What is an Estimate?

An estimate is a provisional cost for the team members getting added to your organization's health benefits. They are estimates and NOT actual premium calculations.

Estimates are approximate values applicable to all types of endorsement orders, including addition, deletion, or even modification requests.

Why are they Estimates?

The actual premium calculation can only be done by the insurer towards the completion of the order.

The actual premium’s value is deducted (if it is an addition request) or refunded (if it is a deletion request) after the order is completed.

The estimates may NOT match the insurance premium. Read the question below to know more about how Plum arrives at the estimated value.

How does Plum calculate these estimates?

Plum arrives at estimated values based on the following factors:

  • The base premium of the policy that is agreed upon between the organization and the insurer at the time of policy purchase

  • The age of the employee, depending on the policy constructs

  • Pro-rata days during the policy tenure, thus based on:

    • Date of Joining (DoJ) or Date of Coverage (DoC)

    • Date of Separation (DoS), in case of deletion request for employee termination

Note: DoJ and DoC are the same if there is sufficient CD balance to cover the employee at the time of joining.

If there’s an insufficient CD balance on the DoJ of an employee, the pro-rata calculation is from the date when there are sufficient funds in the CD account to cover the employee.

What are the possible reasons for the mismatch in Estimates vs. Actual Insurance Premiums?

  • For a deletion request of an employee, in case an employee or their dependent has availed a claim during the policy term, the premium will NOT be refunded for that request.

  • The calculation of pro-rata days is different (This happens when an organization has a low CD balance. In such a situation, the employees’ coverage begins NOT from the day an employee joins the organization but from when there are sufficient funds available in the CD account to safeguard the employees).

When will I not be able to see the Estimates on Plum?

Scenario 1 (Beta launch):

Currently, the Estimate Page has been integrated only with the Addition flows. You will not see estimates when you delete or modify an employee or their family members. This will be made live in the coming weeks.

Scenario 2 (Insurer limitations):

Estimates will be shown only for those benefits for which the base premium has been made available by the insurer.

After a company has purchased a new policy from the Insurer, it takes anywhere between 2-4 weeks for the insurer to issue a policy copy along with the base premium. Until then, the endorsement requests placed on the HR dashboard will not show any estimates as we are still awaiting the rates from the insurer.

Can I obtain a benefit-wise, member-wise detailed breakup for the Estimates?

Yes. You can obtain a member-wise breakup by clicking on the “Download member-wise details” tab.

This will provide you the breakup across several sheets for each insurance benefit, where the base premium is available and an estimate can be calculated.

What do these warnings indicate in the Confirmation Screen? What must I do next?

Example warning 1: Health and Personal Accident insurance benefits

As shown in the image above, there are insufficient funds in the CD balance for both Health Insurance and Personal Accident benefits. While these requests have been submitted to Plum, the insurer will NOT take these requests for processing until you have parked sufficient funds to cover the new employees.

You must click on “Top-up CD Balance” to add sufficient funds to your CD account. Then provide the payment details on the HR Dashboard for our team to notify the insurers ASAP.

To know more about managing your CD balance, read this or watch this video.

Example warning 2: Covid insurance benefit

For the Covid Insurance benefit, your order has been placed. You can also continue to place subsequent orders.

At this stage, you don’t have to do anything. Plum will follow up with the insurer to issue the policy copy and get further details at the earliest. This will help you understand if you have sufficient CD balance to process the order and take the next steps.

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