Reply To: Employee Medical Expense Challenge: Seeking the right solution

  • Sunny Suman

    September 17, 2023 at 9:50 AM

    Hello @shraddhasingh

    Thank you for sharing this real-life HR challenge. It’s a situation that many organizations may encounter, and addressing it appropriately is crucial. I think you have already received the guidance.

    In this case, considering the employee’s genuine lack of awareness about the policy change and the medical exigency, it’s important to balance compassion with fairness and consistency.

    Here are some steps you might consider:

    1. **Review the Policy:**

    First, ensure that the policy documents clearly outline the transition from ESI to GMC and the associated coverage limits. Verify that the policy information was indeed available in the employee self-service portal.

    2. **Communication:**

    If it’s found that the policy information was accessible, use this as an opportunity to improve communication within the organization.

    REINFORCE the importance of employees actively reviewing policy changes during transitions and regularly accessing the self-service portal for policy updates.

    3. **Assisting the current Employee:** While upholding the policy, consider offering some assistance to the employee as an exception in this case, given their genuine lack of awareness. However, make it clear that this is a one-time exception due to the unique circumstances. Emphasize that in the future, all employees are responsible for understanding their coverage. And NO ONE is to receive the benefits more than as per their eligibility.

    4. **Policy Reinforcement:** Use this incident as an opportunity to reinforce the policy and communication procedures. Conduct sessions or workshops to educate employees about their benefits and policies during transitions.

    5. **Monitor and Prevent Misuse:** To prevent potential misuse by other employees, closely monitor similar situations. Implement checks to ensure that employees are informed about policy changes and their responsibilities.

    By addressing this case with a balanced approach, you can assist the employee in need while reinforcing the importance of policy awareness. It also allows the organization to maintain fairness and consistency in benefits administration.

    Thank you for sharing this valuable real-world scenario, and I encourage other HR professionals in our community to share their insights and experiences on how they would handle such situations.

    I believe everyone else’s input are along similar lines. I want everyone to contribute so that we have maximum input and you get to choose the best answer @shraddhasingh what do you think?

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