Home / Health Insurance / Group Health Insurance / Articles / How to Evaluate your Group Medical Cover?

How to Evaluate your Group Medical Cover?

Team AckoJan 17, 2024

Purchasing a Group Medical Cover (GMC) for your employees is not a one-time activity. This is especially true for employee-first organisations that ensure their GMC focuses on overall healthcare and not just on insurance. Such an exhaustive cover needs to be reviewed annually before a renewal to guarantee continued coverage.

A thorough evaluation a month before the policy’s expiry date can highlight the pros and cons of the existing GMC. And then you can fill the gaps accordingly. If you are wondering how to do it, then here are five questions that will help you evaluate your employer-offered group health insurance for the employees.

Contents

New-age insurance

1. Have the objectives been met?

Ideally, the GMC must be purchased or renewed, considering specific objectives in mind. For example, some of the objectives could be as follows.

Increase in employee participation regarding wellness webinars.
Reduction in the number of claims.
Decrease in the number of sick leaves.
Lower employee stress levels.
Rise in availing of overall GMC features.

Actionable

You can review the GMC’s performance based on whether the set objectives were met. If not, find out how wide the gap was and how it can be rectified going ahead? Alternatively, if you have not set any objectives, you must set them before the new GMC’s policy period begins and evaluate the performance while renewing it.

2. Is the offered coverage adequate?

A top-notch GMC must offer adequate coverage to the employees and possibly to their immediate family members.

Ideally, the GMC must take care of the employees’ insurance requirements to reduce their financial burden in case of medical issues. And this can be achieved only if the GMC offers wide-ranging coverage as follows.

Cover for pre-hospitalisation and post-hospitalisation as well.
Low co-pay percentage, if any.
Option to enhance insurance coverage if required.
Coverage for out-of-pocket expenses such as payment for an ambulance.
Coverage for maternity, cataract, etc.

Actionable

Evaluate if the current GMC scores high on the coverage metric based on the above pointers. Note that wide-ranging insurance coverage is a must in today’s age and forms the core of a productive GMC.

3. Is the GMC up to date?

COVID-19 has changed the way we approach daily living. Not surprisingly, it has also influenced how a GMC must be crafted amidst the pandemic. While evaluating your GMC, you must check if it is up-to-date with modern features.

For example, here are some features offered by ACKO’s GMC via the ACKO app, which is designed for the modern era.

Easy onboarding of employees and their family members.
Option to customise the policy with add-ons and top-ups.
Hassle-free claims tracking and settlement.
Free doctor teleconsultations.
Discounted medicines and lab tests.

Actionable

Compare your existing GMC with other options available in the market based on their relevance to the current digital ecosystem and challenges enforced by social distancing.

4. Was enough awareness created about the GMC?

Historically, the GMC has been a standard policy, more of a token than a beneficial perquisite. Thus, there’s a chance that the employees might continue to perceive even an enhanced GMC as being passive if not communicated otherwise.

You can evaluate if adequate awareness measures were undertaken or not based on the following.

Were webinars held to explain the policy in detail?
Were mailers and newsletters sent to educate the employees about the GMC?
Was there enough support from the insurer to resolve employee queries?

Actionable

Verify if the employees were educated about the policy’s coverage, features and how it could be beneficial to them. If not, then going ahead, it must be a priority.

5. Is your employee survey to the point?

Conducting an employee survey is a simple task that can offer insightful information. However, the questions need to be framed strategically to targeted employees. Otherwise, it might come across as generic and non-productive. Here are some examples.

All or a percentage of employees who have raised a claim can be asked to review their experience.
All or a percentage of employees who have availed of GMC features such as teleconsultations can be asked to review their experience.
All or a percentage of employees who did not engage at all could be asked about their reasons for not doing so.

Actionable

As a GMC is directed towards the employees, a well-crafted survey has the potential to offer information that can prove decisive during policy renewal. Negotiations can be made with the existing insurer to modify the cover based on the survey’s results. Alternatively, a new insurer can be looked at.

New-age insurance

If you are searching for a new insurer that is ideal for your organisation’s insurance needs amidst the pandemic, then have a look at ACKO’s GMC. It is cost-effective, offers value for money, allows employees to personalise their plan, comes with an app for everything related to insurance, and has something in store for each employee and not just for those who raise a claim.

You can read more about ACKO’s Group Medical Cover to make an informed decision and 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.