Does your Employer’s Health Insurance Cover Your Spouse?

Health insurance is one of the primary needs of an individual these days. Whether it’s just for an individual or the whole family, a health insurance policy ensures that you will get reimbursement for expenses incurred for availing medical treatment at the hospital in the event of a medical emergency.

Even though it’s recommended to have a family health plan to avail cashless treatment at a network hospital, you can benefit from the policy coverage if it covers only you are the policyholder. The policy benefits are also offered in case of an emergency hospitalization. You can get admitted to a nearby network hospital to avail cashless treatment as per the policy terms.

Health Cover by Employer – Group Insurance

Employers provide health cover to their employees to feel safe at the place of work. These policies cover multiple employees under the same benefits, and thus, are called group insurance policies. Generally, the coverage offered by a group insurance policy is limited to the first person only, i.e. the employee. This means that the employee can benefits from the facilities under the policy terms and not his or her family members. In such a case, each employee has to purchase health insurance separately for his or her family, i.e. a family health plan in general. On the other hand, some employers offer health plans that cover immediate family members of the policyholder too. However, the question arises here is whether the coverage offered by group insurance would be sufficient when you had to file a claim.

Does group health insurance cover immediate family members of an insured?

If we talk about health insurance in India, you have two primary options – health insurance for an individual and the family. Such policies are comprehensive and provide adequate coverage to the each person insured. On the other hand, since employers also provide health coverage to their employees, turns out the coverage is not sufficient when you file a claim. This is because all employees are covered for a single sum assured. Besides, the coverage decreases of the others when you file a claim or vice versa. The following example portrays a real-time scenario:

Suppose you and your spouse are working and you have health insurance cover provided by your employer while he/she does not. Now, you wonder if you can include your spouse in your policy while you are not sure about this feature. You can always ask your employer or the insurer directly if there is any such option. If there is (even with an additional premium), you can consider going for it. However, make sure you confirm how much would be the sum assured there for both of you. If the cover is insufficient or inadequate, then it’s better to opt for an affordable standalone policy for additional coverage.

Purchase Health Insurance Online

If you opt for purchasing a standalone health insurance policy for your spouse, you must bear certain points in mind to make sure you get the best out of the plan. A few of such points are listed below:

1.The premium payable for the coverage2.The degree of coverage offered by the policy3.The reachability of network hospitals4.The sum assured

At the same time, do not forget to verify the claim settlement ratio of the company, as this tells you how many claims the company settles out of the received ones.