FOR ALL CORPORATE AND INDIVIDUAL BUSINESS PERSONS - Providing mandatory medical insurance coverage to workers as part of the National Directives of MHA, GOI

[C PAWAN KUMAR RAO]

the guidelines released by the Ministry of Home Affairs, it has been made mandatory to have health insurance for workers, when restarting of operation starts from 20th April.

Normally in a Factory/ Manufacturing premises, the workers are covered under Workmen Compensation for occupational hazard and not for medical insurance.

Some Workers covered under ESI may not be willing to go for ESI hospitals depending on the availability and facility, especially for COVID.

Seeing this situation, many insurance companies have launched a special drive and offered very competitive premiums for Health Insurance under group coverage. These premiums are almost 50% of normal premiums charged in the market.

 

Circular Ref. No:IRDAI/HLT/CIR/MISC/093/04/2020 Date:16-04-2020 Providing mandatory medical insurance coverage to workers as part of the National Directives of MHA, GOI   Ref: IRDAI/HLT/CIR/MISC/093/04/2020. 16th April, 2020 All General and Stand along Health Insurers (Except AIC and ECGC),   Sub: Providing mandatory medical insurance coverage to workers as part of the National Directives of MHA, GOI   1.    Reference is invited to Order No. 40-3/2020-DM-I (A) dated 15th April, 2020 issued as part of the Consolidated Revised Guidelines by Ministry of Home Affairs, GOI. As per the said order, inter alia; the following are stipulated:                 i.        All industrial and commercial establishments, work places, offices etc. shall put in place arrangements for implementation of Standard Operating Procedure (SOP) before starting their functioning.                    ii.            As per clause no. 5 of Annexure – II of the said SOP for social distancing for offices, workplace, factories and establishments, medical insurance for the workers to be made mandatory.   2.       In light of the above, all General and Health Insurance companies may offer comprehensive health insurance policies either to individuals or groups in order to enable the listed organisations / employers / establishments comply with the above referred directions.   3.       The insurers are advised to devise comprehensive Health insurance products with simple wordings, conditions and at affordable cost to be offered to the stated organisations.   4.    The above referred organisations should be able to continue the Medical Insurance Policy offered by insurers not only for the present situation but for all time.     T L Alamelu MEMBER (Non Life)

 

 

Dear Sir/Madam,

 

Dealing With all Major Companies contact as per your requirement for HEALTH INSURANCE - LIFE INSURANCE - CAR -BIKE- COMMERCIAL VEHICLE INSURANCE , HOME INSURANCE , MARINE INSURANCE,FIRE INSURANCE,LIABILITY INSURANCE,GURANTEE INSURANCE,GROUP TERM INSURANCE, OFFICE INSURANCE , INVESTMENTs { SHARES,MUTUAL FUND, GOVERNMENT BONDS , PRIVATE FDs , FOR HOME LOANS , BUSINESS LOANS} call me 9300136234,9826544985 or mail: cpaw...@gmail.com

 

Group insurance provides supplemental coverage to better ensure the physical, mental and financial health of insured members and their families. Knowing they can benefit from such coverage is reassuring for both employers and employees.

 

 

 

In order to avail the optimum benefits, certain restrictions need to be customized, which include

• Room Rent Clause

Here we have room rent restriction by linking the limits to the percentage of sum insured. On the other hand, it will be better to customize this clause for considering the private or sharing room!

• Copayment Clause

Employees will question hospital for treatment and charges, since a certain amount will also be paid out of pockets of employees, hence it will make the employees aware as well as responsible. Percentage of copayment by an employee shall be nominal. A normal copayment of 10% of claim can reduce the claims of company by more than 15% to 20% at the end of year

• Waiver of Internal congenital exclusion

A part of standard exclusions, however, must be considered while negotiating the premium.

• Disease Wise Cap

For minimizing the claims, limiting the average cost of treatment for the common procedures like cataract surgery, hysterectomy, piles surgery, etc. By doing this, ones who need support for more serious conditions will get the timely assistance and there will be less burden on their pockets!

• Maternity Cap

Normal limit for maternity is 50,000 per claim both for normal and C section delivery. An appropriate segregated limit will also save claims

• Deductibles

Here a flat nominal amount of say Rs 1000 or Rs 2000 is applied as deductibles per claim. However, it’s advisable to apply this clause to those claims where copayment is not applied. In order to restrict small value claims and thereby reduce premium of next year, deductibles clause must be appropriately designed

• Preferred Hospital Network

Insurers have a pre-negotiated tariff with the hospitals and this costs less than the average treatment cost anywhere else. The overall claims can be significantly controlled if the members of the policy are encouraged to opt for the preferred hospitals from the list by removing the certain clauses (copayment and deductible). Also, with preferred hospitals, arrangements can be done for cashless treatment and also by increasing the room rent limit!

• The company may not like to put copayment clause in reimbursement claims as they can execute control while clearing reimbursement claims

 

 

 

EMPLOYEES GROUP INSURANCE ALSO  GIVE BENEFITS TO EMPLOYERS

 

That's because it helps keep your team healthy and happy, and providing health insurance to employees signals that you care about their well-being. Many small business owners agree and offer health insurance benefits even when they aren't required by the Affordable Care Act to provide coverage.

 

 

Thanks & regards

 

C Pawan Kumar R Rao

Insurance Advisor