Health insurance policy for SMEs

 Health insurance policy for SMEs Blog Image
7 August 2023

Small and medium enterprises resort to providing benefits to attract their employees and encourage them to provide their best to the work system, by providing a health insurance service for small and medium enterprises, as this allows the company's employees and their families to obtain health services at reduced costs to maintain their health.

What is health insurance for establishments?

Health insurance for establishments is one of the best systems used to provide medical services and health care to a group of individuals affiliated with companies, specifically small and medium enterprises, as the insurance system depends on collecting a sum of money from these people at a fixed and unified rate through a monthly premium that is deducted from the salary and allocated to provide medical services to them when needed.

What are the parties to the medical insurance system?

This system includes several parties, where:

Insurance Corporation

It is the institution that organizes the provision of medical services to the beneficiaries in return for an agreed financial subscription, as it acts as an intermediary between the beneficiary (the insured) and the health care provider (hospitals and medical centers).

Insured (Beneficiary)

A beneficiary is a group of employees of a small and medium enterprise, who are insured for the purpose of obtaining the benefits of medical services at a reduced cost.

Contract (insurance policy)

The contract represents the documented agreement between the two parties, as it stipulates the percentage of financial deduction that is deducted on a monthly basis in favor of the first party (the insurance company), with the consent of the second party (the beneficiary).

What is the difference between group and individual health insurance?

The health insurance system is divided into two types:

Individual health insurance: It is a system that provides medical services to individuals and their families with separate contracts that need more complex conditions, in addition to the difference in the value of the subscription between males and females, as well as the age group of the individual, where the value of insurance increases with increasing age due to the need to obtain more medical services.

Group health insurance (corporate medical insurance): It is a system that provides medical services to a group of employees of a company or government or private institution, through one contract and unified fees for males and females.

What are the conditions for obtaining a health insurance policy for small and medium enterprises?

An insurance policy is the policy that is concluded between an insurance company and an SME, provided that the company has 50 employees or less, providing them with medical benefits in addition to life insurance.

Factors on which the choice of health insurance for SMEs depends

There are many medical insurance companies that provide different medical services to the employees of the companies, but the choice among them requires the need for the owner of the company to study the advantages of medical insurance granted by different companies to the employees of the small enterprise, which includes the following points:

  • Study the benefits provided by the insurance company and compare them with other companies.

  • Choosing a system that does not require employees to submit a lot of paperwork and procedures.

  • Choose a cost-sensitive system for SMEs.

  • Choosing a system that includes a list of hospitals and medical services near the places of residence of the company's employees to facilitate them.

  • The need to pay attention to the additions covered by the insurance system, where coverage of dental surgeries, eyes, pregnancy and childbirth follow-up.

Advantages of health insurance for small and medium enterprises

This project offers several advantages to subscribers, as it guarantees them the facilities to obtain medical services in the fastest time and at the lowest cost, through:

  • Selecting health facilities and medical centers closest to the employees' residence.

  • Dispensing medicines with the beneficiary bearing a small percentage of the cost.

  • Signing the medical examination and diagnosis at reduced costs.

  • Follow-up cases of recent or previous chronic diseases to participate in insurance and dispense their medications.

  • Coverage of tests and rumors at reduced costs.

  • Coverage of dental examination and oral and maxillofacial operations.

  • Eye operations.

  • Follow-up of pregnancy and childbirth.

  • Work-related injury coverage.

  • Life insurance includes permanent disability, total disability, or death due to accident.

Conditions for the employee's participation in corporate medical insurance

The following conditions must be adhered to in order for the employee to be able to participate in medical insurance belonging to the company in which he works:

  • The employee must exceed the training period within the company.

  • Not to be insured through any other party.

  • Provide the required papers and procedures in order to document the subscription to the insurance.

  • Signing the insurance policy between the employee and the insured company.

  • The employee's commitment to the proper use of medical services and not to exploit them badly.

Why do employees subscribe to insurance schemes?

Medical insurance supports the care of employees working in small and medium enterprises and their families against health risks or infection with some diseases, as the insurance includes diagnosis of the disease and the cost of treatment, in addition to providing an interruption allowance when the employee is exposed to critical medical conditions, and this represents the most important advantages provided by working in companies to employees and their families.

Small enterprises seek to attract their employees and increase their motivation in order to provide the best quality of work, so they offer them the advantage of subscribing to health insurance for small and medium enterprises that allow them to obtain medical services at reduced costs.