Mr. Antony Jacob's Interview in NDTV

What's New in Group Plans?

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.

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