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Heart, head and budgets – why making internal policies clear is essential

Posted by Our Secret Benefits Consultant on Oct 8, 2018 1:50:59 PM


Heart, head and budgets – why making internal policies clear is essential

I was enjoying the September sunshine the other lunchtime, when I took a call from a client regarding an extremely awkward position with an employee’s sick wife. One of the company’s senior employees had come to her desperate for a favour. He wanted to add his wife to the medical insurance policy.

His wife was extremely ill, but the employee had forgotten to add her to the policy at the beginning of the year – the time when new dependents could be added.

The issue in this case wasn’t with the insurance company but with the company’s corporate guidelines. The insurer was more than happy to add the spouse to the policy, but internal guidelines stated employees could only add dependents in January.

There was a degree of flexibility for new starters who could add spouses when they joined and for employees going through life changing events (marriage, moving home, divorce) who could make changes during the year, but for most employees, the policy could only be changed once a year.

My client was at a loss over what to do. This employee was very senior and implied he would go to the CEO if she wasn’t able to do it. At the same time, she felt for him as she knew his wife needed urgent treatment and this was the only way she was going to get it.

It’s a classic tale of do you let your heart rule your head or vice versa?

The issue she faced was if she did add the spouse then she would be going against company policy. Also the employee would almost certainly make a claim straight away, which would increase premiums – something that was unlikely to have been budgeted for.

My advice to her was to speak with the CEO, explain the situation and let him make the decision. It was an unfair position for this senior employee to put her in but she needed to ensure she made the right call.

The reality was adding the wife or not could have been the difference between her living and dying. My client couldn’t make that decision by herself.

In the end it was agreed with the CEO that on this occasion the employee was able to add his wife, she got her treatment and it all worked out well.

The lesson for companies offering medical insurance is to make sure internal policies are clear, are regularly communicated and don’t expose staff to making decisions like this under pressure.

If everyone is fully aware of the rules they shouldn’t need to ask to bend them. Plus if the company policy is adhered to fairly and people can only be added at set times premiums should not increase, and may even reduce.

Topics: Benefits Consultant, secret diary, medical insurance, HR