What is medical insurance for an employee?
This is a type of insurance that pays benefits when a person is sick or injured and normally covers office visits and hospital costs. In other words, payment is made to an insurance company by the employer on the assumption that an employee may fall sick some day; in the event that it happens the insurance company then pays for the medical expenses up to the amount insured by the employer.
What does the law say about medical insurance?
The Workers Compensation Act 2000 requires employers to insure their employees against injuries or scheduled diseases which may be incurred in the course of their employment. There is no specific provision in the law on other kinds of illnesses which may befall an employee. However, some employers chose to insure their workers over and above the minimum required by law.
Some employers pay for general medical cover for their employees, although it should be noted that most of the employers currently do not pay for medical cover for their employees. The most common practice among big employers IS provision of free treatment for their employees in health centres which are owned by such employers.
What happens if an employee is not insured and gets injured at work?
The law clearly states that in case an employee is injured while at work, irrespective of whether the injury occurred as a result of the employee’s negligence or not, the employer is obliged to cater for the treatment costs of the employee. This also includes injuries sustained while travelling from home to the place of work.
Who pays compensation when an employee contracts a disease as a result of the nature of his or her work?
The law requires employers to insure their workers against work related diseases, so in the event of its occurrence the insurance company where the policy was bought pays for the treatment of the worker or any such compensation that may be necessary.
However, if the employer has not insured his or her workers then the responsibility is on the employer to pay for compensation or to treat an employee, whichever is applicable or both.
Why is it important for employees to have medical insurance?
- It reduces the chances of sickness progressing to a serious state due to limited finances.
- It gives the employee peace of mind knowing that health costs have already been covered. With little to worry about, the employee can concentrate on work.
- Employees can go for regular medical checks which reduce the chances of falling sick and missing work due to sickness.
- It reduces pressure on the employee’s salary which can be used for things other than medical bills.
- There is a higher chance of an employee getting better quality medical care when he or she has been insured.
Are members of the employee’s family also covered?
The law does not provide for the family of the employee or his/her dependent relatives under the Workers’ Compensation Act 2000. However, in the case of general medical insurance which is not provided for under the law, the employer may decide to include the dependants of the employer subject to availability of funds in the organisation.
Some collective bargaining agreements also provide for medical coverage for the family and/or dependent relative of the workers, usually up to a maximum of four dependants.
What does an employee need to show in order to get treatment when they have been insured by their employer?
The employee is usually given an insurance card which proves that the employer has paid for medical insurance for the employee. So in the event of injury or sickness the employee may present the card to the health centres affiliated to the insurance company where the employer has paid for the medical insurance.