We live in an uncertain world, and this was, perhaps, most proven by the recent COVID-19 pandemic and the resulting changes in the way we work and what we expect from our family, friends, and workplace. It has also made us deeply aware of the healthcare vulnerabilities within our own families and certainly more aware of the ways in which we pay for those healthcare bills.

Chris George, Co-founder and CEO, QubeHealth, says that having a health insurance cover for yourself and your family is one of the most important risk mitigation measures you can take. “Purchasing it yourself or having the company you work for provide you one as part of ‘employee health benefits’ is as basic today as having a savings account. The challenge, however, has been that even after 30+ years, since health insurance was launched in India, less than half the population has a policy even when a majority of these are covered by government schemes.” Not having a health insurance policy leaves you having to pay for healthcare expenses from your savings or borrowings, known as out-of-pocket-expenditure or OoPE. Surprisingly, as per the Economic Survey 2023, OOPE is at 48% of the total health expenditure!

Employee Healthcare
“Companies that care about their employees, have taken a keen interest in reducing uncertainty in the minds of their team members, especially around the topic of their healthcare. Many have increased health insurance coverage per employee (and their family members), created an emergency corpus fund to provide emergency medical loans to employees and enhanced activities related to employee health and wellbeing,” notes Chris.

Most company-paid, employee health insurance programmes, also known as Group Mediclaim (GMC) or Group Health Insurance (GHI), provide about INR 5 lakhs in Sum Insured (the national average incidentally, is a coverage of INR 3 lakhs per employed Indian). These GHI programmes state that they cover accidental death, maternity and day care procedure coverage, in-patient hospitalisation for you and your family members. “If you go deeper into the benefits document, and apply a forensic eye to understanding these benefits, you begin to realise that the insurance coverage is almost always limited in amount or procedures it covers, with a long list of exclusions,” warns Chris.

What Can Be Done
It is not that employers do not care, they are either not aware as insurance is a complex product, and/or the insurance business profits by adding ‘friction’ into the claims transaction process. Chris lists a few things you should add to your health benefits programme.

Healthcare Credit Line
A line of credit that’s available to every employee, to pay for any healthcare bill that is not covered by the company-provided health insurance programme. Employees should be able to borrow easily with minimal effort on their part, or the HR teams. Add to this, the convenience of a no-cost EMI repayment plan, directly debited from the employee’s salary account.

Non-Cashless Reimbursement Programme
If the company-provided health insurance programme does not cover the hospital or clinic where the employee wishes to undergo the care procedure (non-cashless), then they should have access to money that bridges the gap between the claim date and the claim reimbursement disbursement date. Again, employee should be able to draw down this money quickly, pay the healthcare provider and then claim the insurance money to repay this amount at no-cost.

Healthcare Savings Account
A savings account, in addition to your salary account, that gives the employee the option to deposit a small amount of money every month from their salaries, for a planned future healthcare expense (e.g., maternity or parent’s cataract). Deposits into this account earn an interest, provide expense-specific insurance cover and provide a discount on the proposed expense.

Thoughtful employers can work with professional companies that provide such solutions, and augment or enhance their existing employee health benefits programme. This is a good way to attract talent and retain them, by showing that they are a ‘company that cares’.