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Why Should You Not Rely On Employee Sponsored Health Plans?

Published On Nov 02, 2022 6:28 PM By InsuranceDekho

A working professional who benefits from employer-sponsored health insurance may occasionally take it for granted and fail to pay attention to the terms and conditions that go along with it. This kind of coverage is advantageous in the short term, but in the long run, one has to get independent health insurance in order to stay covered in the long run. 

This is due to the fact that the group health insurance offered by the company frequently falls short of meeting both current and unpredictable future demands. A person with employer health insurance will undoubtedly hesitate before paying more money for a service that is currently covered by their company. To find out more on employee sponsored health plans, read on.

Why Should You Not Rely On Employee Sponsored Health Plans?

Are Employee Sponsored Health Plans Enough For Someone?

Insurance companies will only make the guaranteed payout if it is really necessary. They use the small print in their offer document to safeguard their money, and only fulfil their promises to you once you can no longer find any more fine print to hide behind. Significantly while persuading insurance companies to uphold their commitments under conventional insurance policies is challenging enough, filing a claim under an employer-group policy is even more challenging. By offering their employees insurance policies with the very bare minimum of coverage, businesses and employers also aim to save expenses.

What Are Some Factors That One Should Know About Employee Sponsored Health Plans?

Following are some factors that one should know about employee sponsored health plans -

  1. Co-Payment Clauses - This implies that the insured party will be responsible for the remaining costs of the claim. Since the financial burden is only slightly lessened rather than entirely alleviated, this essentially diminishes the overall value of even having insurance coverage. The majority of conventional insurance policies provide a larger overall amount of financial assistance and do not include co-pay conditions.
  2. Room Rent Caps - This condition essentially states that the hospital will only pay for your room rent every day up to a particular amount or a percentage of the sum insured. . Tenure Of The Policy - You are covered by your corporate health insurance while you are an employee of the company. The coverage will stop the minute your job terminates. Until you find another job, you won't have insurance coverage.
  3. Insured Members - Some employer-sponsored health insurance programmes might not cover your dependant family members. Tl. Additionally, few corporate health insurance plans might not be sufficient if you are responsible for your partner, kids, or elderly parents.
  4. Post-Retirement Cover - Only when you are employed by the firm will you be insured. You won't have the advantage of insurance coverage after retirement, which is when you'll need it the most. It is quite difficult and needs medical testing to obtain a policy after the age of 50. When you purchase a new insurance policy after the age of 50, you must also agree to a clause stating that "pre-existing medical conditions" will not be covered. This clause effectively absolves the insurance company of any liability or responsibility should you end up in the hospital as a result of a condition you had prior to purchasing the policy.


Corporate health insurance provides several benefits, such as minimal waiting periods, low premium costs, and no pre-medical screening, but the coverage level is insufficient to cover all hospitalisation expenses in India. It would be wise to approach your company insurance policy as a backup choice and get a different health insurance plan that gives substantial coverage tailored to your medical needs if you actually want to plan for the future.

Also Read: Offline Or Online: Where To Buy Health Insurance Plans?


This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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