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10 GMC features employers should consider before insuring their employees

Team AckoJan 17, 2024

In the COVID-19 era, insuring your employees is not merely a formality. It is a genuine effort on the employer’s side to ensure the employees’ insurance needs are taken care of. Offering a top-notch Group Medical Cover (GMC) to your employees can foster loyalty, increase productivity, and enhance goodwill. And to do that, employee-first organisations should consider the following 10 GMC features before insuring their employees.

Contents

1. Adequate coverage

Adequate coverage is at the core of an excellent employer-offered health cover.

In theory

The coverage offered should be exhaustive and not limited to hospitalisation.
Pre-hospitalisation and post-hospitalisation expenses should also be covered by the policy.

In practice

Here’s an example. An employee experiences severe stomach ache and visits the doctor. Post examination, the doctor orders a few tests. The results are startling, and the employee is advised to get admitted to a hospital.

Fortunately, the treatment is completed within a week, and the employee is discharged. A few follow-up tests are done in the following weeks, and the treatment is completed in a month.

Here the total expenses include doctor’s consultation fees, diagnostic tests, hospitalisation expenses, and follow-up visits. Thus, an employee-centric insurance policy should cover all these expenses and not just the cost of hospitalisation.

2. Power to personalise

Historically, the GMC has been rigid with no or little scope for personalisation for the employees. After all, the cover is for a group, making it difficult to personalise. However, digital-first insurers have changed the dynamics.

In theory

Individual employees can be presented with an option to personalise their insurance policy.
For example, with ACKO’s Group Medical Cover, each employee covered under the policy can enhance their insurance coverage with the help of suitable add-ons by paying from their pocket. This way, all they have to do is pay for the additional personalised additions for wide-ranging insurance.

In practice

Here’s an example. The Group Medical Covered chosen by the employer does not cover Out-patient Department (OPD) expenses incurred by the employees. If any employee wants such expenses covered by their policy, they can purchase an OPD add-on from the insurer’s app by paying the corresponding amount for the add-on.

3. Hassle-free claim settlement

Insurance is a promise made by the insurer to cover the employees’ finances in certain situations. The time to act on this process comes when the employee raises a claim. It’s here that the employee needs the most support.

In theory

An employee should be able to raise, track, and close claims easily and seamlessly via a mobile app.
An employee should receive timely query resolution regarding any issues pertaining to the insurance cover.

In practice

Here’s an example. An employee has raised a claim by uploading required documents such as medical bills via the insurer’s app but is unsure about the progress. The employee can track the real-time status of the claim’s progression via the insurer’s app. In case there are any queries, the employee can sort them via the app or by calling the insurer.

4. Family support

It will be of great help for the employees if the employer-offered GMC also covers their family members.

In theory

Employees should be able to easily add family members to their policy and customise their cover as well.
The GMC should extend policy benefits such as free doctor consultations to the covered family members.

In practice

Here’s an example. An employee feels that the sum insured offered by the GMC is not enough for the entire family. Therefore, the employee opts to top-up the sum insured by paying the additional premium.

By doing this, the employee does not need a separate Family Floater cover as the entire family is insured at a minimal expense. Now, the covered family members can benefit from the offered services such as free doctor consultations as well.

5. Focus on mental health

Lately, there’s been a lot more awareness regarding mental health. And rightly so, the pandemic has added fuel to the fire as far as deteriorating mental health is concerned. Thus, it’s the need of the hour for a GMC to focus on mental health and insure expenses related to it.

In theory

Employees should be able to access mental health support from certified professionals.
Therapy sessions should be made accessible via the insurer’s app, either free or at a discounted rate.

In practice

Here’s an example. An employee has been feeling low for quite some time. The anxiety and uncertainty due to the pandemic and challenging work-from-home conditions have taken a toll on mental health.

The employee decides to seek professional mental health support by getting in touch with a psychiatrist via the insurer’s app in the form of teleconsultation. After a series of such sessions, the employee feels better and evades a potential breakdown.

6. Preventive healthcare

An ideal GMC should offer preventive healthcare features to the employees to stay proactive.

In theory

The policy should cover diagnostic tests. Employees should be able to avail themselves of such tests at a discount.
Employees should be able to consult doctors regarding their lifestyle issues and address them before they become threatening.

In practice

Here’s an example. It’s time for an employee’s annual health check-up. The employee schedules a diagnostic check-up via the insurance company’s app at a discount and gets the test done. Nothing alarming comes up in the results, which results in peace of mind for the employee and the family members.

Another employee has been leading a sedentary lifestyle amidst social distancing. Fearing physical health issues, the employee consults a doctor via the insurance company’s app. Upon consultations, the doctor advises the employee to focus on a healthy diet, follow an exercise routine, and ensure regular eight-hour sleep to avoid major health issues.

The employee gets a wake-up call and turns their life around in a few months by following the doctor’s advice. Now, the employee leads an active lifestyle and has not fallen prey to lifestyle disease.

7. Discounts on medicine

Timely medication can work wonders. And if it is available at a discount, that’s even better, isn’t it?

In theory

The Group Medical Policy should offer the facility of ordering genuine medicines online at a discount.
Employees will not have to scout for medicine by visiting pharmacies with the online medicine delivery feature. They shall receive timely medication.

In practice

Here’s an example. An employee needs a specific medicine, but it is not in stock at the pharmacies in the locality. Instead of waiting for the medicine to be available later, the employee can simply use the insurance company’s app to order genuine medicines online in a timely manner and at a discounted rate!

8. Minimal OOP expenses

The GMC should be as comprehensive as possible to avoid additional expenses for the employees.

In theory

The employees should benefit from the cover in a manner that results in minimal out-of-pocket (OOP) expenses for them.
The policy should cover the majority of the expenses.

In practice

Here’s an example. Despite the insurance policy having a co-pay clause (where employees contribute a substantial amount during claim settlement), it should take care of most expenses made by an employee.

Expenses for an ambulance should be covered either by the policy or by add-ons to reduce employees’ OOP expenses during claim settlement.

9. Network hospitals

The insurer should have a wide-ranging network of hospitals to facilitate cashless claims.

In theory

The hospitals included in the network should offer high-quality care.
Ideally, top hospitals across cities should be a part of the insurer’s network.

In practice

Here’s an example. An employee is asked by the doctor to get admitted to a hospital to treat issues related to chest congestion. The employee opens the insurer’s app and checks the network hospitals in the vicinity.

Pleased to find the locality’s top hospital under the list of network hospitals, the employee gets admitted to it and gets treated. Later, the hospital bill is settled seamlessly between the hospital and the insurer; the employee is only required to pay the amount not covered by the policy.

10. Incentivising fitness

Sometimes, a lack of motivation can be a huge hurdle in one’s fitness journey. While how and when to overcome this hurdle is a personal call, incentivising fitness-based activities can provide a nudge in the right direction.

In theory

Employees should be able to track their fitness activities via the insurer’s app to plan their fitness regimen.
Achieving certain fitness goals should lead to tangible rewards.

In practice

Here’s an example. An employee syncs the Google Fitness app and the ACKO Health app. Regularly overcomes challenges such as completing 10,000 steps daily. Such an achievement is incentivised in the form of ACKO coins that can be used to collect rewards.

An ongoing process

Buying a Group Medical Cover isn’t the end; it’s the beginning of an ongoing process. Employers need to create awareness about the cover among the employees so that they are aware of the benefits and can avail of them as and when required. The policy needs to be reviewed periodically and renewed based on the assessment. And the cycle continues because employee health cannot and should not be taken for granted.

Note: ACKO’s Group Medical Cover currently (subject to changes) offers all the 10 features mentioned above. If interested in insuring your employees under this cover, you can read more or schedule a demo.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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