The employer action playbook

The findings in this report lead to four decisions about an employer's health benefit: who the service reaches, what a test report explains, what follows a raised result, and how a family gets through a claim. Each decision sits in a provider contract or a service process that an employer can inspect. A large abnormal-result share, by itself, does not say which change to buy.

The playbook starts with the covered family because it accounts for most of the recorded claim cost and has a different mix of test results from employees. It then examines reporting and follow-up, unequal testing uptake across income bands, and claims queries. For each, the next step is to compare the report's finding with the service and records on the employer's own policy.

The laboratory, survey and claims datasets are separate and are not linked at the individual level. Their figures describe reports, responses and claim events, respectively; they do not follow the same people from a test to a claim (Methodology).

Covered family members carry two-thirds of the cost — and different laboratory results#

Claims recorded against covered family members are 66.5% of all claims and 67.8% of incurred cost, against 32.2% on the employee layer. The parent and parent-in-law layer accounts for 36.9% of incurred cost and averages ₹53,981 a claim, the highest average of the four main layers. Spouses, children and parents together are 66.4% of claims; the 66.5% figure also carries the smaller sibling and other buckets.

Incurred is a recorded amount rather than cash paid: 12.8% of it sits against claims still open.

The parent share also differs across account groups.

The parent share is highest in Enterprise and lowest in SME.

The laboratory results do not simply say family members are sicker#

Reading the biomarker reports by their recorded relationship gives a more useful answer than "dependents are worse off". Two flagged-result shares are higher in family-member reports and three in employee reports.

HDL, the lipoprotein that helps carry cholesterol back to the liver, needs a different comparison. The report's broad HDL flag sits at a fixed 40 mg/dL while the clinical criteria are sex-specific, and these two pools are close to mirror images on sex: 33.6% of 7,080 employee reports are female, against 67.1% of 3,768 family-member reports. The same fixed threshold does not apply the clinical criteria equally to women and men. These pooled figures therefore cannot establish which relationship group has more clinically low HDL.

SGPT is a liver enzyme, also called ALT. A raised result can prompt clinical assessment but does not identify a cause (Liver Health). The Vitamin D and B12 rows use the report's comparison cutoffs, not diagnoses from the number alone.

The blood-sugar difference is the largest of the five, at 20.1 percentage points pooled. In every band from the 20s through the 50s it is below five points, and in the thirties it runs the other way.

Across the wider set of reports with a mapped numeric result and a recorded age, 20.1% of 3,768 family-member reports come from people aged 60 or over, against 1.1% of 7,079 employee reports. Those are broader bases than the HbA1c table. The smaller gaps within working-age bands do not establish equivalent blood-sugar results: at 60 and over, the family–employee HbA1c gap is 14.2 points, with only 49 employee reports behind that comparison.

The haemoglobin gap behaves differently. It remains at least 14 points in every working-age band shown.

Fourteen points at the narrowest, twenty at the widest, in the same direction in all four bands. It holds within each sex as well, and the wider of the two gaps is the male one: 5.5% of 4,131 male employee reports sit below 13 g/dL, against 21.7% of 1,079 male family-member reports. Among female reports it is 31.9% of 2,135 against 37.2% of 2,240. Age and sex are two separate cuts here, not a joint adjustment — the descriptive contrast is that the large haemoglobin gap remains within these bands, while the blood-sugar gap is much smaller in the same working-age bands. These separate comparisons do not show how much of either pooled gap age or sex explains. See Anemia and Self vs Dependent.

Where the parent layer's money actually goes#

The layer's most-filed lines and its most expensive lines are not the same lines, which is the practical point.

Adding the displayed rounded shares, the three most-filed lines account for about 37.7% of the layer's claims and 16.7% of its incurred cost. Cardiac and musculoskeletal claims account for about 12.3% of claims and 25.7% of incurred cost — and the parent layer carries 67.2% of all cardiac and circulatory incurred cost in the book, which is what makes it the layer's defining line rather than merely an expensive one. Within the parent layer, musculoskeletal injury accounts for a larger share on mother and mother-in-law claims, while cardiac and circulatory accounts for a larger share on father and father-in-law claims. Claim categories here are reporting buckets built from the recorded ailment and illness text, not validated diagnoses. See Parent Claims and Self vs Dependent.

The parent layer is also not uniformly elderly: 27.7% of parent claims come from people in their fifties, and 6.5% come from people under 50.

A normal cholesterol total hides a low HDL in nearly half of these reports#

A test that returns as a PDF nobody reads changes nothing, and an employer can specify both the report format and the service offered after an abnormal result: which lines are reported, against which reference ranges, with which flags, to whom. Four requirements connect the findings to the service an employer buys.

Report HDL and LDL as separate lines, with the low-HDL flag set by sex. Among the 5,163 reports that carry both an HDL result and a total cholesterol below 200 mg/dL, 47.3% still have HDL below 40 mg/dL — a normal-looking total hides it in nearly half of them. Scored at the clinical criteria, below 50 mg/dL for women and below 40 for men, low HDL covers 70.4% of women's reports and 54.0% of men's, 61.2% of all 7,260; the National Heart, Lung, and Blood Institute uses those sex-specific values in its metabolic syndrome criteria. LDL, which carries cholesterol and can contribute to deposits in artery walls, is at or above 100 mg/dL in 62.6% of 8,054 reports. A summary that reports the total alone is not reporting the finding. See Lipids & CVD Protection.

Require a Vitamin D concentration with bands, not a single flag. Of 6,943 reports, 81.4% are below 30 ng/mL, 60.1% below 20, and 22.2% below 10. Thirty is this report's broader comparison cutoff rather than a clinical target: the Endocrine Society's 2024 guideline records that 25(OH)D levels giving outcome-specific benefit have not been established in trials for healthy adults, and suggests against routine screening in that group. So this is a requirement about how an assay already being run is reported, not an argument for running more of them. A single below-30 mark puts a report at 29 ng/mL and a report at 8 ng/mL in the same bucket, and one in five of these reports sits below 10. The same holds for B12, where 69.6% of 6,192 reports sit below 300 pg/mL. See Vitamin D and Vitamin B12.

Buy two different things for the two blood-sugar groups. Of 7,088 HbA1c reports, 25.4% fall in the prediabetes range (5.7% to below 6.5%) and 13.3% in the diabetes range. Those two groups need different services: clinical assessment for the smaller one — a single assay range is not a diagnosis, and in someone without symptoms a result in the diabetes range needs confirmation — and for the larger one a defined, repeated programme of nutrition and activity support, which is what the US Preventive Services Task Force means when it says clinicians should offer or refer people with prediabetes to effective preventive interventions. Check what your current service already includes before adding anything. See Blood Sugar.

Read your eligibility rule's age trigger against a published starting age. The US Preventive Services Task Force gives a Grade B recommendation to screen for prediabetes and type 2 diabetes in nonpregnant adults aged 35 to 70 who have overweight or obesity and no diabetes symptoms, and says the BMI trigger should be considered at 23 rather than 25 for Asian American patients. That is a recommendation about one population in one health system, not a rule for an Indian employee book — but if your eligibility rule starts at 40, ask the clinical provider how it accounts for younger adults who meet risk-based screening criteria. The right interval is a clinical question this report does not answer.

Full-body testing runs from 15.6% to 54.3% across salary bands#

Of 7,048 responses to the health-check question, 24.3% record a full-body diagnostic test in the year before answering, and 42.3% selected the “None of these” box — although some also selected an action. The five listed actions include seeing a doctor about a symptom as well as screening steps. A company-organised camp or screening appears on 10.5%.

The striking part is how that 24.3% distributes. Testing rises across every named income band without exception.

That is 38.7 percentage points and a 3.5-fold difference between the ends. The obvious objection is that income is standing in for occupation — that better-paid people are in jobs where testing is normal. Inside engineering and software development alone the same series still climbs from 14.3% to 61.5%, again without a single band out of order, though the top band there rests on only 52 responses. The gradient therefore appears within this recorded job-function group too; differences in age, roles and other factors within that group remain possible. Of the three work styles, responses describing physically active work have the lowest testing share, at 16.9% of 838 responses, against 24.9% in sedentary roles and 25.9% in mixed ones.

WHI 2025 also reported a large income gradient in full-body testing, running from 27.4% to 66.7%, a spread of 39.3 points. WHI 2026's runs from 15.6% to 54.3%, a spread of 38.7 points.

The income pattern appears in both editions, but WHI 2025 lacks the question and answered base needed to compare rates. The 2026 results are self-reported testing in the preceding year.

What this measures is uptake. It does not measure what each band was offered, what it cost them in time or pay, or why anyone declined — those factors are not measured by this 2026 item, and the saved 2025 page does not establish them. See Preventive Care, Income & job role and Sedentary vs Active.

Claims with a query are refused more often#

Across all claims, those with a query are refused more often: 5.4% against 2.9% without a query.

Three questions for the annual review, and two habits to retire#

Three questions are worth putting before the next renewal. This report answers the third from the aggregate book; the first two have to come from your own broker and provider records.

And two habits worth retiring.

Stop assuming the grade ladder is the right eligibility rule. Two things sit against it: a 38.7-point spread in testing across salary bands, and a published screening recommendation for nonpregnant, asymptomatic adults aged 35–70 with overweight or obesity. Neither says test everyone every year, and neither settles what your rule should be. If your rule starts at 40 or changes with seniority, ask the clinical provider to explain its basis and whether it meets the needs of the covered groups.

Stop reading the claims book by count alone. Frequency tells you which claim categories occur most often, which helps plan service capacity. It does not tell you what share of incurred cost each category carries: a year-end review ranked by volume opens on a category that is 15.7% of claims and about a hundredth of incurred cost.