Employer Health Insurance Schemes: Is Your Work Plan Still the Right Cover for You?
Having access to health insurance through your employer can be a valuable workplace benefit.
Your employer may arrange a group scheme, contribute towards the cost of your health insurance or, in some cases, pay the premium.
But there's an important question employees should still ask: Is the health insurance plan available through work actually the right plan for me?
Being part of an employer scheme doesn't remove the need to understand your cover and review whether it suits your circumstances.
What Is a Group Health Insurance Scheme?
A work group scheme is a health insurance arrangement organised or administered through an employer.
Importantly, being part of a group scheme doesn't necessarily mean your employer pays the full cost of your insurance.
The exact arrangement will depend on your employer and the scheme available.
Insurers may also offer group discounts. Under current Irish health insurance rules, a group discount of up to 10% can be offered on a policy at the insurer's discretion.
Is a Company Plan Only Available Through an Employer?
Not necessarily.
The Health Insurance Authority defines a company plan as a health insurance policy marketed towards companies, but confirms that anyone can buy a company policy even if they are not an employee of that company.
This is an important distinction because consumers sometimes assume that policies described as "company" or "corporate" plans are exclusively available through employers.
Start by Understanding What You Have
If your employer provides or contributes towards health insurance, find out exactly what plan you're on and what it includes.
Don't judge the policy solely on the fact that it's available through work.
Look at the actual benefits.
For example:
- Which hospitals are covered?
- What level of accommodation is covered?
- Are inpatient excesses applicable?
- What outpatient or day-to-day benefits are available?
- What limits apply to those benefits?
- Are there shortfalls for particular hospitals or treatments?
The answers can help you establish whether the policy fits your own healthcare priorities.
Does the Same Plan Suit Your Whole Family?
If your spouse, partner or children are included on your health insurance, it's also worth considering whether everyone needs exactly the same cover.
Different family members can have different healthcare priorities.
Rather than automatically placing everyone on one plan, review what each person needs and investigate the options available.
The goal should be to make sure you're paying for cover that makes sense for the people actually using it.
Look at More Than Your Employer's Contribution
If your employer pays some or all of your health insurance premium, that's naturally an important factor.
But the cost to you shouldn't be the only consideration.
A plan can be inexpensive from your perspective because your employer contributes towards it, while still not providing the level of cover you would personally prefer.
Consider both sides of the equation: what is the policy costing you, and what cover are you receiving in return?
Can You Choose a Different Health Insurance Plan?
The options available through a workplace scheme will depend on the particular arrangement.
However, it's worth asking your employer, benefits provider or insurer what choices are available rather than assuming the default plan is your only option.
There may also be health insurance policies on the wider market that are worth comparing with your current cover.
Understanding your options allows you to make the decision based on your circumstances rather than simply remaining on the same plan by default.
What Happens If You Leave Your Job?
If your employer is currently arranging or contributing towards your health insurance, changing jobs is a good time to review your position.
Find out when the employer's contribution or arrangement ends and what you need to do to maintain your own cover.
This can be particularly important if you are aged 35 or over. Under Lifetime Community Rating rules, a break in health insurance cover of more than 13 weeks can have implications in certain circumstances.
If you're leaving a job and aren't sure what happens to your health insurance, check with your employer and insurer before your existing arrangement finishes.
Don't Put Your Health Insurance on Autopilot
Employer health insurance can be an excellent benefit, but it shouldn't become something you stop reviewing simply because it's arranged through work.
Your circumstances can change. Your family's requirements can change. And the health insurance market itself can change.
Take the time to understand:
- What you're covered for
- What you're not covered for
- Which hospitals you can access
- What you may have to pay yourself
- What your employer contributes
- Whether alternative plans are available
- Whether the policy still represents good value for you and your family
The right workplace health insurance arrangement isn't necessarily the one you've always had. It's the one that provides an appropriate balance of cover, access and cost for your circumstances.
At Health Insurance Ireland, we can help individuals and employers better understand health insurance options and make informed decisions about cover. Get in touch to find out more.
Enquiry Form: Click here
Email: info@healthinsuranceireland.ie
