Group Health Insurance

Group Health documents

At Navigator, we pride ourselves in being able to source a mix of comprehensive and cost effective cover for our clients and provide a mix of plans that suit your staff in their locales.

Summary of Terms used in Group Medical Insurance

Community Rating:
At renewal, your group's premium will be substantially determined by the claims' experience of all those in the same plan(s).
Continuation Terms:
When an employee with/without his/her family leave your company, it is possible they may be able to continue the cover on their own account, either with the same or reduced benefits.

Options will commonly be:

  • to be accepted on the new plan according to the underwriting assessment that was made when first joining the company. Note: Some insurers will underwrite Health Declarations from staff at the start of their cover, EVEN IF these Health Declarations are not required for the Group plan.
  • to be underwritten from scratch, and if preexisting conditions have developed, to face the possibility of being rejected outright,
  • to be able to continue cover with no additional restrictions
  • For US based plans: COBRA continuation regulations enable you to maintain the same cover for 18 months by paying your employer the monthly premium plus a couple of percent in administration charges. There will be a problem if the company is no longer in business.
  • If you can take individual cover on leaving the employer, your premium will possibly increase and you may face geographic restrictions in terms of where the cover may be valid.
  • Some group policies are actually a collection of individual policies that are grouped for billing purposes. Plans like this facilitate transfer subsequently to portable individual plans with little if any changes in terms.
Country of Jurisdiction:
You may be based in Malaysia, but the country and the law under which any legal action against the insurer or the place where any arbitration proceedings would have to proceed, will be determined by the contract.
Experience Rating:
This means your group renewal premium will be largely a factor off the claim history of staff and dependents. Most groups have a pattern of claiming outpatient bills and over-utilization of this cover is commonly the reason for premiums being increased by more than the rate of medical inflation.
Full Underwriting:
Each staff will be individually assessed regarding their personal health histories and will face the possibility of:
  • premium being increased,
  • preexisting health problems not being covered, or possibly,
  • cover being declined completely.
Conditional acceptance of Preexisting conditions:
Some plans say things like~ if you have no need for treatment or no evidence of their being a problem that should have been treated in the 3 months prior to joining the programme, then you will be covered. If the problem does surface in the next 12 months, you will still be covered from the time you have been insured for 12 months.
Medical History Disregarded [MHD]:
Such plans guarantee acceptance with as few as 2 staff, but mostly the insurers need 10 - 30 + employees, apart from dependents. Seldom to such plans practice community rating and mostly they will rate at renewal, according to your group's claim's experience.
No Worse Transfer Terms Transfer [NWT]:
This means that if you have an existing group cover, your staff will be accepted on the same terms as they were accepted by the previous insurer.

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