Understanding the Graded Cover in Group Health Insurance

Graded Cover in Group Health Insurance

Many employees do not pay any heed to the graded cover in group health insurance. Insurance companies offer different benefits to employees based on their criteria. Therefore, the employees must understand the eligibility criteria for high coverage. Further, they must verify or check if the eligibility criteria are correctly applied.

Let us discuss the graded cover in group health insurance on the following basis.

1. Designation

   The insurance benefits are generally differentiated based on the designation of the employee. The criteria of designation are applied for health, accident and life insurance policies. Therefore, the sum is assured based on the designation level. Further, the designation is categorised into three or four groups. The sum assured is determined for each group.

   Example

   • The employees working on the field level or low level can be offered health insurance or the sum assured of INR 3 lakh. Therefore, during the medical expenses, INR 3 lakh shall be reimbursed to such employees.
   • The graded cover in group health insurance for the middle or supervisory level of employees can be determined as INR 5 lakh. Therefore, an amount of up to INR 5 lakh shall be reimbursed to the employees in case of a medical emergency.
   • The employees placed on the top level of management are entitled to higher sum assured. So, they may obtain a sum assured of INR 10 lakh. Therefore, such employees shall be paid up to INR 10 lakh during a medical emergency.

2. Salary

   The insurance benefits can also be based on the salaries of employees. The CTC of the employees has a crucial role to play in order to determine the group insurance benefits.

   It is common to link the salaries of employees to insurance coverage. The insurer may make it obligatory to offer coverage that should not exceed 10 times the salary or CTC of employees.

   Example

   • An employee earning INR 2 lakhs per annum can be assured of coverage of up to INR 5 lakh in case of a medical emergency.
   • In addition, an employee with a CTC of INR 10 lakh can be guaranteed medical coverage of up to INR 15 lakh for medical expenses.

   The employees must contact HR to verify if the sum assured is updated upon an increment in the salary. The nominee may find difficulties while claiming the appropriate coverage if the salary is not updated to the coverage.

3. Family Size

   The family size is another option to differentiate the benefits of a group health insurance policy. It is generally applicable in healthcare insurance when the family has also been added to the group health insurance scheme.

   Example

   • A company may provide INR 2 lakh health coverage to an unmarried employee.
   • Further, the company may offer INR 5 lakh healthcare coverage to a married employee but no child.
   • Furthermore, the company may offer coverage of INR 10 lakh to a married employee with two children.

Conclusion

The employee must keep his current designation, CTC and family status updated to the group insurance coverage. In addition, the employee must understand the basic of the sum assured to comprehend the coverage.