What is a midterm addition?

Midterm additions refer to the process of adding an employee’s family member who is not new to the family to the group health insurance policy.

When does a midterm addition happen?

Insurers typically allow the addition of a newly-wedded spouse or newborn children (within 30 days of birth) to a group health insurance policy at any point in time.

For cases outside of the ones mentioned above, here’s an example of when midterm additions can occur.

Sometimes, you or your employees may inadvertently miss adding a family member to your group health insurance policy.

Your employee may realize that this family member has been missed only at the time of hospitalisation because of a missing health ID.

A midterm request is raised to add the dependent missed to the group health insurance policy in such situations.

Why are midterm additions NOT allowed?

Insurers typically reject midterm additions as they expect upcoming claims.

The insurer expects the employee and employer to take responsibility for adding all family members when adding a new employee to the group health insurance policy.

⚠️ Insurers typically expect employers and employees to be mindful while adding family members to their policy at the very beginning or as soon as they join the company.

Insurers typically do not allow any midterm addition apart from the ones mentioned below because it is considered selection, and they expect upcoming claims

What are the types of additions of family members that are allowed/not allowed?

Allowed

Newly-wedded spouse (within 30 days), newborn child (within 30 days)

Not allowed

Adding any other dependents midway

In case of a missed family member, how can Plum help you with midterm requests?

While midterm requests are generally not considered by insurers, we at Plum will leverage our deep relationships with insurers to try and get an exception approved for midterm requests. Please note, though, as Plum wants to help here, we have to abide by the insurance policy (legal contract) under the Insurance Act 1938.

To help process the exception, please write to care@plumhq.com with the following:

1.

Please help us understand the reason for the miss in addition in at least 50 words.

2.

You acknowledge that you are aware that the date of addition will be considered from the date Plum sends this data to the insurer. And no claims prior to this date for the midterm dependent will be honoured.

3.

You acknowledge that you are aware of this miss and that no further such requests will be entertained by the insurer going forward.

4.

If the above does not suffice, the insurer may also advise on a waiting period of up to 30 days from the interaction date (the date the data is sent to the insurer for endorsement).

This means that claims for the midterm dependents will be honored only after the set period prescribed by the insurer. We would require you to acknowledge this as well.

Important points to be noted

  • As this is an exception request and this will be scrutinized by the insurer, the endorsement completion of these members will take longer.

  • Once we receive the above confirmation from you, we will negotiate with the insurer and try to get approval.

  • The acceptance of the midterm addition is at the sole discretion of the insurer.

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