In India, many salaried individuals rely entirely on the health insurance provided by their employer. It seems convenient. You do not have to fill out long forms or compare policies. The premiums are often paid by the company. And you get a sense of security just by being covered. But this sense of security may not always match the actual protection you need.
Employer group insurance has its advantages, but it also comes with several limitations. These limitations can leave significant coverage gaps. If you do not plan for them in advance, you may face financial stress during a medical emergency. Let us understand what these gaps are and how to address them.
1. The Cover Ends When the Job Does
The most common issue with employer health cover is that it ends when you leave the job. Whether you resign, retire or are laid off, the policy stops. In such moments, you may not have any other plan in place. Starting a new plan at that time can be expensive, especially if you are older or have medical issues.
What you can do:
Buy an individual health policy early in life. This gives you long-term protection. Keep it active even when your employer offers group insurance. That way, you will always have a backup.
2. One Policy Cannot Suit Everyone
Employer insurance covers all employees under the same terms. A young graduate and a married employee with children may get the same sum insured and features. But health needs vary. Some may need maternity benefits. Others may need regular OPD consultations. A single, standard policy cannot meet all these needs.
Solution:
Consider buying a personal plan that matches your stage of life. Choose features that matter to you. You can also use a term plan calculator to decide how much cover your family needs in case of a health crisis or loss of income due to illness.
3. No Say in the Coverage Details
Employers choose the insurer, decide the sum insured and handle the terms. As an employee, you do not have much control. If the company reduces the cover to save cost or switches to a lesser-known insurer, you cannot object. Your benefits can change overnight without your input.
To gain more control:
Get your own plan where you can select the provider, hospital network, claim limits and add-on options. This gives you peace of mind and stability.
4. The Cover May Not Be Enough
In India, the average group health cover ranges from Rs. 2 to 5 lakhs. This may be fine for minor hospitalisation. But for serious treatments like cancer, cardiac surgery or intensive care, the cost can cross Rs. 10 lakhs. Once the group cover limit is exhausted, the remaining bill must be paid by you.
Tip:
Buy a super top-up plan in your name. It adds an extra layer of protection once your base cover runs out. It is also more affordable than buying a large individual policy from the start.
5. No Tax Benefit for You
The premium for group insurance is paid by your employer. So, you cannot claim it under Section 80D. You miss the opportunity to reduce your taxable income even though you are technically insured.
What to do instead:
Purchase a separate health policy for yourself or your parents. This way, you can claim tax deductions and also build long-term protection.
6. Hospital Choices May Be Limited
Group insurance often ties you to a limited set of hospitals. If your preferred doctor or hospital is outside this network, you may not get cashless service. Or you may have to pay a large part of the bill yourself.
Fix this by:
Checking the network list in your policy. And choose an individual plan that includes your preferred hospitals. Look for one with a wide or pan-India network, especially if you travel often or live in a different city from your hometown.
7. No Portability Across Jobs or Locations
Group plans cannot be transferred. If you switch jobs, move to a new city or start your own business, the policy does not follow you. You need to find new coverage each time, which may lead to delays, new waiting periods or uncovered conditions.
How to stay protected:
Keep a personal policy active alongside your employer plan. It will give you uninterrupted coverage no matter where you work or live.
Build a Personal Safety Net Before You Need It
It is easy to assume your employer’s policy is enough. But health emergencies do not wait for job stability. The real risk lies in being underprepared. That is why you need to build your own personal cover alongside the one provided at work.
Start small if needed, but start early. Choose your own insurer. Review your plan each year. Make sure your family is also covered. Group insurance should be the first layer of protection, not the only one.
In a world where healthcare costs are rising with inflation and careers are more fluid than ever, having full control over your health cover is no longer optional. It is essential.