Sign In
For assistance with claim related queries in the CYCLONE affected regions of Tamil Nadu, Andhra Pradesh, and Kerala, please click here

Is your employer’s health insurance coverage sufficient?

The benefits of securing a job in a reputed company are manifold. Provident fund, transport allowance, and health insurance—all these and more are usually offered by employers to hire the best talent. However, when it comes to your employer's mediclaim policy, you should check if it is enough to meet your and your family's healthcare needs.

Remember, many insurance companies entertain claims hesitatingly. Some may even try to hide behind the fine print to give low payouts. Also, claiming via employer health insurance can prove to be a tedious process due to policy clauses aiming at a broader group of employees. Moreover, since businesses are always looking to cut their costs, most of them end up offering bare-minimum coverage insurance plans to their employees.

In addition, employer policies may come with co-pay and room-rent limiting clauses. That is because such plans are way cheaper than regular policies. Companies use the fine print as a tool to reduce their liability. However, they still manage to attract and retain employees even by offering a threadbare mediclaim policy.

Therefore, it is very important to study and understand the policy clauses of your employer's mediclaim policy to know its true coverage. This will help you decide if you need additional coverage. Here are the two most ignored aspects of an employer's health insurance policy.

Co-pay clauses

The co-pay clause necessitates the health insurance provider to pay only a part of the total expenses while the insured party is left to pay the rest of the amount. As a result, you do not receive enough cover and the financial burden persists.

On the other hand, a standard mediclaim policy not only comes without the co-pay clause but also offers more financial aid.

Room-rent limiting clauses

Under this clause, the health insurance provider is liable to only bear a fixed percentage of the hospital room rent per day. Also, this usually works out to be merely half the total rent. More so, your cover is limited to the room rent charges and does not include doctor and other expenses. Thus, you end up paying a substantial amount of medical treatment costs.

Health insurance providers add such clauses in the mediclaim policy documents to lower their total liability. However, you may need additional coverage via a separate insurance policy for many other reasons. Some of them are:

1)    Employment status

You can enjoy your employer's health insurance cover for as long as you are employed with the company. It means you will lose your insurance coverage if you change jobs or are terminated.

Even so, armed with individual insurance cover, you do not have to worry about financial support in case of a medical contingency.

2)    Number of beneficiaries

Many times, your employer's mediclaim policy may not offer coverage to your dependents. Because of this, you will be left with no other option but to insure your family members on your own. Thus, you should think of purchasing either a family health insurance plan or individual health insurance for each member of your family.

3)    Employer insurance is merely an added benefit

Employers are not entitled to provide insurance coverage. They can withdraw insurance coverage whenever they want. Thus, relying only on the insurance cover your employer provides would be a costly mistake. There is no surety that the employer health insurance policy will prove useful when you need it.

4)    Cover for your post-retirement years

Note that you can avail of your employer insurance cover only for your employment term. That means you will be left without insurance coverage during your retirement years, which is when you need it the most.

Furthermore, getting a mediclaim policy after you are 50 years old is not easy. More so, you have to undergo a series of tests. Also, you will not have coverage for pre-existing medical conditions. Apart from that, your insurer is not liable to pay your hospital fees if you require hospitalisation for a medical ailment that you are diagnosed with before buying the policy.

5)    Your employer can review the terms and conditions of your healthcare policy at any time

Both insurers and employers are always looking for ways to save money and lower their liability. Hence, they can choose to add, edit, or modify the clauses in insurance policies at any time. Therefore, it makes sense to get a personal mediclaim policy to eliminate any uncertainties regarding your medical treatment expenses.

6)    Adequate coverage

Group employer policies may not provide enough coverage. And, if you require long-term hospitalisation due to a terminal illness, the meagre amount promised by employer health insurance may not even help. Here again, a personal health insurance plan can save you. 


While having employer mediclaim policy cover helps, it may or may not be sufficient to meet your needs in the face of a medical crisis. Therefore, instead of taking your employer's health insurance for granted, read and understand the policy details to know how much coverage you actually have. This will save you from surprises when you make a claim.

Meanwhile, consider investing in a personal health insurance policy to ensure robust coverage for yourself and your family. It is safer to treat your employer's insurance coverage only as additional or secondary cover.