Employee benefits

5 Details of Group Medical Insurance Explained

In order to safeguard the health of employees, most companies would purchase medical insurance for their employees, so that they can work at ease. There are over hundred kinds of group medical insurance plans on the market. For a layman, all group medical insurance plans could look similar. How can employers choose a suitable group medical insurance plan for their employees? What details need to be paid attention to? This article offers 5 details that you should watch out for when choosing a group medical insurance.

What is Group Medical Insurance?

Group medical insurance is a medical insurance plan provided for employees from the company. It is renewed on an annual basis and the underwriting requirements are relatively more relaxed than that of individual insurance. Nowadays, some forms of new group medical insurance will even exempt health declaration of employees from small and medium-sized enterprises (SMEs). In addition to providing basic hospitalisation and surgical protection, companies can mix and match medical insurance schemes according to the number and rank of employees.

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Detail 1: How to choose between inpatient treatment and outpatient treatment?

Coverage of group medical insurance can be divided into inpatient and outpatient treatments. Plans in the market generally offer both inpatient and outpatient benefits, each with different reimbursement limits.


Inpatient benefits provide protection coverage for hospitalisation and surgery, such as in-hospital specialist consultation fees, ICU costs, surgical costs, anesthesiologist’s fees, as well as some extended coverage for organ transplantation, renal dialysis, cancer treatment, and hospital income. To reduce the financial burden of employers and employees, StartupCare SME Group Medical Insurance Plan provides hospital income and cash benefits of up to HK $2000 per day.


Outpatient benefits is one of the most commonly used group medical insurance services, which applies to cases where hospitalisation is not required. In fact, in addition to the general diagnosis and drug costs for Traditional Chinese and Western medicine, "outpatient benefits'' may also cover physiotherapist’s or chiropractor’s visit, bonesetter, acupuncturist’s treatment and even outpatient surgery.


Indeed outpatient benefits are popular, but the level of inpatient coverage is also worth noting. Say if an employee is unfortunately admitted to the hospital, he or she may have to settle this expensive hospital bill. And this is where the amount of coverage comes into play. Therefore, employers are best to understand the team’s needs in order to provide suitable protection.

Detail 2: Can insurance plans be tailor-made according to the needs of employees?

Insurance companies would formulate different package plans for SMEs or startups to easily choose from, which come with pre-defined coverage and premium table.

Nevertheless, the scale of SMEs and startups can range from 3 to 100 employees, while each employee's need for insurance coverage could also differ. Tailor-made plans have therefore been introduced in the market for ease of customisation. In terms of hospital and surgical benefits, companies can increase the reimbursement limit of a certain benefit or request additional benefit items as needed.

Bear in mind the renewal premium of tailor-made plans depends on the overall claim ratio, that is, the higher the insurance claim rate of the team, the higher the renewal premium. That's why tailor-made plans may not be the best for SMEs that wish to control costs. Package plan on the other hand simplify decision-making process and gives better control of the annual renewal premium.


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Detail 3: Are pre-existing conditions of employees covered?

Pre-existing condition refers to when the insured is diagnosed, has obvious symptoms or received treatment from an injury or disease before the insurance policy takes effect, e.g. diabetes, cancer, mental illness. Most of the medical insurance products on the market do not cover pre-existing conditions. Therefore, it is necessary to read the terms and understand your employees' physical conditions before purchasing the insurance.


How about if the employee is already suffering from a condition? In order to avoid having to compensate beyond the original underwriting risks, in case the insured was suffering from latent disease at the time of enrolment, most insurance companies will offer a "waiting period", that is, a specified time starting from the effective date of the insurance policy. Under StartupCare, insured employees will be reimbursed for "pre-existing condition" treatments after the 12-month waiting period starting from the effective date of the policy. During the waiting period, insured employees will still receive other benefits within the insurance coverage.

Detail 4: Hassle-free hospital claims

Some employees often complain not being able to fully claim their hospital expenses, and one of the key reasons is the sub-limits within the insurance coverage. This is the upper limit that caps each of the line item expense, such as surgeon's fees, ward and meal expenses, and hospital miscellaneous expenses. Employees therefore had to go through each expense detail in the hospital, so as to ensure that these do not exceed the respective limits.


Employers can always consider taking out a group medical insurance plan with an annual limit instead of a sub-limit two avoid this situation. As long as the total hospital bill does not exceed the annual maximum limit, employees can receive full reimbursement. StartupCare's Group Medical Insurance offers the choice of annual limit for inpatient benefits, which employees do not have to worry about claim issues under this comprehensive coverage.


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Detail 5: Are e-claims provided?

Small teams of startups and SMEs often have to handle claims by themselves, from filling in the claim application form to submitting the claim supporting documents. These complicated procedures could result in reimbursement being received only after several months the employees have submitted the application.


To accelerate claim process, digital claims have emerged in recent years. Employees can submit claims and upload copies of relevant supporting documents online and via mobile applications. They can also check the progress and make amendments anytime and anywhere, saving time for paperwork and back-and-forth.


In addition to using mobile apps to process claims, employers can also manage employees' medical insurance status via StartupCare one-stop management dashboard. SMEs can now enjoy a seamless work experience - enrol employees, view all policy information and manage employees’ status, all in a few clicks.


Do I need additional personal medical insurance with group medical insurance in place?

You may be satisfied with your group medical insurance, but if you need more comprehensive protection, then additional personal medical insurance is the way to go.


With the rising medical costs in private hospitals, personal medical insurance comes in handy. Besides, employees will no longer have the group medical insurance protection after they leave the company or retire. It is even more likely that retired employees are unable to take out personal medical insurance because of their age or physical condition. It is better to purchase personal medical insurance sooner than later.


You may have heard of a “deductible"  in some insurance products. The premium of these products is generally lower, which is recommended for those who already have group medical insurance. When employees make a claim, they can pay the deductible via the group medical insurance policy, while the remaining expenses to be borne by personal medical insurance. Check out StartupCare's personal and family hospital income plan that offer up to HK$ 1,000 hospital cash benefit per night in addition to your original insurance. In this difficult period, there is also a lump sum cash benefit of HK $50,000 in case of COVID-19, giving you and your team extra protection.


StartupCare is a one-stop digitised insurance platform that helps employers of startups and SMEs to mix and match group medical insurance plans flexibly. Holistic health is at the core of our philosophy, we believe happier and healthier employees would help your business thrives! Click here or email to hk@startupcare.co to learn more about our group medical insurance solutions!

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