Employee Benefits Insurance

In short

An employee benefits programme usually combines three covers: group health insurance for hospitalisation, group personal accident for accidental death and disability, and group term life for a lump sum to the family. They are bought together because each one covers what the others do not.

Overview

Benefits are judged by employees on one day: the day someone tries to use them. That is why we spend as much time on the claims desk, the hospital network and the enrolment process as on the premium.

We design the structure - who is covered, whether parents are included, what the sum insured is, what room rent and co-pay apply - then take it to the market and manage enrolment, e-cards, additions, deletions and claims through the year.

What is covered, and what is not

Typically covered

Group health: hospitalisation for employees and, where chosen, spouse, children and parents
Maternity benefit, where added
Pre-existing conditions, usually covered from day one in group schemes
Group personal accident: accidental death, permanent and temporary disability, 24 hours a day
Group term life: a lump sum, typically a multiple of annual salary
Mid-term additions for new joiners and new dependents

Typically excluded

Cosmetic and elective treatment
Treatment outside the policy's hospital definition
Self-inflicted injury and intoxication-related claims under accident cover
Suicide within the first year under most life policies
Dependents not declared before the claim

Cover and exclusions vary by insurer and by the wording issued for your risk. We confirm the exact terms on the quotation before you buy.

Who needs this cover

Any employer of ten or more people, and smaller employers competing for skilled staff. In many sectors a medical policy is now the first question a candidate asks about.

Why buy this through Trust Cover

Insurer-neutral advice

Quotations from several insurers, compared on wording and claims record, not premium alone.

Exclusions explained first

You see what is not covered before you buy, in plain language.

Claims handled by us

We prepare the file, submit it and chase settlement on your behalf.

How a claim works

Cashless: the employee shows the e-card at a network hospital and the TPA desk raises pre-authorisation. Tell us at the same time and we follow it.
Reimbursement: keep all original bills, discharge summary and investigation reports.
Submit within the policy timeline - late submission is a common rejection reason.
We track the claim with the insurer or TPA and challenge unfair deductions.

Documents you will need

Employee census: name, date of birth, gender, date of joining, dependent details
Headcount by grade and annual salary for life and accident sizing
Previous policy and claims history, if any
Your dependent policy: spouse and children only, or parents too

Working with us

We are insurer-neutral. For every enquiry we approach multiple insurers, compare the wordings as well as the premiums, and tell you where they differ on the points that decide a claim.

After the policy is issued we stay involved: endorsements, mid-term changes, renewal reminders that start ninety days before expiry, and claims that we prepare, submit and follow to settlement.

Employee Benefits - frequently asked questions

What is the minimum group size for a group health policy?

It varies by insurer. Many will write a group scheme from around seven to ten employees, and some go lower where the structure is straightforward. We will tell you which insurers will look at your headcount.

Can employees add their parents to the group policy?

Usually yes, either included in the corporate structure or on a voluntary basis where the employee pays the additional premium. Parental cover is the single biggest driver of group medical premium, so it is worth modelling both ways.

How are new joiners added during the year?

By endorsement. You send us the details, we file the addition with the insurer and the employee is covered from the effective date. Our system tracks additions and deletions so nothing is missed at renewal.

What happens to cover when an employee leaves?

Cover ends on the date of exit, and the member is removed by endorsement. Some insurers allow the employee to convert to an individual policy - worth asking about, because it preserves continuity.

Are pre-existing conditions covered under a group policy?

In most group schemes yes, from day one, which is the main advantage of group cover over an individual policy. It depends on the terms negotiated with the insurer.