Employee Health Insurance is the type of insurance the employee of an organization enrolls into after joining the company or within the period of employment. The employer bears the employees� medical expenditures. There are varieties of health insurance policies from long-term care for prolonged sickness or dental care to short term medical checkups or hospitalization due to accidents or sudden illness. Policies cover the costs of doctors, hospital stays, various medical tests and diagnosis, medicine costs, etc.
An employee is eligible to enroll for a medical insurance during the initial joining in the company or during specified months of the year (called open enrollment). An employee is asked to stick to the plan which he (or she) has chosen, in order to avoid any hassle or inconveniences (in part of the employer and the insurance company). However changes can be made if there is a change of life status, such as marriage, divorce, birth of a child or death in the family, which will directly affect the coverage needs. The Employer usually offers a Fee-for-Service and Managed Care plans. Some Group plans are also offers that include dental and vision Insurance in addition to medical coverage.
Fee-for-Service – It is also called as Indemnity or Traditional plans ease the customer by supplying complete freedom to choose their doctors (including specialists) and hospitals. However this plan is quite expensive for the employer, hence not much popular. HMO and PPO or HMO and POS are some of this type.
Managed Care � No options are laid. Certain doctors, hospitals and health care providers with a range of quality health services at a reduced cost are provided to the customers (or employees). It is mandatory to stay within the plan’s network of providers and health facilities to avail the best benefits.
Employee Health Insurance Benefits are the most important benefits for any employee of any organization. Insured employees get medical benefits and other health facilities from doctors, medical centers, hospitals and clinics. Emergency cases are also covered through these plans. These may include the employee alone or the immediate family as well, depending on the employer.
It is necessary that all employees covered by insurance understand the basics of their Health Insurance Benefits. These include:
- Premiums: The monthly premium for the health insurance policy is paid by the employer. The amount varies depending on whether the employee alone is insured or if it is a group insurance covering his/her family members as well.
- Deductibles and co-payments: A part of the total cost, deductibles or co-payments are the amount the insured person pays to the doctor or at the hospital. The rest of the payment is done as a part of the Insurance. The amount of deductible is inversely proportional to the amount of premium.
- Out-of-pocket expenses: These are the costs the employee has to pay, in total before the insurer pays for the remaining amount. This means that once the insured person pays up the entire amount payable from his side, the rest of the expenses will be handled by the insurer.
- Coverage of services: Insurance plans cover medical expenses incurred by the employee during his or her tenure as an employee of any organization. These include physicians, specialists, hospitals, medical centers, pathological laboratories, emergency and surgeries. It is necessary that the employees should be aware of the scope and type of their individual policies.
- Ancillary care: Some health insurance plans also cover apart from basic medical health, ancillary care like eye and dental care. These are considered as riders with the remaining coverage.
More Information Related to Insurance
Last Updated on : 26th August 2013