Insurance: employees

What corporate employee insurance includes

A corporate program is a contract that a company concludes for the benefit of its employees and sometimes their family members. It may include voluntary health insurance, accident and sickness insurance, and life insurance. For the employer it is a tool for attracting and retaining staff, a way to get people back to work faster after illness or injury, and part of the benefits package. Programs are arranged by companies of any size — from a small office to large enterprises with branches in different regions.

Compulsory insurance of an employee against accidents in the course of performing work (official) duties is a separate matter: in Kazakhstan the employer is required by law to conclude such a contract. Voluntary programs do not replace the compulsory contract but supplement it.

Coverage options

Voluntary health insurance

• outpatient care: doctor appointments, diagnostics, tests;
• inpatient treatment, emergency and planned;
• ambulance care, home doctor visits;
• medication cover, dentistry, preventive check-ups and vaccination — as options.

Accident and life

• payment in the event of injury, temporary loss of working capacity, disability;
• payment to beneficiaries on the death of the insured;
• cover 24 hours a day or only during working hours, including on business trips.

What is usually not covered

• diseases expressly excluded by the program: often oncological and mental illnesses and HIV; restrictions may apply to chronic diseases;
• cosmetic and aesthetic services, treatment without medical indications;
• events under the influence of alcohol or drugs, intentional harm to one's own health;
• dangerous sports, unless included;
• services outside the agreed clinic network without a referral from the insurer.

What determines the price

The price is determined by the size of the group, its age and sex composition, occupational risks (office staff or production workers), the scope of medical services and the level of clinics in the network, limits for each section, and the region of service. The program's loss ratio in previous periods also matters: if employees use the policy actively, the insurer revises the terms at renewal. A company can distribute employees among different program options — for example, an extended one for management and a basic one for everyone else.

How to choose a program and what to check in the contract

• Participants. Who is included — all employees or certain categories, the terms for new employees, and the option to add relatives at the employee's expense.
• Age restrictions and health requirements for inclusion in the program.
• Clinic network. Whether there are suitable medical centres near the offices and branches, and how service is organised in other cities.
• Limits — overall per insured person and by type of care.
• Service procedure. A 24-hour call centre, approval of services, referral to a clinic, and reimbursement if the employee paid for treatment personally.
• Changes to the list during the contract term: adding and removing employees, and recalculation of the premium.

What to do if an insured event occurs

Under health insurance the employee calls the insurer's call centre at the number stated in the policy: the service is approved and they are referred to a clinic in the network. If care was paid for personally, keep the receipts, the contract with the clinic and the medical documents and submit them for reimbursement within the set period. In the event of an accident, it is important to seek medical help promptly, inform the employer and the insurer, and collect the medical documents and the documents on the incident. It is convenient for the employer to appoint a responsible employee who keeps the lists of insured persons and helps colleagues with claims.

How Polis Re helps

The broker helps formulate the goals of the program, compare the offers of several insurers by scope of services, clinic network and limits, organise the adding and removing of employees and resolve disputed situations during claims settlement. You can see the approximate cost in the employee program calculator and the employee accident insurance calculator; for personal programs see the health insurance section. To select a corporate program, send a request to the broker.