What's New in Group Plans?

[Apollo Munich CEO]

If you retire or change jobs

Most advisers suggest an individual health plan along with the
employer group cover because you are liable to be left in the lurch
after retirement or if you change jobs or the entrepreneurial bug
bites you. Not any longer. Insurers are now offering plans that enable
seamless transition from a group to an individual cover while
continuing with the benefits and without impacting your claim status.

"In case of small and medium enterprises of 10-100 employees, we offer
pre-underwritten insurance covers, wherein benefits, such as a waiting
period waiver and pre-existing disease coverage, can be carried
forward after retirement or while leaving an organisation," says
Antony Jacob, CEO, Apollo Munich Health Insurance.

So you can easily transit from the group policy to an individual or a
family health insurance policy. Max Bupa Health Insurance also offers
this facility, but instead of only SMEs, it provides this for all
corporates. "We are the only ones who offer a benefit where the
employee can shift from a group to an individual cover," says Damien
Marmion, chief executive officer, Max Bupa.

If you have senior citizen dependants

Though corporates have not yet put a blanket ban on group covers that
include senior citizen dependants, more and more are opting out of
such policies or asking for a higher premium to be paid by the
employee. "Insurers are requesting the corporates that an additional
premium be paid by employees. In fact, this year, they are insisting
that if the employee doesn't accept such a cover, he will not be made
this offer again," says Sudhir Sarnobat, co-founder and CEO,
Medimanage, a health insurance broking firm.

So it makes sense to pay a little higher premium and take the
dependant cover from your employer because of the benefits it offers.
"In the corporate group policy, there are no medical tests, all pre-
existing diseases are covered, and you can have a cover for your
parents till the time you retire, an age at which they are unlikely to
get any other cover in the market," adds Sarnobat.

If you choose a PPN hospital

In case of an individual policy, you can get cashless facility at a
number of hospitals, but the employer cover may now restrict you to a
lesser number of hospitals. This is because the public sector
insurers, which cover 70% of the corporate and retail market, are
enticing corporates to buy a plan which covers the preferred partner
network (PPN) of hospitals.

"If the corporate agrees to restrict itself to a network of, say, 650
hospitals, the insurer offers a 10% discount in premium over and above
the regular discount. The premium is higher if the corporate insists
on all the 3,000 hospitals. This is because they have a negotiated
rate with the PPN hospitals and would like to get more business at
that cost," says Sarnobat.