Mediclaim insurance has become an integral part of employee benefits for companies in India. With rising healthcare costs, providing adequate health insurance coverage for employees is no longer an option but a necessity for businesses. However, the mediclaim segment is undergoing rapid changes in regulations, product features, claim settlement processes and more. This blog post discusses some of the most important business considerations regarding mediclaim insurance in the coming years.
The insurance regulator, IRDAI, has been tweaking mediclaim guidelines regularly to standardise policy wordings, plug loopholes, enhance trans- parency in claim settlement and protect policyholders' interests. Businesses need to track regulatory changes closely as they impact which expenses can be claimed, co-payment clauses, mandatory covers, etc.
Insurers are launching apps and web-based mediclaim products with technological features to enhance user experience. These include online purchases, teleconsultations, electronic claims submissions, digital storage of health records, personalised wellness management, and more.
Gone are the days of one-size-fits-all mediclaim policies. Today, companies can choose modular and customisable group insurance plans based on their specific needs regarding sum insured, room-rent limits, co-payment ratio, excluded illnesses, pre/post hospitalisation cover, etc.
There is a solid industry-level push towards preventive care as part of mediclaim coverage. Many policies now cover annual health check-ups, vaccination expenses, doctor consultations, etc. Some insurers provide targeted wellness initiatives like health risk assessments, chronic condition management programs, health coaching, etc.
Basic mediclaim coverage is no longer enough for employee health insurance. Leading insurance companies now bundle in value-added services like unlimited teleconsultations, health concierge services, home healthcare visits, health risk assessments, customised wellness initiatives, etc.
Before selecting a group mediclaim policy, companies must assess employee health profiles - common illnesses, claims patterns, maternity needs, etc. This helps design optimal insurance plans and plug gaps through appropriate exclusions, co-pays and sub-limits if needed.
Companies should adopt a holistic approach to employee health centred around wellness and preventive care. Tie-ups with insurers providing targeted wellness solutions and in-house initiatives like health camps, ergonomic workplaces, and health risk assessments can help build a healthy workforce.
Despite group mediclaim policies, many employees buy top-up plans to bridge coverage gaps. Common gaps include exclusions like pre-existing illnesses, maternity claims, and expensive procedures like organ transplants that exhaust the sum insured limit.
Companies must ensure employees a smooth claim settlement experience through insurer tie-ups that offer technology-driven solutions like app-based filing, document uploads, and claims tracking. Dedicated claim settlement teams and health guard services help employees navigate mediclaim better.
While selecting insurers, companies must check network coverage across top hospitals in all key locations. Many policies restrict claim payouts for non-network hospitals or impose penalties. Hence, a robust cashless network with credible hospitals is a must to avoid claim rejection.
Employees are often unaware of policy provisions and end up with rejected claims. Companies must continuously educate staff on mediclaim benefits, claim procedures, included/excluded expenses, documentation needed, etc., through emails, text messages and policy booklet.
With rising healthcare costs, providing adequate health insurance for employees is crucial for companies today. Prudent selection of mediclaim policies based on the latest trends and workforce health risks is vital. Innovative insurers like ACKO lead the way with cutting-edge health insurance products that offer an enhanced user experience. Partnering with such insurers can help businesses invest strategically in employee health for a healthier and more productive workforce.
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