Corporate health insurance plans its Purpose and Impacts

Corporate health plan

Here we will discuss about the Corporate health insurance plans its benefits and impacts.

The corporate health plan is a health plan contracted by the company for the benefit of employees and, generally, it is contracted by co- payment , in which the organization and employees share the costs of the service.

In other words: in most cases, the company pays the monthly fee and employees pay the fees when using medical services, such as consultations and exams. However, there are other plans, including those paid in full by the institution, and this is chosen according to the reality and needs of each business.

Purpose of Corporate health insurance plans

The corporate health plan covers an organization’s employees, but not just them.

According to the law that governs the topic, the company may also offer the benefit to a series of other people, as long as it is provided for in the contract, such as partners and administrators, retirees, temporary workers, interns, minor apprentices and members of the employee’s family.

The advantage of extending the corporate plan is to reduce absenteeism rates due to absences to treat sick relatives, for example, in addition to being another differentiator for the company, which will be better seen by employees and job candidates.

It is important to say that offering a health plan is not mandatory for the company, as there is nothing provided for in labor legislation. However, it can be interesting for maintaining the  employee’s quality of life  and improving their satisfaction.

What to look for when choosing a health plan?

Before choosing the ideal health plan for your team, it is essential to know what they really need. The health plan must meet the demands of employees and be in accordance with the profile of each of them.

Otherwise, it will not meet the needs, generating dissatisfaction and even losses for the company. So, to choose the best option, survey the following data to guide your choice:

1-Number of employees in each age group

It is important to remember that the age group directly influences the price of the plan. The variation can reach up to 450%,  according to the National Supplementary Health Agency  (ANS), since the older the employee, the higher the monthly fee charged.

Although age ranges are usually standardized, they may vary from one operator to another.

However, it is essential to be alert. The ANS determines that the value of the last installment (people over 59 years of age) cannot be greater than 6 times the value of the first (from 0 to 18 years of age), hence the importance of the research.

2-Gender of employees

The needs of men and women are different and this must be taken into account when contracting a corporate health plan.

Companies with young women (or married men) should offer plans with obstetric services. The same must be observed if the opposite happens, as the company could pay dearly for a service that will not be used.

Furthermore, it is necessary to pay attention to coverage of basic services, specific to men and women, such as gynecological and urological services.

3-Marital status and number of children of employees

At the beginning of the article, we talked about the advantages of taking out a plan that also includes the employee’s dependents. This is possible for those who have spouses or partners, children up to 21 or 24 years old, attending higher education, grandparents, grandchildren, great-grandparents and great-grandchildren.

To include the family nucleus, the company must request proof of ties, such as birth and marriage certificates or proof of stable union.

4-Geographic coverage

It is important to define a level of coverage — whether municipal, state, national or by region — that is appropriate to the employee’s needs.

Companies with many external collaborators, or that carry out activities in different parts of the country, can opt for a more comprehensive plan. This will guarantee service, even if far from the company’s headquarters.

5-Number of employees with chronic illnesses

Some companies have the abusive practice of dismissing employees who discover they have  chronic diseases , such as diabetes, Alzheimer’s and hypertension.

The issue is delicate for both employer and employee and requires common sense from both parties, as ideally there should be support for the employee in this condition.

However, be aware of some illnesses that may make it difficult to take out a health plan for a particular beneficiary or make treatment more expensive.

6-Referenced network

The set of hospitals, clinics and diagnostic centers that will serve beneficiaries is called a referenced network. It is important to check that the contracted plan offers a wide range of medical services and that there is no variation in this coverage.

A good network is one that offers establishments close to employees’ places of work and residence and that are a reference in service.

Another possibility is to purchase plans that offer a refund option. It may be that the employee wants to be accompanied by a doctor they trust or has a preference for a specific medical center that is not within the accredited network.

In this case, the employee will pay for the expense and then provide proof of the expense that will be covered by the health plan.

Why the health plan stands out among the most valued benefits

If, before going through the covid-19 pandemic, access to health services — including health insurance — led the research carried out with market professionals, during the crisis, expectations for the post-pandemic period are no different.

A study carried out by a consultancy in Human Resources found that traditional benefits, such as medical assistance and health insurance, are among the most valued by professionals, with medical assistance being the most important corporate benefit for 77.8%.

Among the main reasons for this preference is the lack of access to health services , especially in relation to supplementary health. During the pandemic, the fear of falling ill and needing hospital care contributed to this service becoming even more relevant for professionals and their families.

Why your company should bet on health benefits

If, on the one hand, health benefits help in the daily lives of employees and represent savings with this type of service, on the other, companies also have several advantages. We’ve listed a few below.

1- It raises the competitive edge and reinforces employer branding

Have you noticed how not all companies offer health plans to their employees? This is because hiring good benefits, such as those in the health area, requires a high investment. So much so that the health plan is the most expensive benefit for organizations.

This is a competitive advantage and one that adds more value to the company in the labor market, improving its employer branding . When a professional has to choose between the most relevant company to work for, the one that offers good benefits will certainly come out ahead.

2-Increases company reliability

Employees who have health benefits from the organization understand that this is a company investment in their work, well-being and professional development.

3-Improves productivity rates

Consequently, when workers believe in how much the company values ​​them and can count on the savings obtained from these benefits, they feel more motivated and engaged with the activities and are able to produce more.

What are the impacts of the health plan offer for employees

Previously, we said that health benefits are among the most desired by employees , right? However, despite having a relatively high cost, they cost less than switching employees.

The entire process of attracting and hiring talent is more costly than investing in good benefits and retaining those who are already on the team, as this involves costs such as:

  • negotiation of new salaries;
  • payment of labor rights such as INSS and FGTS for a new employee;
  • indemnities and fines with the contract termination process;
  • all the necessary procedures to publicize the vacancy, as well as the carrying out of dynamics and interviews. These are activities that, in addition to resulting in more financial expenses, also demand an expense of time.

How to evaluate the coverage offered?

The coverage of a health plan is the list of medical procedures that are covered by the contract, such as: consultations, exams, hospital admission, childbirth and surgeries.

There are different types of plans and each of them has a different type of coverage. The ANS regulates the minimum mandatory procedures that plans must have through a list called the List of Health Procedures and Events. See:

1-Reference plane

It is the most complete type of plan and must offer medical care, laboratory tests, imaging, treatments, hospitalizations, obstetrics and surgeries. Includes comprehensive urgent and emergency care, after 24 hours of hiring, and accommodation in an infirmary.

2-Outpatient plan

It comprises basic medical services in clinics, offices, diagnostic and examination clinics. It must offer medical consultations of various specialties and also hospital admission for a maximum period of 12 hours, hemodialysis, chemotherapy, if there is no need for hospitalization, radiotherapy under the same conditions and ophthalmological surgeries.

3-Hospital plan

It is one that offers hospital care with hospitalization, surgeries and coverage of all services that are necessary for this. The law does not allow a maximum time for the beneficiary to be hospitalized to be implemented.

4-Hospital plan with obstetrics

It offers the same coverage as the hospital plan, but includes prenatal care, hospitalization for childbirth, postpartum medical services and care for the newborn baby for 30 days.

5-Dental plan

The segmentation with dental services covers consultations, exams, urgent and emergency care and treatments requested by the dentist;

In which cases can the contract be terminated?

The conditions for terminating the service must be set out in the contract signed between the company and provider. Still, some special conditions must be taken into account.

Without the contracting company’s agreement, the contract can only be interrupted due to fraud or, after one year, with 60 days’ notice. The same goes for the company you hired.

In the employer-employee relationship, those who cease to be employees of the company cease to be beneficiaries of the plan (with the exception of those laid off and retired who, as we will see, follow another rule). Dependents will stop benefiting from the plan when they no longer meet the requirements for this, such as turning 21 years of age or in the event of separation.

Retirees and laid-off people deserve special attention. Those who are dismissed without just cause are required to maintain the plan as long as it is also offered to active employees, as long as they are not hired into a new job. The same goes for retirees. But, to do so, he must meet some conditions:

  • having contributed, in part, to the plan, when on active duty;
  • assume full payment of the benefit;
  • formalize maintenance after 30 days of the company’s announcement.

The corporate health plan is an important benefit not only for employees, but also for the organization. Employees need to have quality medical care that helps them take care of their health, allowing them to work longer and better.

In this way, companies benefit from increased productivity and satisfaction levels, reduced absence and absenteeism rates and the  attraction of new talent .

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