Coverage Analysis
A presentation-ready summary of this organization's benefits — built from the same live dashboard data.
Time range
Coverage Overview
100 employees fully covered across GMC, GPA, GTL, and health benefits.
Employees covered
100
GMC sum insured
₹5,00,000 / employee
Insurers
ICICI Lombard (GMC), ICICI Prudential (GPA, GTL)
Every employee is enrolled in all four benefit lines — no gaps in the base coverage today.
Satisfaction & NPS
Employees and HR are both highly satisfied with the program — cashless is trusted more than reimbursement.
Employee CSAT
92%
HR CSAT
96%
Cashless NPS
89%
Reimbursement NPS
78%
The 11-point NPS gap between cashless (89%) and reimbursement (78%) lines up with the reimbursement-ratio trend elsewhere in this deck — cashless is clearly the stronger member experience, and worth steering more claims toward.
Claims Performance
Claim incidence is 14 / 100 employees claimed, in line with market — but turnaround time is climbing.
Org claim ratio (GMC)
14 / 100 employees claimed
6.8% of sum insured utilized
Avg claim TAT
14.2 days avg
up from 9.1 days last month
Avg claim amount
₹2.4L avg claim
up from ₹1.8L last month
Claims are taking longer to close — check for a bottleneck with the TPA or missing documents.
Benefit Utilization
Wellness perks are underused relative to the core medical cover.
Gym benefit
17%
down from 31% last month
Mental health benefit
2%
near zero for 2 straight months
Teleconsultations
41%
up from 33% last month
83/100 employees haven't used the gym benefit yet; 34/100 haven't availed their annual health checkup.
Onboarding & Activation
New joiner benefit activation has dropped to 62%.
New joiners
20
Not yet activated
8
Missing GTL nominee details
9% of employees
up from 4% last month
Over a third of recent joiners haven't activated any benefit — check the onboarding nudge flow.
Funding Health (CD Account)
CD balance of ₹1,000 is below the ₹2,500 needed to cover even one new addition.
Current balance
₹1,000
Per-employee cost
₹2,500
Pending additions
6
Top up the CD account before new joiners or dependent additions are processed, to avoid a coverage-activation delay.
Renewal Considerations
A few things worth weighing before the next renewal conversation with the insurer.
- Mental Health Benefit Usage is 2% — barely used. Try a low-cost awareness push this quarter before renewal; if usage still doesn't move, it may not be worth paying for as a rider next time.
- Gym Benefit Utilisation is 17% (down from 31% last month). Same call to make: promote it harder before renewal, or consider dropping it if usage stays low — insurers typically price a rider into the premium regardless of how much it's actually used.
- Org Claim Ratio (14 / 100 employees claimed) and SI utilization (6.8% of sum insured utilized) are both healthy and within market norms — this is real leverage to push back on a premium hike at renewal, not just accept the insurer's proposed rate.
- Cashless Claim Rate has slipped to 66% (down from 78% last month). Worth asking the insurer to expand or refresh the network hospital list before renewal — a falling cashless rate usually points to a network gap near where employees actually live.
- Teleconsultation Utilisation is 41% (up from 33% last month) — a rare bright spot. Make sure it's retained, or even expanded, in the next renewal since it's clearly delivering value relative to cost.
None of these are decisions to make from a dashboard alone — they're starting points for a renewal discussion, not settled conclusions.