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health insurance for small businesses cost

10 August 2023

Most companies, especially small ones, seek to provide benefits and services to their employees, in order to attract employees to work and encourage them to give their best to the company, and this requires studying the cost of health insurance for small companies that the employee and his family members bear in exchange for obtaining medical services in less complicated ways.

What is employee medical insurance?

Medical insurance for employees is known as the system of the Financial Regulatory Authority, through which an equal financial value is collected from all employees working in the company, whether private or governmental, and then used to provide various health services when they need them.

What are the types of corporate medical insurance?

The types of medical insurance are divided according to the limits of coverage provided geographically into:

Local Medical Insurance

The beneficiary is supported to benefit from the medical services available within the country through which the participant is subscribed, provided that the value of the cost is calculated in the local currency.

International Medical Insurance

The beneficiary shall be guaranteed the right to obtain all medical services agreed upon inside or outside the country in which he is subscribed, provided that the subscription value is calculated in foreign currency.

What are the benefits of health insurance for small businesses?

The health insurance system offers several advantages for employees of small businesses, the most important of which are:

Providing material and psychological support to the company's employees.

Benefit from various medical services at reduced costs.

Facilitating access to medical services through the insurance system.

The corporate insurance system includes the provision of medical services to the employee and his family.

How much does health insurance for small businesses cost?

It was found that the cost of medical insurance increased between 2022 to 2023 by an estimated 4%, due to the instability of the dollar rate in the local market, which negatively affected the provision of medical services, and determining the cost of health insurance for small companies depends on the size of the premiums that correspond to the medical needs and the satisfactory condition of the insured employee, where the health insurance program is chosen that is commensurate with the health status and average annual income of the employee, in order to determine the deductible percentage Which falls on the insured person, in addition to the benefit of family members benefiting from medical services that raise the value of insurance.

What is the deductible?

It is the percentage borne by the insured employee (beneficiary), which is agreed upon through the contract signed between the customer and the insurance company (insurance policy), and the terms of the agreement vary as follows:

The insurance company bears the full cost of 100% of the cost of dispensing treatment or the costs of minor surgeries performed within the hospitals of the insurance system.

Or the insurance company bears only 80% of the cost of treatment, provided that the beneficiary pays an estimated amount of 20% of the total costs of the medical service.

What types of coverage does the Corporate Medical Insurance System cover?

The medical insurance program provides companies with a range of medical benefits by facilitating access to the following services, in addition to bearing their cost according to the percentage of coverage agreed upon in the insurance program, where:

  • Choose the coverage list from hospitals, medical centers and clinics located in places close to the employee's place of residence.

  • Bear up to 100% of the total cost of the medical service provided to the employee, such as signing a medical examination or radiology.

  • Surgical coverage of up to 80%, provided that it is not cosmetic.

  • In cases where the patient is required to stay in the hospital, the costs of accommodation for one companion with the patient are covered.

  • Bear the costs of medical examination in clinics affiliated to the insurance program.

  • Coverage for natural births up to EGP 10,000, or EGP 15,000 in caesarean sections up to a maximum.

  • Coverage of dental treatment and oral and maxillofacial surgeries, provided that they are not cosmetic surgeries.

However, it should be borne in mind that the insurance company is not responsible for covering any medical services other than those mentioned in the insurance policy agreed upon between the parties.

Conditions for the employee to benefit from the health insurance benefit

The employee's participation in the corporate medical insurance service requires that he meet several conditions, the most important of which are:

  • Not to have the benefit of medical insurance on the other hand.

  • The medical service program provided by the insurance company is commensurate with the value of the salary received by the employee.

  • Deducting a fixed amount of money from the employee's monthly salary.

  • Signature of the insured employee on the insurance policy.

  • The need to preserve the employee's insurance card or his family members, and in the event of its damage or loss, the beneficiary shall bear the costs of issuing a new card after informing the responsible authority.

  • The employee's obligation to inform the responsible authorities in the event of any matter that affects the entitlement of the beneficiary or any of his family members to obtain the benefits provided by the medical insurance.

Factors on the basis of which the cost of health insurance for small businesses is calculated

The cost is calculated based on several points determined by the following factors:

  • The size of the coverage provided: The cost depends on the size of the coverage provided to the beneficiary, as the higher the volume of coverage provided by the insurance company, the greater the value of the cost paid in return.

  • Additional benefits: There are some additional medical services, such as dental coverage and pregnancy follow-up, so the cost of insurance increases, but it should be taken into account that the additional benefits are optional.

  • Risk factors: The higher the risk, the higher the value of insurance.

  • Age group: The cost of insurance increases with the age of the beneficiary, due to the increase in the volume of medical services he needs, starting from the age of 21 years.

  • Number of family members covered by medical insurance.

  • The health status of the insured: The more the volume of medical services required, the insurance premium increases, and the health condition is evaluated by conducting medical examinations or knowing the patient's history of the case by asking some questions.

  • Average income: The higher the average monthly income of the employee, the more he can choose between different insurance programs that offer them better benefits.

  • The nature of the insured's work.

  • Insurance category.

  • City of work.

When does the insurance policy expire?

The insurance contract between the insurer and the beneficiary may be considered null and void in the following cases:

  • Death of the employee (insured).

  • The expiry of the period of employment by departure from the pension.

  • The employee moves to work for a new work organization.

Companies tend to provide low-cost services and benefits to their employees, especially small companies, as a kind of financial and psychological support to motivate workers to do their best towards work and improve productivity, including facilitating employees' access to health insurance services for small businesses.