Why SMEs Should Negotiate Custom Group Medical Insurance Plans - Not Just Buy What's Offered?

 Providing a group health insurance policy to small and medium enterprises (SMEs) in India is no longer considered a luxury but rather a basic requirement when it comes to talent acquisition and retention. While most SMEs tend to go with off-the-shelf plans from insurers, they overlook crucial fundamental negotiations, which might lead to coverage gaps and wasted benefits.  

 

For a balanced cost and employee wellness framework, understanding how to optimise group medical insurance plans is vital for these organisations.  

 

Untailored Group Health Insurance Policies: The Issue 

Off-the-shelf group health insurance policies face several challenges, especially from the perspective of organising real-world employees. Some of the issues include: 

- Capped maternity benefits 

- Exclusions for pre-existing conditions 

- Sub-limits on room rent or ICU charges 

- No OPD or mental health coverage 

- Unreasonably low premium caps 

 

Even though premiums from such plans seem to be more attractive, the sheer limitation on useful claims makes these redundant and inconvenient for employees during stressful medical emergencies.  

 

What Can Be Customised - And Why It Matters 

Today’almost every company considers their employees’ coverage during business trips or relocations, making group medical insurance incredibly necessary and more flexible than before.  

 

Custom add-ons available for negotiation now include specialised inclusions like:  

✔ No Waiting Period for Pre-Existing Conditions: A great add-on for more experienced employees with active treatments. 

✔ Enhanced Maternity Cover: Customizable limits of ₹50,000–₹1 lakh are beneficial to younger teams starting families.   

✔ Mental Health Benefits: As workplace stress escalates, including coverage for therapy or psychiatric consultations demonstrates a proactive strategy.   

✔ OPD and Telemedicine: Everyday health needs like diagnostics and GP visits, including virtual consults, are covered to improve benefit utilisation.   

✔ Parental Coverage Add-Ons: Optional riders to include dependent parents significantly enhance the perceived value without drastically increasing the costs.   

 

How to Approach Customisation Strategically   

  • Conduct an employee health needs assessment for policy renewal.   

  • Collaborate with a negotiating broker or advisor.   

  • Go with insurers providing API access and tech-enabled claim dashboards for HR.   

  • Emphasize claim settlement history, not just premium quote comparisons.   

 

Final Thoughts   

A well-founded group health insurance policy is a security for employees, and enhances employer branding, productivity, and morale. Proactive coverage term negotiations based on actual workforce demographics make SMEs get a better ROI from their group medical insurance investments.   

 

With the right customisation, insurance transcends compliance and becomes a strategic differentiator. 

 

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