Corporate Health Insurance: What is it & How Does it Work?

A Corporate Health Insurance policy is like a Group Insurance that provides coverage for a group of individuals, such as members of a professional association, a society, or employees of an organisation, against illness, accidents, and other health issues.In India, before the pandemic, the government did not mandate insurance coverage for companies. Although many companies offered Corporate Health Insurance, others overlooked the potential advantages that Group Health Insurance could offer. However, after the pandemic scare, the government introduced new regulations. On 1 April 2020, the Insurance Regulatory and Development Authority of India (IRDAI) issued a circular, making it a must for companies to provide Medical Insurance coverage for their employees.

A Corporate Health Insurance plan is a pragmatic way for your company to look after your workforce. The plan provides healthcare coverage to your employees, including hospitalisation, outpatient services, preventive care, and other benefits specified in the policy. This way, your employees can seek medical treatment from a network of healthcare providers associated with the insurance plan. Corporate health coverage helps your employees access treatments, reduces out-of-pocket expenses, and promotes your employee's well-being.

• The employer owns the insurance contract or is the policyholder, while employees receive insurance certificates.
• The corporate health plan covers employees only during their employment with the company.
• The premium for a Corporate Medical Insurance policy does not increase with the increasing age of the employees. This is a key difference from traditional Health Insurance contracts.
• The employees' family members can also enjoy policy benefits, depending on the type of policy chosen.

To be eligible for Corporate Group Health Insurance, all you need to do is be employed with the organisation providing the Health Insurance policy. You can avail of Health Insurance benefits of a Corporate Health Insurance policy until you are associated with the company.

Attract and retain top talent:

Offering Employee Health Insurance as a benefit demonstrates care for your employees and creates a positive perception of your organisation, making it more appealing to potential talent and reducing turnover.

Boost focus and job satisfaction:

Providing benefits and perks, including Health Insurance, can motivate your employees, increase job satisfaction, and enhance productivity.

Benefit to employees and their families at lower cost:

One major advantage of Corporate Medical cover is the relatively lower premium compared to individual Health Insurance policies.

Flexible premium payment terms:

Premium payments for Corporate Health Insurance policies can be made monthly, quarterly or annually.

Tax benefits:

Your organisation can seek tax exemption on premiums paid for the Employer-Employee Insurance plan according to Section 37(1) of the Income Tax Act, 1961. You can declare these premiums as a business expense, thereby deducting them from your company's profits. This deduction helps in reducing the tax liability of your organisation.

Family coverage at zero cost:

Most Corporate Health Insurance plans allow you to extend coverage to your family members, including parents and in-laws. This can be either at no additional cost or a marginal cost. This provides financial security to your loved ones and strengthens the company's reputation.

No restrictions on coverage:

Corporate Health Insurance plans usually provide extensive coverage. They cover almost all kinds of diseases. This also typically includes any pre-existing diseases you may have. These covers also come with no requirement for pre-medical examinations.

Family coverage at lower costs:

Most Corporate Health plans allow you to add more family members to your coverage plan at minimal additional costs.

Tax benefits under 80D:

You can claim tax exemption of up to ₹ 25,000 if you pay part or the full premium of your Corporate Health policy.

Smooth and easy claims:

With a Corporate Health Insurance policy, employees can avoid the hassle of settling medical bills themselves. They can simply submit their hospital bills to their employer for convenient reimbursement if the hospital is on the network list.

Preventive treatments:

Many insurance companies offer wellness initiatives, such as educating employees on various health aspects, providing access to doctor consultations, offering discounts on medicines and health check-ups, and even supporting gym memberships. These preventive measures can contribute to the overall well-being of employees and help them maintain good health.

Employers provide Corporate Group Insurance to their employees as part of their employee benefits package. The coverage extends to all eligible employees working in the organisation. Regular Health Insurance policies are bought by individuals or families directly from insurance providers. They are not tied to any specific employer or restricted to a particular group of people.

• In Corporate Group Insurance, the premium is generally paid by the employer. The policyholder pays the premium directly to the insurance company in regular Health Insurance.
• Corporate Group Insurance plans are typically standardised and may offer limited customisation options than regular Health Insurance. They often have simplified underwriting processes, and some may not require medical underwriting at all. In contrast, individual Health Insurance policies generally involve more extensive underwriting, and coverage for pre-existing conditions may be subject to waiting periods or exclusions.
• Group Insurance coverage is tied to employment with the specific company. If you leave the company or retire, you may lose the Group Health Insurance benefits. On the other hand, individual Health Insurance policies are portable. You can continue the coverage even if you change jobs or leave your current employer.

Also read: Why Individual Health Insurance Is A Must Buy Over Corporate Health Insurance?

Health Insurance policies can provide assistance only to a certain extent. The finer details of these inclusions are mentioned in the terms of your insurance plan. Among the more common inclusions are:

Pre-existing conditions:

Many policies may include coverage for pre-existing medical conditions. Your policy may mandate a specific waiting period after policy inception.

Hospitalisation expenses:

Coverage for expenses related to your hospitalisation, including room charges, nursing care, surgeon fees, anaesthesia, and medical tests.

Day-care procedures:

Coverage for specified medical procedures that do not require overnight hospitalisation, such as cataract surgery, dialysis, chemotherapy, and radiotherapy.

Pre-and post-hospitalisation expenses:

Coverage for medical expenses incurred before and after your hospitalisation, including diagnostic tests, consultations, medications, and follow-up visits.

Ambulance services:

Coverage for emergency road ambulance services required in case of your hospitalisation or medical treatment.

Maternity benefits:

Coverage for pre-and post-natal expenses, including prenatal care, childbirth, and newborn care. Your plan may have waiting periods or limits on maternity coverage.

Outpatient services:

Coverage for medical consultations, diagnostic tests, medications, and treatments you receive on an outpatient basis.

Wellness and preventive care:

Coverage for your health check-ups, vaccinations, preventive screenings, and wellness programs.

Emergency care:

Coverage for emergency medical care, including emergency room visits and treatment of accidental injuries you may require.

Alternative treatments:

Coverage for alternative or complementary therapies like Ayurveda, Homeopathy, or Naturopathy, depending on the policy terms.

Mental health coverage:

Coverage for mental health consultations, counselling, and treatments for specified conditions.

There are certain things that a Health Insurance plan just cannot cover, such as:

Cosmetic procedures:

Corporate Health plans typically do not cover non-medically necessary cosmetic surgeries, procedures, or treatments.

Dental and vision care:

Routine dental and vision care, such as dental cleanings, fillings, and eyeglasses, may not be a part of a Corporate Health plan.

Experimental or investigational treatments:

Treatments considered experimental or not widely accepted are usually a part of exclusions.

Self-inflicted injuries:

These policies also do not cover injuries resulting from self-harm or intentional actions.

Substance abuse and addiction:

You may be unable to raise any claims for treatment for substance abuse, drug addiction, and rehabilitation programs.

Weight loss programs:

Weight loss treatments, surgeries, or related programs are usually not a part of a Corporate Health plan.

Certain high-risk activities:

Injuries or treatments related to high-risk activities like extreme sports, mountaineering, or hazardous occupations may be excluded.

Non-medical expenses:

Corporate Health plans also do not usually cover expenses that are not directly related to medical treatment, such as transportation costs or telephone charges.

Certain chronic conditions:

Some Corporate Health Insurance policies may exclude coverage for specific chronic conditions or limit coverage for their treatment.Remember that these inclusions and exclusions can vary, so it is crucial for you to carefully review the terms and conditions of your Corporate Health Insurance policy to understand what is covered and what is not.Also read: Is Corporate Or Company Health Insurance Enough?

When evaluating your Corporate Health Insurance policy, there are several crucial factors to consider:

1. Know the Sum Assured provided. Ensure your policy includes essential medical services such as hospital treatments, doctor consultations, medications, diagnostic tests, and emergency care.
2. Check the network of hospitals and if your preferred doctors, hospitals, and specialists are included in the network, as this can affect the accessibility and quality of care you receive.
3. Know about the policy's cost-sharing features, including deductibles, co-payments, and co-insurance. You should know how much you will have to pay out of pocket for different services and treatments.
4. Evaluating your policy's limits and maximum coverage amounts is essential. Check the annual and lifetime limits and see if they are adequate for your medical requirements. And note any limitations or exclusions that may apply to your policy.

Finally, carefully read your policy's terms and conditions, including any waiting periods, pre-existing condition clauses, and renewal provisions. Understanding the details will help you make informed decisions about your healthcare coverage.

Your claim acceptance or rejection largely depends on the documents you provide to your insurance company. You require the following original documents whenever you want to raise a claim.

• Filled-up claim form with the sign of the doctor
• Medical reports
• Doctor's prescription
• Final bill with the breakup
• Cash memos, itemised bills
• Discharge summary
• In case of an accident, a police report is required.

To raise a claim, you can simply contact your insurance provider through the contact number or email address provided by your company. Remember, you must do this immediately once you or a covered family member requires medical attention. After this, you need to submit a claim form along with documents that your insurer mandates.

• After the pandemic, on 1 April 2020, the Insurance Regulatory and Development Authority of India (IRDAI) issued a circular making it mandatory for companies to have Medical Insurance coverage for their employees.
• Your company can avail of tax exemption for the premiums paid towards the Employer-Employee Insurance plan under various sections of the Income Tax Act 1961. You can deduct the premiums from your company's profits by considering them as a business expense. The deduction helps lower the tax liability, providing a tax-saving benefit.
• As an employer, providing Corporate Health Insurance can help attract and retain talented employees in your company, improve employee satisfaction, and promote a healthy workforce.
• As an employee, it is important for you to understand what Corporate Health Insurance is. Also, update yourself about the exclusions and limitations in your policy, as certain conditions, treatments, or services may not be covered. By reviewing the policy terms, you can make wise decisions to protect your finances in a medical emergency.