Don't just rely on your employer's insurance, get yours too

Nitya had been working for the same company for over 10 years now. All this while, she was under the impression that the employer’s group insurance cover of Rs 3 lakh was sufficient for her. So, she did not buy any additional personal insurance, exclusively for herself and her family. 

But a debilitating breast cancer diagnosis left her with long, extremely expensive hospital visits, treatments and medication bills, and a meagre cover from her company. In the end, with minimal group insurance and zero personal health insurance coverage, Nitya had to bear the entire financial weight of her treatment 

Health ailments and diseases can come knocking anytime. And bearing them can be a nightmare. Such is its extent that reports suggest your regular health insurance coverage is rendered inadequate every five years. With 14% medical inflation singing Indian pockets, getting a solid health cover, all for yourself and family is a necessity. 

Why do you need your own insurance?
Says Bhakti Rasal, Associate member of Insurance Institute of India (specialization in health insurance) “While group insurance plans are cheaper in rates, without any waiting periods and  medical underwriting relaxations, they come with high financial risks that can cost you way more during a medical emergency”. 

“Group insurance plans are tailor-made for larger groups. So, individual factors like lifestyle co-morbidities, habits, past family history and annual income are not evaluated. So, the person is more vulnerable in case of medical trouble. 

Consider this. The average cost of breast cancer treatment in India is about Rs 15,00,000. This includes pre-procedure test costs (up to Rs 1,00,000), drug and treatment costs (up to Rs 10,00,000) and post-hospitalization expenses. So, even if Nitya’s company paid the entire Rs 3,00,000, what about the remaining Rs 12,00,000 that Nitya had to personally pay.

Had she opted for a separate health insurance, she would have had the liberty to choose the sum insured, unlike group cover. With individual health insurance, you can also choose the type of coverage that matters most to you, such as dental, vision, or any specific disease coverage. This level of control is not available in a group policy. 

One of the biggest drawbacks of having just a group insurance plan is the seriously limited choice of the doctors and specialist network you can avail services from. Any professionals out of this list might not be covered by the policy. 

In-between work? Who covers for you?
Group insurance cover is only applicable if you’re working with a company. So, if Nitya had to leave her company due to her medical condition, the group insurance cover will not be extend to her, which means she will end up paying the entire treatment cost from her end. Similarly, if you’re switching jobs, temporarily unemployed, or even self employed, you’d be left without any cover. 

And if you think a plain top-up above employer’s group insurance policy makes up for it, make no mistake. Even if Nitya had brought a top-up worth Rs 5,00,000 over and above the company’s policy, it will not kick in till the company does not pay the insured Rs 3,00,000. 

Had Nitya taken a personal health insurance worth Rs 20,00,000, she could have saved paying Rs 5,00,000 from her own pocket. This figure would have been Rs 8,00,000, if both group and self health insurance comes to force.

Rasal continues, “Most employees are unaware of the terms and conditions, sub-limits, co-pay conditions, and exclusions  of the insurance contract for which all the group members enrolled. Having personal health insurance is important, not just for your health, but for your financial well-being as well”.