How to Design a Major Medical Insurance Program for Employees

Protecting employee health is now a cornerstone of modern business management. A well-designed Major Medical Insurance (MMI) program not only serves as an employee benefit but also strengthens talent retention, boosts productivity, and provides financial protection for both employees and the company.

However, structuring this program requires a strategic approach that goes beyond selecting a standard policy. As a specialized insurance broker, we act as an advisor and partner in developing a scheme tailored to the real needs of the organization and its workforce.

1. Workforce Diagnosis and Analysis

The first step is understanding the workforce profile:

• Average age and distribution by range.

• Positions and hierarchical levels.

• Risks associated with activities (e.g., field vs. office staff).

• Existing health coverages or benefits.

Broker’s role: Using actuarial analysis tools and market benchmarks, the broker identifies protection gaps and opportunities to design appropriate coverage.

2. Defining Program Objectives

The insurance must align with the company’s human capital strategy. Key questions include:

• Is the primary goal retention, talent acquisition, or financial protection?

• Should the plan be standardized or segmented by employee level?

• Should it include additional benefits such as check-ups, telemedicine, or corporate wellness programs?

Broker’s role: Leading strategic workshops with HR and Finance to set clear goals and success criteria.

3. Technical Coverage Design

Based on the diagnosis and objectives, the broker designs the program considering:

• Sum insured: Coverage limit per insured person and per event.

• Deductibles and coinsurance: Balancing premium cost with employee contribution.

• Geographic coverage: National, international, or hybrid.

• Hospital and doctor networks: Matched to employee location and needs.

• Additional benefits: Dental, vision, maternity, pre-existing conditions, and telemedicine.

Broker’s role: Presenting comparative scenarios and financial impact analyses, guiding optimal condition selection.

4. Insurer Selection and Negotiation

Choosing an insurer shouldn’t be based solely on price. Key factors include:

• Financial strength and experience in corporate health insurance.

• Claim ratios and payment timelines.

• Digital administration capabilities (apps, user portals).

• Prevention programs and post-claim support.

  
  

Broker’s role: Leveraging market knowledge and negotiation power to secure favorable terms, coverage extensions, and service guarantees.

5. Employee Communication and Training

A program delivers value only if employees understand and use it effectively:

• Informative sessions and educational materials.

• Clear explanations of key concepts: deductible, coinsurance, sum insured, waiting periods.

• Support channels for inquiries.

Broker’s role: Creating communication campaigns and workshops to ensure proper understanding and reduce unnecessary complaints or claims.

6. Ongoing Administration and Monitoring

Managing an MMI program requires continuous oversight:

• Tracking new enrollments and cancellations.

• Regular claims reporting.

• Adjustments during renewals to optimize premiums and coverage.

• Employee satisfaction surveys.

Broker’s role: Providing operational and strategic support with tools that help HR manage efficiently and make data-driven decisions.

Conclusion

Building a Major Medical Insurance program for employees combines risk analysis, technical design, and talent management. A consultative insurance broker becomes a strategic partner, ensuring every peso invested in this benefit yields returns through employee well-being, productivity, and long-term loyalty.

Sáas HC Solutions

At Sáas, we have a team of consultants specialized in designing employee insurance programs aligned with your company’s talent management and benefits strategy. Our approach combines detailed workforce analysis, technical design, and negotiation with leading insurers to deliver comprehensive solutions that enhance protection, well-being, and talent retention.

Let’s discuss how to structure a strategic life and health insurance program that drives your organization’s strength, engagement, and long-term sustainability.