What to look for when choosing daily allowance insurance in the event of illness

When an employee is absent due to illness, the company is obliged to continue paying their salary. To fulfil this obligation, it generally has a daily allowance insurance policy, which handles much of the administrative work and makes payments after a contractually agreed waiting period. At first glance, this seems like a simple formality with little room for manoeuvre. And yet, it is well worth comparing insurers’ offers – particularly for SMEs – as there are significant differences that can have a major impact when it comes to something as essential as daily illness insurance.

When comparing offers, the first instinct is often to look at the price. This applies just as much to social insurance as it does to fashion! We then quickly forget that daily allowance insurance is much more than just a commercial contract. Above all, it is about supporting people, and it is therefore the quality of this support that determines whether each situation ends favourably for the employees concerned and their employer. Several aspects should therefore be taken into account in the assessment.

For HR managers, it is a great advantage to be able to deal with a single point of contact within the insurance company who is competent and responsible for following up on sick leave claims. The claims manager does not merely verify medical certificates and initiate payments. This person effectively acts as a central hub between the various parties involved. This specialist’s main task is to assess each situation correctly and ask the right questions at the right time. This key contact must therefore combine a good knowledge of the company in question, a sound understanding of medical matters, insurance expertise, as well as extensive practical experience and a great deal of tact.

Many issues relating to employees’ incapacity for work cannot, by their very nature, be addressed with a standardised response, as each situation is unique. Thus, incapacity for work often cannot be assessed on the basis of a single diagnosis. Similarly, the option of a phased return to work cannot be assessed without being aware of the insured person’s specific circumstances. What applies to the handling of claims also applies to the fundamental principles of collaboration between the employer and the insurer: a good insurer stands out for its ability to adapt its processes to the needs and structure of the company in order to ensure a tailored and efficient collaboration.

The terms of an efficient working relationship can vary considerably from one client to another. A key element is the provision of a simple interface that enables administrative tasks to be carried out efficiently. Furthermore, communication tailored to the client’s specific needs and organisational structure is of particular importance. Whilst a company with a large HR department may wish to be kept informed almost in real time of the progress of a case and therefore prefers a continuous flow of information, one-off updates upon completion of certain stages may prove more relevant for an SME. However, all companies share the same expectation: to be able to assess as early as possible whether and when employees will be able to return to work, as well as any necessary adjustments to the workplace. To answer these questions, it is essential to be able to count on the expertise of a Case Manager.

Groupe Mutuel not only has claims management specialists who meet the criteria mentioned above but also offers a Corporate Customer Area, providing a user-friendly interface for handling administrative procedures. Furthermore, Groupe Mutuel brings together strong multidisciplinary expertise, enabling businesses of all sizes to implement effective absence management and sustainable workplace health management.

In Switzerland, there is no general obligation for companies to take out daily illness benefit insurance. However, they are subject to a legal obligation to continue paying salaries in accordance with Art. 324a of the Swiss Code of Obligations. If the employment contract lasts for more than three months, the employer must pay 100% of the salary from the first day and for a certain period (the Bern, Basel or Zurich scales apply here). However, if there is daily illness allowance insurance in place, the payment amounts to 80% of the insured salary, paid after a waiting period and for a maximum of 730 days over a period of 900 days. No deductions for AVS/AI/APG contributions are made from these payments.

In the latest issue of GMpro magazine, you’ll find out what steps are taken following a sick leave notification. Find out more.

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