Hi All,
I am working with Singapore based company. Want to know about medical insurance plan for employee. Employee strength is less than ten in India.
Can anybody suggest me any medical insurance plan for employee.
Kind Regards,
Mayura
From India, Mumbai
I am working with Singapore based company. Want to know about medical insurance plan for employee. Employee strength is less than ten in India.
Can anybody suggest me any medical insurance plan for employee.
Kind Regards,
Mayura
From India, Mumbai
25
Hi Mayura,
Pls let me know your contact information or you may share your query at www.amarverma.com/forum/index.php
best reg.
Verma, Amar N.
From India, Delhi
Pls let me know your contact information or you may share your query at www.amarverma.com/forum/index.php
best reg.
Verma, Amar N.
From India, Delhi
Hi Mayura,
We have a floater policy wherein our employees & their family members are covered into it. It basically covers (5+1) i.e employee, parents(both), spouse, two children.
It really helps if ypur employees are not earning much salarie. I am not aware about the grades/levels there but these things you need to consider.
let me know your doubts are clear/ not.
Mitr
From Spain
We have a floater policy wherein our employees & their family members are covered into it. It basically covers (5+1) i.e employee, parents(both), spouse, two children.
It really helps if ypur employees are not earning much salarie. I am not aware about the grades/levels there but these things you need to consider.
let me know your doubts are clear/ not.
Mitr
From Spain
there should not be any difference based on grade in case of medical. Medical emergencies are applicable to all irrespective of Grade/level. So go for a policy common for all and it is quiet easy when the group is small but you may not get the best deal from the Insurance companies.
rgds
From India, Mumbai
rgds
From India, Mumbai
Hi, Mayura,
Hope the below policy can be help.
HEALTH CARE PLANS
I. GENERAL
Comprehensive medical coverage is provided through Hospitalization, Medical-Surgical, Major Medical Expense and Major Dental Expense Insurance Plans offered as a package or through Health Maintenance Organizations O-TMO) available as an option at an employee's request. Eligible employees are covered by medical plans and to elect the health care plan offered by the Company or by the Health Maintenance Organization automatically to participate in the Company's Major Dental Expense Plan.
Active employees between the ages of 65 and 69 may choose the medical coverage they prefer, either Medicare or the Health Care Plan. This choice is also required for the spouses of employees who are in the same age category.
The choice of the Health Care Plan provides the employee with primary coverage under this plan. Medicare will provide secondary coverage for eligible expenses not covered by the Company plan. If Medicare is chosen as the primary insurer, the employee has only this coverage. Additional information may be obtained from the HR Department.
A. Medical Benefits.
The benefits provided under the health care plans are as follows:
1. Hospitalization.
The Plan provides full hospital care, including bed, board and other services, for up to 365 days in a semiprivate room. Outpatient care for accidents and emergencies, such as sudden and serious illness as well as minor surgery, are also covered by the plan. Pre-surgical testing is also available.
2. Medical-Surgical.
Surgical and anesthetic procedures resulting from injury or sickness, including child-birth, are covered under a plan that reimburses covered employees for reasonable and customary fees charged in various geographic areas. Surgery may be performed in a hospital or a doctor's office. Emergency outpatient treatment is covered by the Plan when these services are contracted out by the hospital to an independent physician or professional corporation, and are not covered by the Hospitalization Plan.
3. Major Medical Expense Insurance.
To supplement Hospitalization and Medical-Surgical benefits, Major Medical coverage offers protection in the event of extraordinary medical expenses arising from serious injury or prolonged illness. This coverage also provides benefits for medical expenses outside the scope of Hospitalization and Medical-Surgical insurance, such as charges for prescription drugs and psychiatric care.
After the deductible has been met, the Major Medical Plan pays 80 percent of the first $ of eligible medical expenses incurred in a calendar year and 100 percent of eligible expenses beyond that. In total, the Plan limits the individual's eligible, annual out-of-pocket costs to $ of eligible expenses. Payment for outpatient psychiatric treatment is 80 percent of the reasonable and customary fee for the first 10 visits in a calendar year, 60 percent for the second 10 visits, and 50 percent for the third 10 visits in a calendar year. The maximum amount reimbursable in any one year is $__ . The individual deductible is the first $ of eligible expenses paid by the employee during a calendar year. The family deductible is the first $ of eligible expenses collectively incurred by covered family members (not counting more than $ for any one person) during a calendar year. Once the family deductible is satisfied all covered family members will be eligible for benefits for the remainder of the year without the necessity of meeting additional deductibles.
Maximum lifetime coverage under the Major Medical Plan is $ for each individual for all causes. Each January 1, benefits of up to $1,000 charged against the maximum coverage (except for psychiatric services which are limited to $ ) are automatically restored to the individual's coverage for future use.
The Plan excludes expenses for services, treatment and supplies provided under Hospitalization and Medical-Surgical Plans or under Medicare. For this purpose it is assumed that the individual, if eligible for Medicare, has enrolled in both Parts A and R of that program. The Plan also contains a provision coordinating benefits with those received under other health care plans so that the total benefits do not exceed 100 percent of the allowable expenses. Benefits that are coordinated include medical and dental coverage under a governmental program or provided or required by statute, and group insurance or other coverage for a group of individuals, including student coverage obtained through an educational institution above the high-school level.
4. Major Dental Expense Plan.
The Plan is designed to help pay for complex and costly dental expenses rather than those dental services which are routine and can be normally budgeted. The Plan pays 50 percent of eligible Major dental expenses incurred in a calendar year, excluding the appropriate deductible for an individual or a family. The individual deductible is the first $ of eligible expenses paid by the employee during a calendar year. The family deductible is the first $ of eligible expenses collectively incurred by covered family members (not counting more than $ for any one person) during a calendar year. Once the deductible is satisfied, covered family members are eligible for benefits for the remainder of that calendar year. A maximum of $ expenses per covered member is allowable each benefit year.
Among those services covered by the Plan is orthodontia for a dependent child under age 19 which is needed to correct the child's bite, not primarily for cosmetic purposes. Payments begin with the first appliance installation and continue in quarterly payments until the treatment is completed, or when the $ lifetime maximum for orthodontia is reached, or when the child no longer meets the Plan's eligibility requirements, whichever occurs first.
Eligible dental services are those services which are 1) listed on the back of the dental claim form, 2) part of the dentist's proposed course of treatment, and 3) not excluded in the section of the Plan entitled "Exclusions under Dental Benefits."
An additional resource for meeting Major dental expenses which are not covered by the Plan or whose cost exceed the Plan's limit of payment is a Profit Sharing Plan Withdrawal or loan.
B. Maternity Coverage
The health care plans offer maternity coverage for women who are insured as an employee or dependent.
C. Program for Elective Surgical Second Opinion (PRESSO)
Employees and their dependents who are enrolled in the Company's health care plans may use PRESSO to obtain a second opinion as to whether recommended elective surgery is the most appropriate course of action. The total cost of a second opinion, including fees for office visits, laboratory tests and x-rays, is covered by the program. An employee is not required to follow the second surgeon's advice in order to qualify for benefits provided under the Company's health care plans.
PRESSO is presently available only in the certain area of the city. The service is obtained by telephoning the Second Opinion Referral Center. Eligible employees outside the city area must travel to the city at their own expense until PRESSO services are available in their areas.
II. PROCEDURE
The following provisions apply to all three health care plans unless otherwise stated.
A. Eligibility
Exempt and non-exempt full-time and salaried part-time employees are eligible for coverage under the health care plans at the date of hire. Employees who elect to begin health care plan coverage upon employment pay the full cost of the coverage for the first three months. After three months of employment the cost of coverage is shared by the employee and the Company.
Eligible dependents include the employee's spouse (unless legally separated) and unmarried children less than 19 years old, including legally adopted children, foster children and stepchildren. Unmarried children 2 9 years old but less than 23 years old are eligible if they are full-time students who wholly depend on the employee for support and maintenance. In addition, a dependent unmarried child covered prior to the age of 19 who is mentally or physically incapable of self-support may receive medical benefits past the age of 19 until eligible for Medicare provided the employee's coverage remains in effect, the child's condition remains the same, and the HR Department is notified of this condition within 30 days of the child's nineteenth birthday.
If a dependent other than a newborn child is confined for medical care in an institution or at home when coverage would normally start, the dependent will not be covered by the Medical-Surgical and Major Medical Expense Insurance Plans until a final release from confinement is given by a doctor.
B. Contributions
The rates for medical insurance depend upon the coverage -- individual or family (employee and one or more dependents). The Company pays most of the cost of medical insurance. Participating employees contribute the remainder of the cost through payroll deductions, which are adjusted the first pay period of each July to the extent of 25 percent of the actual increase in the cost incurred in the previous calendar year.
C. Identification Cards
Identification cards are issued for the Hospitalization Plan providing the number of the Company and an individual identification number. Identification cards are not required for the Medical-Surgical and Major Medical Expense Insurance Plans which are self-insured by the Company and administered by the Insurance Company.
D. Claims Processing
The claims are processed by the hospital. Medical-Surgical and Major Medical claims are processed on the same form, which is obtained from supervisors and submitted directly to the Insurance Company. Dental claims forms may also be obtained from the supervisor and submitted to the Insurance Company.
E. Termination of Employment
The employee's medical insurance is modified or discontinued (depending on the reasons for termination of employment) as follows:
1. Retirement.
Hospitalization and Medical-Surgical coverage cease for the employee or spouse at the age of eligibility for Medicare. These coverage are carried without contribution until that age in the event of the early retirement of the employee. Under the Major Medical Expense Insurance Plan, retired employee with a minimum of five years of continuous service prior to retirement receive non-contributory modified coverage with a maximum lifetime payment of $ . Additional requirements for this coverage will include participation in either a Health Maintenance Organization (HMO) or the Company Health Care Plan for one year for retirements, up to five years for retirements. When the employee retires, the spouse, covered children under 19 and covered children who are full-time students up to the age of 23 are eligible for Medical benefits. The coverage of eligible dependents continues after the death of the retired employee. Major Dental Expense coverage is discontinued at retirement.
2. Other Terminations.
When employment terminates for reasons other than retirement, the Company's group policies for Hospitalization and Medical-Surgical Expense Insurance Plans may be converted to Individual policies on a direct-payment basis. The conversion privilege for the Medical-Surgical Plan, however, is available only to individuals who have been covered under the group insurance policy for at least three months. Conversion applications are provided at the exit interview.
For simplicity and better understanding, the health care plans have been described in this manual in rather general terms. The benefits are explained in greater detail in the booklet which is given to employees. The extent of each employee and dependent's insurance is governed at all times by the complete terms of the group policies issued by Company and Insurance Company.
Best regards,
John
From China, Shanghai
Hope the below policy can be help.
HEALTH CARE PLANS
I. GENERAL
Comprehensive medical coverage is provided through Hospitalization, Medical-Surgical, Major Medical Expense and Major Dental Expense Insurance Plans offered as a package or through Health Maintenance Organizations O-TMO) available as an option at an employee's request. Eligible employees are covered by medical plans and to elect the health care plan offered by the Company or by the Health Maintenance Organization automatically to participate in the Company's Major Dental Expense Plan.
Active employees between the ages of 65 and 69 may choose the medical coverage they prefer, either Medicare or the Health Care Plan. This choice is also required for the spouses of employees who are in the same age category.
The choice of the Health Care Plan provides the employee with primary coverage under this plan. Medicare will provide secondary coverage for eligible expenses not covered by the Company plan. If Medicare is chosen as the primary insurer, the employee has only this coverage. Additional information may be obtained from the HR Department.
A. Medical Benefits.
The benefits provided under the health care plans are as follows:
1. Hospitalization.
The Plan provides full hospital care, including bed, board and other services, for up to 365 days in a semiprivate room. Outpatient care for accidents and emergencies, such as sudden and serious illness as well as minor surgery, are also covered by the plan. Pre-surgical testing is also available.
2. Medical-Surgical.
Surgical and anesthetic procedures resulting from injury or sickness, including child-birth, are covered under a plan that reimburses covered employees for reasonable and customary fees charged in various geographic areas. Surgery may be performed in a hospital or a doctor's office. Emergency outpatient treatment is covered by the Plan when these services are contracted out by the hospital to an independent physician or professional corporation, and are not covered by the Hospitalization Plan.
3. Major Medical Expense Insurance.
To supplement Hospitalization and Medical-Surgical benefits, Major Medical coverage offers protection in the event of extraordinary medical expenses arising from serious injury or prolonged illness. This coverage also provides benefits for medical expenses outside the scope of Hospitalization and Medical-Surgical insurance, such as charges for prescription drugs and psychiatric care.
After the deductible has been met, the Major Medical Plan pays 80 percent of the first $ of eligible medical expenses incurred in a calendar year and 100 percent of eligible expenses beyond that. In total, the Plan limits the individual's eligible, annual out-of-pocket costs to $ of eligible expenses. Payment for outpatient psychiatric treatment is 80 percent of the reasonable and customary fee for the first 10 visits in a calendar year, 60 percent for the second 10 visits, and 50 percent for the third 10 visits in a calendar year. The maximum amount reimbursable in any one year is $__ . The individual deductible is the first $ of eligible expenses paid by the employee during a calendar year. The family deductible is the first $ of eligible expenses collectively incurred by covered family members (not counting more than $ for any one person) during a calendar year. Once the family deductible is satisfied all covered family members will be eligible for benefits for the remainder of the year without the necessity of meeting additional deductibles.
Maximum lifetime coverage under the Major Medical Plan is $ for each individual for all causes. Each January 1, benefits of up to $1,000 charged against the maximum coverage (except for psychiatric services which are limited to $ ) are automatically restored to the individual's coverage for future use.
The Plan excludes expenses for services, treatment and supplies provided under Hospitalization and Medical-Surgical Plans or under Medicare. For this purpose it is assumed that the individual, if eligible for Medicare, has enrolled in both Parts A and R of that program. The Plan also contains a provision coordinating benefits with those received under other health care plans so that the total benefits do not exceed 100 percent of the allowable expenses. Benefits that are coordinated include medical and dental coverage under a governmental program or provided or required by statute, and group insurance or other coverage for a group of individuals, including student coverage obtained through an educational institution above the high-school level.
4. Major Dental Expense Plan.
The Plan is designed to help pay for complex and costly dental expenses rather than those dental services which are routine and can be normally budgeted. The Plan pays 50 percent of eligible Major dental expenses incurred in a calendar year, excluding the appropriate deductible for an individual or a family. The individual deductible is the first $ of eligible expenses paid by the employee during a calendar year. The family deductible is the first $ of eligible expenses collectively incurred by covered family members (not counting more than $ for any one person) during a calendar year. Once the deductible is satisfied, covered family members are eligible for benefits for the remainder of that calendar year. A maximum of $ expenses per covered member is allowable each benefit year.
Among those services covered by the Plan is orthodontia for a dependent child under age 19 which is needed to correct the child's bite, not primarily for cosmetic purposes. Payments begin with the first appliance installation and continue in quarterly payments until the treatment is completed, or when the $ lifetime maximum for orthodontia is reached, or when the child no longer meets the Plan's eligibility requirements, whichever occurs first.
Eligible dental services are those services which are 1) listed on the back of the dental claim form, 2) part of the dentist's proposed course of treatment, and 3) not excluded in the section of the Plan entitled "Exclusions under Dental Benefits."
An additional resource for meeting Major dental expenses which are not covered by the Plan or whose cost exceed the Plan's limit of payment is a Profit Sharing Plan Withdrawal or loan.
B. Maternity Coverage
The health care plans offer maternity coverage for women who are insured as an employee or dependent.
C. Program for Elective Surgical Second Opinion (PRESSO)
Employees and their dependents who are enrolled in the Company's health care plans may use PRESSO to obtain a second opinion as to whether recommended elective surgery is the most appropriate course of action. The total cost of a second opinion, including fees for office visits, laboratory tests and x-rays, is covered by the program. An employee is not required to follow the second surgeon's advice in order to qualify for benefits provided under the Company's health care plans.
PRESSO is presently available only in the certain area of the city. The service is obtained by telephoning the Second Opinion Referral Center. Eligible employees outside the city area must travel to the city at their own expense until PRESSO services are available in their areas.
II. PROCEDURE
The following provisions apply to all three health care plans unless otherwise stated.
A. Eligibility
Exempt and non-exempt full-time and salaried part-time employees are eligible for coverage under the health care plans at the date of hire. Employees who elect to begin health care plan coverage upon employment pay the full cost of the coverage for the first three months. After three months of employment the cost of coverage is shared by the employee and the Company.
Eligible dependents include the employee's spouse (unless legally separated) and unmarried children less than 19 years old, including legally adopted children, foster children and stepchildren. Unmarried children 2 9 years old but less than 23 years old are eligible if they are full-time students who wholly depend on the employee for support and maintenance. In addition, a dependent unmarried child covered prior to the age of 19 who is mentally or physically incapable of self-support may receive medical benefits past the age of 19 until eligible for Medicare provided the employee's coverage remains in effect, the child's condition remains the same, and the HR Department is notified of this condition within 30 days of the child's nineteenth birthday.
If a dependent other than a newborn child is confined for medical care in an institution or at home when coverage would normally start, the dependent will not be covered by the Medical-Surgical and Major Medical Expense Insurance Plans until a final release from confinement is given by a doctor.
B. Contributions
The rates for medical insurance depend upon the coverage -- individual or family (employee and one or more dependents). The Company pays most of the cost of medical insurance. Participating employees contribute the remainder of the cost through payroll deductions, which are adjusted the first pay period of each July to the extent of 25 percent of the actual increase in the cost incurred in the previous calendar year.
C. Identification Cards
Identification cards are issued for the Hospitalization Plan providing the number of the Company and an individual identification number. Identification cards are not required for the Medical-Surgical and Major Medical Expense Insurance Plans which are self-insured by the Company and administered by the Insurance Company.
D. Claims Processing
The claims are processed by the hospital. Medical-Surgical and Major Medical claims are processed on the same form, which is obtained from supervisors and submitted directly to the Insurance Company. Dental claims forms may also be obtained from the supervisor and submitted to the Insurance Company.
E. Termination of Employment
The employee's medical insurance is modified or discontinued (depending on the reasons for termination of employment) as follows:
1. Retirement.
Hospitalization and Medical-Surgical coverage cease for the employee or spouse at the age of eligibility for Medicare. These coverage are carried without contribution until that age in the event of the early retirement of the employee. Under the Major Medical Expense Insurance Plan, retired employee with a minimum of five years of continuous service prior to retirement receive non-contributory modified coverage with a maximum lifetime payment of $ . Additional requirements for this coverage will include participation in either a Health Maintenance Organization (HMO) or the Company Health Care Plan for one year for retirements, up to five years for retirements. When the employee retires, the spouse, covered children under 19 and covered children who are full-time students up to the age of 23 are eligible for Medical benefits. The coverage of eligible dependents continues after the death of the retired employee. Major Dental Expense coverage is discontinued at retirement.
2. Other Terminations.
When employment terminates for reasons other than retirement, the Company's group policies for Hospitalization and Medical-Surgical Expense Insurance Plans may be converted to Individual policies on a direct-payment basis. The conversion privilege for the Medical-Surgical Plan, however, is available only to individuals who have been covered under the group insurance policy for at least three months. Conversion applications are provided at the exit interview.
For simplicity and better understanding, the health care plans have been described in this manual in rather general terms. The benefits are explained in greater detail in the booklet which is given to employees. The extent of each employee and dependent's insurance is governed at all times by the complete terms of the group policies issued by Company and Insurance Company.
Best regards,
John
From China, Shanghai
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