thing called Sum Insured? When you decide on a health insurance policy or a personal accident policy, there is a pre-determined “sum-insured” involved whether it is a family floater or an individual health cover. Depending upon the chosen plan and the required monetary coverage, the sum insured is the amount available to the policyholder and their family on annual basis. Presuming that you have consumed the entire sum for a particular year, the successive cashless claims will get rejected. However, if a part of your sum assured is still integral, the insurance provider might provide the policyholder with reimbursement at a later stage.

2. Ignoring the exclusions
There are several diseases, illnesses and sicknesses for which coverage is not there in most of the health insurance plans. These are specifically and explicitly mentioned in the policies as being ‘not covered’. These are fundamentally diseases for which you can’t file a claim and are generally referred to as exclusions of the policy. However, if certain plans or policies provide coverage for any such disease, then a waiting period will be there for the same. So, if you file a cashless claim for one such disease/medical condition that is excluded, then rejection is understandable.

3. Suppression, misrepresentation of facts
Some common causes for claims being overruled are non-disclosures, partial disclosures and wrong disclosures of significant and essential details such as age, nature of occupation, income, current insurance plans, major ailments or pre-existing medical conditions. Coverage is provided on the basis of the data given by the nominator on the proposal form, so any inconsistency between the declaration and the reality during the time of filing claims can easily lead to the refusal of the claim. The only solution to this problem is to be quick and precise while filling forms.

4. Exceeding the time limit
In a health insurance policy, the individuals are required to apply for compensation within a certain time frame. As for emergency admission, the time allotted is 24 hours after the patient has been admitted, and in other cases, it can change according to the type of policy the policyholder has opted for and the treatment being availed by the policyholder. If the policyholder doesn’t apply within the time indicated, the claim can be rejected.

So, if you take our advice, don’t just depend on your corporate health insurance plan. The wise thing to do is to take a personal health insurance plan so that you are never under-insured or left without health insurance.

After all, this is about the most important aspect of life: your well-being.

It can be easily established that in order to avoid cashless claim rejection, one should possess a good understanding of your health insurance policy, ideally from the time when making the purchase. Then, you need to compare health insurance plans online to understand what is on offer, comparing with what you need and then choose a policy that best meets your requirements. It is also appropriate to maintain a record of all your documents.pre and post hospitalization expenses, hospitalization records, diagnostic tests, discharge summary, investigation reports, etc. These documents can be extremely vital if your insurer needs clarifications.

Khurram Zahid

The post Is depending on a group health insurance policy good enough? appeared first on Smartchoice.pk.

How to Design an Employee Benefits Programme

Handling employee benefits is an important and costly effort for employers. Though most employers are required to provide mandatory benefits which are rewarding for their organizations, worker’s compensation insurance and other fixed ones, mostly other benefits are voluntary in nature and determined by the company.
Benefits programs by an organization vary greatly, but typically they include health insurance, life and disability insurance, retirement income plan benefits, paid-time-off benefits, and educational assistance programs. Benefits selection to be offered to employees and design are critical components in the total compensation costs.
In some cases, benefits offered to employees account for 40 per cent or more of total compensation costs. Due to the employer cost investment and the importance of employee benefits in employing and retaining, companies should have a well-thought-out benefits plan design that meets both the worker’s needs and employer objectives.

Step 1: Identify the Organization’s Benefits Objectives and Budget

An important and first step in designing an employee benefits program is to identify its objectives. This identification will provide overall guidance in instituting the selection and design of the benefits program. Generally, this practice does not result in a list of specific benefits offered but rather provides an overview of the administration’s objectives of offering benefits that reflect and reciprocate both the employer and employee needs.
The organization’s business and/or HR approach will help guide the development of the benefits objectives, as these goals should help achieve the overall strategic goals. Factors such as company size, location, industry and collective bargaining agreements should be always considered in the development of the benefits objectives. Some companies choose to have general benefits objectives, whereas others integrate the objectives in their total compensation philosophy of the organization. The benefits objectives are not stationary and should be assessed and revised to reflect the current company strategy and employee needs.
Sample objective: To establish and maintain competitive employee benefits health insurance benefits based on employees’ needs for paid time off and protection against the risks of old age, loss of health and loss of life.

Equally important is determining the budget available for spending on benefits, as most employers have price constraints in offering benefits to employees. If a current benefits plan exists, organizations should analyze current welfares costs and projected costs and create a reasonable spreadsheet outlining annual benefits costs. The rising cost of offering benefits such as health insurance will greatly affect an employer’s benefits.
If no current benefits program is being offered to the employee, the company may need to obtain quotes for a few key benefits to estimate a welfares budget. HR with sound understanding may be helpful in this process.

Step 2: Conduct a Needs Assessment

A needs/requirements assessment should be piloted to determine the best welfares selection and design based on the needs and requirements of the employees. The needs assessment may include a company’s perception of employee benefits needs, competitor’s welfares practices, and tax laws and regulations. But a more current trend is to take a market research approach to employee benefits planning.
The Common market research techniques include a member of staff inquiries in the form of personal interviews, simplified questionnaires or sophisticated research methods. Even though employee feedback will most likely result in higher employee motivation and satisfaction with the welfares offerings, this is true only to the level that the employer is committed to using the feedback in benefits selection and design.
If a current benefits plan exists, the employer may also conduct a utilization review of each plan to determine actual employee use. Knowing the frequency a particular benefit is used and to what extent may help the employer determine cost-saving design practices. For insurance plans such as a medical plan, the carrier will often provide a utilization review for the employer.
Organizations should analyze the existing workforce demographic that is the assessment based on their age, gender and pace they are coming from to assist in determining the needs of various categories of employees. Younger workers may value paid time off more, whereas older workers may place a higher value on retirement income plans.

Managers can analyze and assess the needs assessment results and compare them with any existing benefits/perks and against available benefits to prioritize which benefits will be most helpful in achieving the objectives of the benefits being offered for the organization.
The company will also need to consider and foresee any legal requirements regarding benefits offerings. Some companies may have obligations to offer benefits by law, such as any rule or any obligation mentioned by SECP that needs to be fulfilled by the companies. Employers will need to determine if they are covered by this action and the impact this will have on the decisions and design of member of staff health insurance plans.
Paid sick leave is another benefit that is quickly becoming an obligatory offering for many companies. State and local laws even if they don’t require employers to offer paid sick leave to employees, yet the employers provide these benefits to ensure that the employee is comfortable and does not feel exploited, hence offering paid leave also assures more productivity.

Step 3: Formulate a Benefits Plan Program

Once the needs assessment and gap analysis are complete, the employer will need to formulate the new health insurance policy. Using the data collected from all resources in Step 2, the employer can begin to articulate benefits offerings in order of priority. Then the company will need to determine the cost of providing the prioritized benefits and evaluate it against the benefits budget existing within the company.
This step is complex and compound and the employers may need to consider many factors:
1. Can change be made to the current plan design to induce cost savings?
2. Can perks that are underused or not valued by employees be removed and something more attractive is added?
3. What are the administrative expenses incurred for the benefits?
4. What cost-containment features can be put in place?
5. Will employees have to contribute, from their monthly salary and how much?
These are the certain aspects the managers would keep under evaluation when determining whether to add, change or eliminate benefits offerings.

Step 4: Communicate the Benefits Plan to Employees

In this era of inclusivity, it is important to take all stakeholders in an organization when making a decision, if more than one party involved is going to benefit, be affected or have an influence over the process of decision making.
In today’s world communication is very important and designing the right communication strategy is a critical element to the perks being offered to the employees planning and management.
Employee understanding of the benefits is critical and significant to employee buy-in. Without buy-in, the manager’s efforts, no matter how perfectly designed to meet employees’ needs, may be ineffective and futile. If employee input was obtained in designing the perks programme and used in the benefits design process, employers should be sure to share this with their staff and let them know how their feedback influenced the overall designing of the perks and benefits.
The positive impact on hiring, retention and employee morale may be lost without effective communication plans. Although the company is obliged to provide communications to comply with laws regarding disclosure of various benefits policies and plans, such as a plan description and summary, the communications with the staff should go beyond the legal requirements. Good health and other benefits communication objectives should include:
1. Creating awareness and appreciation of the new or existing benefits and improving employee financial security and providing them with mental peace knowing that their health is covered for any unforeseen situation.
2. Providing a high level of understanding of the benefits offered and a systematic way to avail those benefits.
3. Encouraging wise use of benefits.

Step 5: Develop a Periodic Evaluation Process to Determine Effectiveness of Benefits

Periodically reviewing the benefits and the health insurance policy provided is another important step in the benefits management process. The benefits provided to the staff must be assessed regularly to determine if it is meeting the organization’s objectives and employees’ needs.
Changes in the business climate, the economy, the monitoring environment and workforce demographics all create dynamic forces that affect benefits that are being offered. Employers should consider developing goals and parameters to assess the benefits’ effectiveness and make adjustments as necessary. Companies may also consider using external or international trends and benchmarking data to evaluate the effectiveness of the health insurance policy and other benefits provided or conduct employee surveys or a full-fledge needs assessment repeatedly.

Group Health Insurance –FAQs

Q1: What is Group Health Insurance?
Group Health Insurance is can be understood as outsourcing of the medical facility of the employees and their immediate dependents by the Company to the Insurance Company. It is universally recognized as the best way to safeguard an employee’s interest in the occurrence of loss by illness or bodily injury.

Q2: Why Group Health Insurance?
Group health insurance has multiple benefits that can help an organization in the longer run
1. Attracting and retaining employees
2. The plans are Affordable and help
3. Convenience Flexibility ( in case of cashless hospitalization)
4. Easy fits with Company’s budget
5. Tax advantage for the organization of tax-free claim amounts

Q3: What is covered in Hospitalization & Related (H&R) Benefits?
The benefits which are offered by the organization under H&R includes:
1. Hospital Stay
2. Doctor visits Pre and Post stay Surgery
3. Specialized Diagnostic Test Inpatient Treatments
4. Emergency Accidental Treatment. Pre-Hospitalization
5. Post-Hospitalization Per day room limits
6. Medications required for in-patient care

Q4: What is covered in Maternity Benefits?
Provision of the maternity coverage lies within the sole discretion of the company, the company has the full right to decide on it and the decision is made based on the cost and customization of the plan.
If the company plans to offer maternity coverage the limit given for each female spouse and female married employee under Maternity benefits which includes:
1. Prenatal treatment Childbirth
2. Postnatal treatment Complicated Delivery

Q5: What is covered in OPD?
OPD is again a benefit whose provision depends on the employer, not every organization offers OPD benefit and almost all organizations in Pakistan have a definite cap to OPD consultations. The reason for the cap is that it’s a confirmed expense. An annual limit is given for insured under OPD benefits includes:
Consultations
Medicines
Diagnostic Tests

Q6: What is the eligibility of Employees & Spouses?
The eligibility criteria are usually set by the insurance provider and employer together minimum eligibility age is 18 years Maximum eligibility age of Entry is 59 years maximum eligibility age of Expiry is 65 years.
Spouse age for maternity coverage is from 18 to 45 years

Q7: What is the eligibility of Dependents?
The plan offered by organizations varies from employer to employer maximum eligibility age of Entry is 18 years for the children generally rest of the terms and conditions apply.

Q8: What is the minimum number of Lives to acquire a Group Health Insurance Policy?
There must be at least 05 people in an organization to obtain a Group Health Insurance Policy. This can further be discussed with the insurance provider when opting for a plan.

Q9: What is the step to be followed by group health Insurance plans?
When planning to get insured all these things need to be followed in sequence
Step 1: Submission of complete data which includes ages, designations and benefits to be offered to employees.
Step 2: Submission of Proposal citing Premium which is based on age band rates applied on the provided data of the company according to the required benefits.
Step 3: Send acceptance along with the payment of the premium to the insurance provider.
Step 4: Issue Healthcare Identification (HCI) cards and Policy Document.

Q10: Which hospitals are on the panel?
The hospital panel list varies from insurance provider to insurance provider. If you buy group health insurance from an A++ or AA++ reputed insurance provider you will be provided with almost all trusted and desired hospitals on the panel.
For further information on the exact panellist, please refer Preferred Panel Hospital List from the insurance provider.

Q11: How can employees use our HCI card?
For emergency hospitalizations in case of accidents or emergencies, Cardholders may present an insurance provider HCI card to get admitted to a PPN hospital. In case of a Non-Emergency Treatment from PPN Hospital, the Cardholder should seek a Credit letter from the insurance provider in most cases. Terms and conditions applied.

Q12: How do organizations determine who should get a Group Health Plan?
The organizations need to set their goals and priorities of which benefit do they intend to provide to the employees and the ratio of investment versus the returns of that benefit. Many organizations provide the health benefit considering it a basic benefit having a positive impact on the overall organizational goals.

Q13: Whom can organizations enrol under their corporate health policy?
Organizations when providing health insurance can include, the employee their spouse up to the age of 59 years and a maximum of 4 dependent children above 90 days old, in your policy. Once enrolled, the coverage can be continued up to the age of 60 years.

Q14: How does the Group Health Plan work?
The group health plans extents to employees, spouses and children, the parents of the employee are not covered under the health plan provided by the organization. There is a definite limit set by the employer which needs to be met and if over exceeded the Health Insurance Policy would cover only up to for instance Rs.100,000/-, while the remaining amount of Rs.150,000/- would have to be borne by the employee himself.
The maximum amount that can be claimed under the policy during a policy year will be limited to the Annual Family Limit selected by the employer.

Q15: What is the General Waiting Period?
In the first policy year, coverage would be effective after thirty days once the policy has been issued and has been delivered to the main Insured Member, except for Accidental Emergencies which will be covered from the date of the purchase of the policy.

Q16: Is there a waiting period to incorporate health plans like Individual or family health plans?
Unlike the general health plans for individuals and families, there is no waiting period required when you purchase a “Group Health Insurance Plan.” The plan or the coverage starts from the date of purchase of the policy.

Q17: What are the advantages of a Network Hospital?
Reputable insurance providers have developed a network of over 200 plus carefully selected hospitals nationwide. You can download a complete list of Network Hospitals from their respective websites or can inquire about them by calling on their customer service helpline.
In the event of hospitalisation, you can choose any of the Network Hospitals for your treatment without having to pay out of pocket. You can avail of the credit facility by a simple pre-authorization procedure and the insurance provider will settle the bill directly to the hospital, as per your entitlement.

Q18: Can I be treated at a Non-Network Hospital?
Yes! But the immediate treatment expenses will be borne by you. The insurance provider will reimburse these expenditures on submission of the original bills, subject to equitable charges that would have been sustained at a comparable network hospital for a similar treatment.

Q19: Are pre-existing medical conditions covered?
The pre-existing medical condition means any sickness, disease or injury or any symptom related to such sickness, disease or injury which has been diagnosed, treated or is under treatment or has been known, even if no medical advice or treatment was sought, before the effective date of this insurance.
Pre-existing conditions, if any, must be disclosed by the insured member at the time of enrolment in the general health insurance plans but in the group health insurance plans, it is decided by the employer to offer pre-existing medical coverage or not. Usually, the treatments required due to pre-existing conditions are covered under the group health insurance policy.

Q20: Is there any exclusion?
Expense arising from or related to Pre-existing conditions, Pregnancy and Childbirth, Outpatient treatment, war, invasion, civil unrest, infertility, cosmetic treatment, routine medical check-up etc provision of the coverage depends on the plan chosen by the employer. Dental and suicidal tendencies are not provided coverage for in almost all corporate health insurance plans.

Q21: Are there any in-admissible conditions?
The policy may and may not be available to people suffering from Cancer, Diabetes or HIV/AIDS depending on the coverage provided and procured by the organization.

Q22: Will I be insured after leaving the organization?
Usually, the employee is not covered after leaving the organization and is immediately deleted by the employer providing the health coverage.

Q23: In how many days will I receive the policy documents?
Your policy documents along with your Health card will be dispatched to you within the max of 30 working days once the account has been debited. One thing to note is that the policy becomes effective once the premium is paid by the organization and acknowledged by the policy provider.

Q24: What is the procedure in case an organization wants to cancel Group Health Plan?
Once it purchases the corporate, the organisation cannot cancel or even make any changes once the premium is paid. The changes required or if the organization aims to cancel the plan can only be done after one year of the plan purchased. It is advised that whenever buying health insurance employees they need to be sure of the plan the organization is opting for.

Q25: is the insurance provider available on the market?
There are multiple renowned and trustworthy group health insurance providers, like Jubilee Life, EFU Allianz Adamjee Life, IGI – Life Vitality, TPL Insurance, Pak-Qatar Takaful, Salam Takalful these are someone the renowned underwriters of this Policy. These are the specialised Health Insurance companies in Pakistan.

Q26: How to get the best Group Health Insurance Plan for the organization?
There are multiple ways to procure the best health insurance plan for your organization. The plans= can be bought directly from the insurance provider or any of your trusted agents who can provide you with the best deal and plans with the best customization that fulfils the needs and requirements of the organization buying health insurance for its employees.
There is a benefits column in the policy document, the organization should properly read and it should be understood by the employers when procuring the health insurance for instance
1. They should see coverage till which age is available means minimum and maximum age to buy insurance
2. They are getting pre-existing or emergency coverage or not
3. If the organization is procuring maternity benefits what would be the terms and conditions associated with it and what would be the maternity limit?
In addition to this, when procuring the health insurance plan, the organization can definitely choose to pay online for any of the desired plans purchased for their organizations.

Q27: What is the procedure to add or delete an employee?
An email has to be sent to add or delete to the insurance provider or the point of account of the insurance provider, mentioning the policy effective date. Deletion of the employee can be done immediately and addition takes 3 to 5 working days.

Pro-rate basis: the addition and deletion of an employee are done on the pro-rate basis for instance if one employee health is 12k if the employee leaves after 6 months after the date of purchase of the insurance policy the balance is given to the client organization at the time of renewal. Same if the addition of the employee, if insurance is balanced at the time of renewal or the end of the policy term.
In maternity situations, the plan procured with maternity, no addition or deletion of an employee affects the premiums paid for. It’s the cost on which a pro-rate basis is inapplicable. Addition or deletion is only a health premium not in the case of maternity premium.

Conclusion

We hope that the information provided in the blog would be helpful and after this blog, you stand better educated on the terms and information related to corporate health insurance plans, the nitty-gritty of it and the ways to means to maximum utilization of the plan.

Khurram Zahid

The post Steps to Design Group Health Insurance and Important FAQs! appeared first on Smartchoice.pk.

Buying insurance for the business, big or small (group coverage) has different rules and procedures than buying just for yourself or your family (individual coverage).

In the comprehensive guide corporate insurance guide for 2021 for corporate health insurance below, we have outlined group/corporate coverage basics.

What Is Group Coverage?

Group medical coverage refers to a single policy issued to a group (typically a business with employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and their immediate dependents.

Individual medical/health coverage, on the other hand, is a single policy issued to a single person or family.

The rules are quite different for group coverage versus individual coverage, in large part because the insurance provider’s risk is calculated differently. With individual coverage, the insurance providers historically based their premium rates (or denies coverage) on the detailed medical history of the person or family.

With groups such as small businesses, the insurance provider determines a premium price based on risk dynamics balanced over the entire group being insured, using general information on members of the group, such as age or gender. Insurance providers are required by law to offer coverage to small groups and cannot deny the said requirement of any organization.

Is corporate health Insurance Required?

While there is no law requiring small business owners to provide health insurance but small business owners should be aware of when deciding whether to purchase insurance for their employees. If a small business owner does choose to offer coverage, some regulations are needed to be followed the most important of which we explain in this article.

Though large companies and corporations may face consequences if they do not offer coverage if small businesses with fewer than 50 full-time-equivalent employees will not be penalized if they do not provide coverage. If you have at least 50 full-time-equivalent employees but none receive an individual premium tax credit or cost-sharing reductions (both based on income), there’s no penalty whether or not you offer health insurance.

What makes your Business Eligible for Group Coverage?

Small employers can procure group coverage should they choose to purchase it, regardless of the employees’ health status. A “small employer” is defined as a business with 2 to 50 full-time workers. Owners are also generally counted as employees, so sole proprietorships with one employee usually fall into this group, as do partnerships without any employees (by definition partnerships have two or more partners). It is also defined as the self-employed as “groups of one” and require insurance provider to guarantee to issue them coverage in the small group insurance.

Who Is Eligible for Coverage?

The general rule is that if an employer offers group health coverage to any full-time employees, the company must offer coverage to all full-time employees. The company has the option to offer coverage to part-time employees (which can be defined as those working fewer than 30 hours per week). If the company offers coverage to any part-time employees, all of them must be offered health insurance coverage. These guidelines apply regardless of the medical condition of the employees. In other words, any suitable employee can’t be denied coverage based on previous medical complications, known as “preexisting condition”.

In addition, any dependents of entitled employees are generally entitled to the health insurance coverage under a group plan procured by the organization. Dependents include spouses, children, and in some cases if the organization allows parents of the employees. Dependents cannot enrol for coverage unless the employee has been enrolled in the health insurance plan.

What Do Employers Have to Pay?

Some companies who choose to offer health insurance coverage choose to pay the full premium, while others require staff to pay a portion. When considering what portion of the premium to pay, employers should be aware businesses can avail tax credits to help balance the cost of health insurance.

Corporate Health Insurance

A corporate health insurance plan is a type of coverage that covers groups in professional organizations from various risks and uncertainties such as employees’ health, accidents, financial losses, and more. Group health insurance is synonymous with corporate health insurance. Corporate medical insurance is becoming prevalent and customary in Pakistan as more and more companies are providing health benefit covers for the well-being of their employees and workers.

What Are The Benefits Of Corporate Health Insurance Policies?

Added Health Coverage
Incorporate medical insurance plans, employees can choose to opt for additional family health or individual health insurance plans. This provides them with added insurance cover if the employer provides the desired option to enhance the coverage umbrella.

Pre-Existing Disease Cover
Some organizations may provide their staff with health insurance coverage for a pre-existing medical condition. These covers and benefits are available for the employees from the very first day and some companies offer insurance even to employees suffering from chronic ailments such as diabetes, hypertension, and other chronic diseases.

Maternity Coverage
Many companies provide high maternity health insurance coverage to take care of their female staff and the dependents of male employees. The plan procured by the organization also covers childbirth expenses under these benefits. Moreover, many businesses also include/ add newborn babies under the group health insurance plan without undertaking any waiting period.

Job Satisfaction
Providing corporate medical health insurance policies shows the employees that the company cares for their health and well-being. This leads to greater job satisfaction, comforts employees, makes them feel valued and content working in the organization. This benefit leads to overall better employee performance and decreases employee turnover as well.

Support in Times of Sudden Medical Emergencies
Corporate health insurance policies provide much-needed financial assistance in times of need. If a worker or his/her dependent relative come across a sudden medical emergency, then the organization’s health insurance benefit safeguards that they do not have to compromise on the quality of medical treatment that is required for the employee or its dependents.

Attracting Good Employees
A corporate health insurance policy is a great perk and benefit for any individual seeking a job in an organization. Having good health insurance coverage for employees and their families helps in finding and retaining good employees/workers.

Performance and Morale-Boosting
When an organization provides concrete corporate health insurance coverage to its employees, it offers them peace of mind and increases their morale, which, in turn, benefits their organizational overall performance.

How Are Corporate Health Insurance Policies Different From Regular Plans?

Corporate health insurance coverage is not the same as regular health insurance plans as they are provided to employees and their dependents by the company as opposed to the individual buying it for himself/herself. Moreover, the waiting period under health insurance plans, which are generally prolonged durations of one month usually, a condition placed by the insurance provider is waived off under corporate health insurance policy. Under these plans, medical examinations are skipped as well. The premiums are significantly smaller in amount than the regular individual or family health insurance policy. This is because of the larger number of employees insured. Leading to a simple formula of “economies of scale”.

Before joining any business, it is important to look into the corporate health insurance policy and coverage offered. An organization may have a custom-made plan for their workers or may adopt from the plans offered by the insurers. Have a look at the necessary policy documentation before getting yourself enrolled in one such corporate health insurance policy. Make sure you do a good amount of research before buying any health insurance coverage. Our health insurance comprehensive guide for 2021 and 2022 has all the information related to, types of health insurance policies, the status of chronic health-related problems, premiums etc. Be well informed and make the right choice to secure yourself and your family future.

What does this mean for small companies?

In a post-COVID world and after the world has seen the importance of health and the expenses if and when required related to it, as the job market rebounds, companies looking to recruit and retain top talent can expect a quality health benefit to be top of mind for candidates applying for the job and working at the organization.
Health benefits are an essential tool in recruiting and retention, but due to rising costs, less than half of small companies can offer them. Even among those that do, the majority of them offer employee’s just one policy choice.
2. Fortunately, small employers have options in 2021 in Pakistan. A stabilized individual health insurance market and an innovative commercial health insurance sector have produced several viable health insurance options small employers can use to win the war for talent.
Of course, in this article, we’ll cover what all of this means more as we go over health reimbursement arrangements (HRAs) to provide full and in-depth information.
• Eligibility requirements
• Pros and cons
• Budget guidelines
• First steps for implementation
We’ll also deliberate how to react to the best decision for your business, including considerations you should make when evaluating your options. We will also take a look at the future of health benefits for small employers, what you might see going forward, and how you can ensure you’re positioned for a safe pocket.

Pros

• It’s tax-free
The organizations can deduct 100 per cent of group health insurance premiums, and employee’s share of the premium can be paid with pretax money and save big.

• Small employers can get a tax credit
According to the laws and regulatory bodies, small business health care can avail the tax credit option available to the companies with a group policy purchased, and pay at least half of the health insurance premiums for their workers. The tax credit is usually worth up to 50 per cent of the costs that organizations pay for employees’ premiums.

• It’s easily obtainable online or through a health insurance facilitator
Small employers can purchase a policy directly from a health insurance company or keeping themselves one step ahead they can compare and buy from health insurance facilitators with minimal effort.

• Most employees are familiar with it
Because employees often associate health benefits with group health insurance, offering a group policy requires minimal hand-holding or small employers’ facilitation.

Cons

• It can be expensive
Many companies can’t afford a group health insurance policy. Group health insurance has roughly increased in cost over the past few years, keeping in view the customization and benefits undertaken by the organization and there’s no indication those cost increases will slow down. By 2025, group health insurance penetration is expected to increase double the fold keeping in view the present scenario but that would also indicate that there would be a surge in the prices as well which the companies need to understand and deliberate upon.

• It’s complex
Ongoing regulatory changes and the lengthy annual renewal process leech away time that most small employers don’t have. Usually, they must also play the facilitator, negotiating between employees and the insurance provider.

• It’s one-size-fits-all
Personnel of small organizations are often in varied situations, but with group health insurance, the company typically chooses just one policy to satisfy everyone. This inevitably causes dissatisfaction among some employees. It is the issue that one thing desired by one may not be ideal for another, but while corporate health insurance policy, an organization needs to be extra vigilant and careful.

• Minimum participation requirements can be difficult to meet
With an unpredictable economy in this Post- Covid19 situation and many employees who choose to use their spouse’s plan instead, small companies often struggle to meet these minimum participation inceptions to qualify and sustain the cost incurred for group health insurance.

• Employees who have other health care solutions don’t get a benefit
Employees who choose not to participate in the organization’s policy, whether because they’re enrolled through a family member’s plan or because they’re using an alternative. It is presumed that with no concrete benefits except health insurance which they are unable to make most of it and nothing more to gain outside of salary, they’re more likely to leave the organization or might be on the constant lookout for opportunities.

• Would the employees who live in different states may not get a benefit?

While living in Pakistan, rest assured that employers can purchase a health insurance policy that has a national coverage policy, these policies are both easy to use and provide a huge coverage area. Companies procuring corporate health insurance can do so without leaving out any employee from any part of Pakistan. This may be one of the unique selling points for the organization to retain and recruit top talent.

How can I choose the best health benefit for my organization?

Choosing between these five health benefits options can be difficult.
In this section, we’ll walk you through the most important questions you should ask when weighing each option, including:

1. Based on eligibility criteria, which options can my organization offer?
2. What is my organization willing and able to spend on health benefits?
3. Which employees do I want to include in the benefit
4. How much time do I have to administer the benefit?
5. What are employees’ current insurance statuses?
6. What do my employees prefer?
7. Should I give maternity benefits?
8. Would OPD’s be an attractive feature for the employees?

Let’s dive in.

Based on eligibility criteria, which options can my organization offer?

The first step is to use eligibility criteria to weed out all options your organization can’t offer. For example, if you have just one full-time employee, you can’t offer group health insurance, in Pakistan, you can buy group health insurance for as low as 10 employees in your organization.
Once you’ve narrowed down your list, you can proceed to the next question.

What’s my organization willing and able to spend on health benefits?

For most small companies, the cost is the single biggest factor in their health benefits decisions. If this is the case for your organization, you can use cost to help narrow your options down further. First, determine how much you are willing and able to spend on health benefits. In general, you should aim to spend as much as you can afford on health benefits; next to salaries, they’re the top influencer on where people work.
Once you’ve calculated this figure, compare it to the estimated cost of each health benefit option your organization is eligible for. You should research estimates for your geographic area and industry to get a more accurate projection.

After comparing these projections to your budget, you may be able to eliminate some options. Many small employers can’t afford traditional group or self-funded health insurance, for example. Some companies may offer group health insurance to their employees on hospitalization but it may not offer the frill benefits of OPD’s and maternity since they increase the health insurance plans cost many folds for an organization.

How much time do I have to administer the benefit?

Another consideration is how much time you have or a designated employee has to administer health benefits. Small employers and employees wear many hats, so their time is limited. Some health benefit options require more administration time than others. Self-funded health insurance typically requires the most time, followed by a group health policy and since you have to manage a group plan and an HRA. You need a policy that is very much less time-intensive.
If you don’t have a lot of time to administer health benefits, consider one of the last three options listed above.

What are employees’ current insurance statuses?

Beyond business considerations, companies should also evaluate each benefit option from the workers’ perspective. The first step is to consider their current insurance status and determine how the company can provide value from the benefit.
Organizations need to understand that all workers are valuable to the organization, companies should narrow the list of options to those that will best serve them, their interest and their employees. In general, a company aim should be to provide the employees with the best value regardless of their situation even if some compensations are subject to income tax.

What do usually employees prefer?

Every organization should consider their employees’ preferences on health benefits they need and want. The employees are more likely to use benefits that deliver on what they want, which ultimately helps the company accomplish the goal of hiring and keeping them for a longer run.

Employees generally evaluate and assess health benefits by three standards:

• How much the benefit will cost them or be useful to them?
• How the benefit will integrate with their individual health care preferences
• How familiar they are with the benefit and the actual usefulness of Benefit-cost affects employees with most health benefits options, but it’s especially true with h group and self-bought health insurance. Corporate health insurance offered by the organization in contrast, don’t involve employee contributions at all, though low allowance amounts typically require employees to shoulder more out-of-pocket costs.

Employees also want to know how your benefit will integrate with their individual health care preferences. Will your group health insurance policy cover their doctor, for example? Or provide coverage for mental health services? The provision of the right information is typically the best way to ensure employees can use their benefit to cover the health care they value get the most out of the offered benefit and utilize them. Finally, employees gravitate toward benefits that are familiar to them. This generally favors group health insurance over newer offerings.

Making the final decision

Employers must balance each of these contemplations to arrive at the best health insurance policy decision for their organization and workers. Although each organization is different, group health insurance is typically the least disruptive value offering. If the organization can afford it and the majority of employees would receive significant value from it, group health may be the best choice.

This is not the case for many small employers, though. Rising costs and increased administrative complexity have put group health insurance out of reach. What’s more and ineffective is that these benefits often fail to meet the needs of an increasingly diverse set of employees.

In this case, comparing the quotes from multiple providers and buying insurance is almost always the best choice for small employers. There are no minimum contribution requirements, no arguing with health insurance providers, and no decisions that benefit some employees but not others. And rather than forcing employers to select and sponsor a limited number of programs an organization to give its employees tax-free money to spend on the health care services they find most valuable.

Any new benefit has already helped thousands of small employers offer health benefits and compete for the most talented employees.

What’s the future of small business health benefits in Pakistan?

Personalized solutions like the tailored and customized are the future of small employer health benefits. This is because employees can take their own individual policies with them from job to job.

And this is a bonus for employees since we’ve seen how unpredictable the economy is during the pandemic and post-COVID19. No matter if they’re employed at one company or another, employees still need health insurance, and being able to take their policy from one employer to another helps reduce the amount of change they have to face when changing jobs. As traditional options like group health insurance become untenable for many organizations, the pressure to create alternatives that allow employers to control costs and employees to make their own health care choices has grown. This will continue to be the case through 2021 and beyond.

Which companies provide group health insurance?

There are many insurance providers in Pakistan that provide corporate health insurance. Providers like Jubilee General Insurance, IGI General, TPL, Askari general insurance and other big insurance companies have A+ and AA++ ratings and have the capacity to ensure against premiums and provide coverage.

What customization can be provided or procured in the corporate health insurance plans?

The plans can be customized and tailored as per the needs and requirements of the organization. These plans offer high value to the employees and provide benefits and coverage that are not available in the individual and family retail health insurance plans.

One of the major health insurance benefits is that that many organizations can provide is OPD and maternity benefits it which are rarely part of any health insurance plans in Pakistan. Hence the health insurance plans can be customized and made on the “basis-to-fit-everybody’s-requirements.

Conclusion

2021 is set to be an eventful year for employers. Between managing the business during an epidemic and navigating a change in the present administration, employers have their work cut out for them. Small employers are prepared to meet this opportunity with more health benefits options available than ever before. By carefully considering their benefits goals, budget, and employee situations and preferences, these employers can make a choice that will help them hire and keep employees and succeed in 2021 and the future.

Khurram Zahid

The post Group Health Insurance in Pakistan: A Comprehensive Guide for Businesses & Corporates appeared first on Smartchoice.pk.