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Group Health insurance policy is usually taken by the employer of an organization to cover their employees which can be extended to the family of the employees. The group health insurance premium is usually paid by the employer as a part of the employee benefits offered to the employees. But in certain situations, the group health insurance premium would be collected from the employees either fully or partially depending on the agreement between the employees and the employer.
Scenario 1: No pay- No Cover: –
The first scenario is when the group health insurance premium is not paid by the employer to the insurance company. In this case there would be no health insurance cover available to the employees and their families. No pay, no cover would be exercised by the insurance company. As per the insurance act, insurance cover shall be provided only after the receipt of premium.
If the employee has not paid his/her share of the premium, then the employer can prevent the employee from having health insurance cover. It would usually be not participating from the employee’s end where the employee would not pay the premium and not participate in the group health insurance cover.
Scenario 2: – No pay – Full Cover:-
This scenario arises when the employer pays the premium on behalf of the employee to the insurance company and the employee enjoys the health cover as suggested by Ethika Insurance. Employers provide health insurance cover to employees as a part of employee benefits where the premium would be paid by the employer completely and the employee enjoys the health insurance cover.
Most of the large scale organizations provide health insurance cover to employees without deduction of any amount from the salary of employees. This is done as a part of the employees benefits such as Provident fund, life insurance, accident insurance and health insurance etc.
Scenario 3: – No pay – Partial cover:-
In this scenario, the employee might be covered under the basic health insurance policy but to cover the dependents the employee might be asked to bear the premium. If the employee is not willing to pay his share of the group health insurance premium to cover family members then the health care cover would be limited to the employee only as per the policy of the company.
Most of the organizations include the family members of employees on payment of additional premium. It is a participating policy where the employee can decide to opt in or out of the group health insurance policy. If the employee decides to opt out, then the health care cover would not be provided to the family members of the employee.
Scenario 4: – No pay – Policy lapse:-
This is the scenario where the insured does not pay the renewal premium on time. In this case the group health insurance policy will expire, and a new group health insurance policy has to be taken by the insured. The health care cover would not be available to the members if the premium is not paid on time and Renewal is not done.
