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Group Health Insurance

Owing to the ever-rising medical expenses, investing in health insurance policy options has become crucial for all people. Among the diverse health insurance plans found today as per the insurance needs of individuals and family, group medical insurance is one of the most popular ones to consider. Such group health insurance policies are typically designed to provide adequate risk coverage for healthcare expenses to the people who are a part of a certain group. In other words, it is called as employer’s policy which is designed to cover a group of employees in an organization.

What’s a Group Health Insurance?

A group mediclaim policy is offered by the employers to its employees. There are a considerable number of group health insurance policies in India, hence, every company should customize a policy scheme as per the coverage needs for their distinct employees. A group medical insurance policy, may provide coverage to the dependents of the insured individuals as well. Employers can easily compare policies of group health insurance online and select the perfect one for their company based on their workers' distinct requirements.

Features of Group Health Insurance Plans

Some of the salient features of group health insurance include:

  • Certain scheme options provide coverage for boarding costs, in addition to anesthetist, consultant and surgeon fees.
  • Group mediclaim policy for employees provides the advantage of the cashless facility and direct settlement of bills with the hospital.
  • Corporate medical insurance scheme options tend to provide coverage for both pre and post-hospitalization charges for a particular period.
  • Certain group medical insurance policies offer maternity benefits as well.
  • Many group health insurance plans provide coverage for the instances of less than 24 hours of hospitalization for particular procedures like a tonsillectomy, chemotherapy, and eye surgery. 
  • In addition to the employees, group mediclaim insurance policy for employees typically covers their spouse, children and dependent parents as well. 

Benefits Offered by Group Health Insurance Policies

Group mediclaim insurance policy for employees provides certain advantages for both the employers and the employees. 

Advantages of Employer 

A group health insurance policy benefits the employers in the following ways:

  • Aids in Worker Retention: Retaining well-qualified and dedicated employees often become a complex task for contemporary employers. The overall chance of not leaving a particular organization increases significantly if they are provided with coverage under a corporate health insurance policy by their employers. 
  • Tax Benefits: Employers can avail tax benefits by providing a group mediclaim policy for employees. 
  • Motivates Employees: Offering group insurance for employees can go a long way in motivating them, especially in the modern world, where medical expenses are extremely high. It further helps in productivity as well. 

Advantages for the Employees  

The employees can avail the following benefits:

  • Pre-existing Diseases are Covered from the 1st day: Differing from the majority of individual health insurance policy schemes, most group health insurance plans tend to provide coverage for pre-existing ailments right from day 1. The employees hence do not have to deal with any waiting period for any type of pre-existing disease in a corporate medical insurance scheme option. 
  • Inexpensive Coverage: Group mediclaim policy for employeesis known to provide affordable coverage than an individual insurance policy. 
  • Maternity Coverage: There are many group health insurance plans available that provide wider maternity coverage to the insured than other medical insurance options. They cover for C-section, normal deliveries, as well as the newborn babies. 
  • Boosts Motivation: With various attractions and protections, employees feel secured with a healing plan offered by the employer and thus, keep themselves motivated

Who Should Buy a Group Health Insurance Plan?

Any company with more than 10 employees should ideally invest in a group mediclaim policy for employees to protect their workers. 

  • Small Companies and Startups: People who have just established their startup and have at least 15 employees must invest in group medical insurance policy and protect the employees. Such policy scheme options shall also help in tax savings. As group health insurance plans typically are customized based on employee strength, such firms do not have to incur much high expense to provide group insurance for employees.
  • Medium-sized companies: Investing in medical insurance, can be quite helpful for these firms to boost the motivation level and the happiness of the employees, as well as to retain them for longer.
  • Large Organizations and established startups: When joining any large and established organization, the employees typically expect certain perks or privileges. Group health insurance policy can be a part of their package. Hence, if a company has up to 1000 members, it is prudent to cover those workers and their dependents with a group mediclaim policy schemethat would increase the overall goodwill of the company and provide a sense of security to the discerning employees. 

Group Health Insurance Inclusions 

Here are some of the common inclusions provided by major group health insurance plans to their discerning policyholders:

  • Pre-existing diseases
  • Maternity cover (Some group mediclaim policy options may have however had a 9 months waiting period for this)
  • Pre and post-hospitalization expenses
  • Domiciliary and daycare expenses
  • Fees of medical practitioners
  • Room rent and nursing charges
  • Expenses related to: Anesthesia, oxygen, blood, OT charges, medicines and drugs, diagnostic tests 
  • Ambulance charges cover
  • Coverage for radiotherapy, chemotherapy, pacemaker cost, and so on 

Group Health Insurance Exclusions 

Here are the common exclusions that almost all group insurance for employees have: 

Certain corporate health insurance scheme plans do not cover the parents of the employee.

  • No coverage is provided for non-allopathic treatments like homeopathy, Ayurveda, and so on.
  • Group mediclaim policy for employees typically is limited and valid only until the employee works with the company.
  • Congenital diseases, as well as costs taking place in the treatment of AIDS and other related alignments.
  • Any disease or complications that arise out of the use or abuse of alcohol or drug.

Group Health Insurance Vs Individual Health Insurance 

Individual Health Insurance

Group Health Insurance

Each insured individual is the direct point of contact with their relevant insurance provider

The employer/ organization is the direct point of contact with the relevant group health insurance service provider

All insured individuals have the right to cancel their policy at any point in time

Only the employer is provided with the right to cancel the group policy scheme option

Such insurance policy schemes are valid for as long as the insured individual has paid his/her respective premium yearly.

Group insurance for employees tends to be valid for as long as the employee is working with the organization

The premium rates of such plans are typically  dependent on individual’s age, medical history, health conditions, lifestyle (smoker/non-smoker)

A group medical insurance policy would majorly depend on the employee and the organization's financial strength

 

In most cases, certain pre-medical checkups are conducted for individual health insurance by the insurer on which policies are issued.

No pre-medical check-ups required for availing group health insurance plans, hence the chances of policies being declined due to pre-existing conditions also decrease dramatically 

 

Every individual has to remember a separate renewal date under individual insurance plans

There is no need to remember various renewal dates, as there is only a single renewal date for all individuals covered under a group health insurance plan

How does a Group Health Insurance Plan Work?

An organization generally chooses a group mediclaim policy for employees and pays its premium on behalf of the workers. This group medical insurance is offered as a healthcare benefit to the workers. 

As the group medical insurance policy shall be taken for all the employees working in the organization, its basic plan and the overall sum insured shall also be the same for all the employees. However, in certain cases, the employees may opt to add dependents such as their spouse and children or even senior parents for an additional premium payout. 

Companies Offering Group Health Insurance Plans in India

Find below some of the insurance providers offering group health insurance policies in India.

Insurance Provider

Waiting period for pre-existing ailments

Incurred claim ratio

Renewability

Network hospitals

Aditya Birla Health Insurance

4 years

59%

N/A

6000 and above

Cholamandalam MS General Insurance

4 years

35%

N/A

7240 and above

Digit General Insurance

N/A

11%

N/A

5900 and above

Future Generali General Insurance

4 years

73%

Lifelong

5000 and above

HDFC ERGO General Insurance

4 years

62%

N/A

10,000 and above

IFFCO Tokio General Insurance

N/A

102%

N/A

5000 and above

Kotak Mahindra General Insurance

4 years

47%

Lifelong

4800 and above 

Liberty General Insurance

4 years

82%

N/A

5000 and above

ManipalCigna Health Insurance

4 years

90%

Lifelong

6500 and above

Oriental General Insurance

4 years

108.80%

N/A

4300 and above           

Reliance General Insurance

N/A

94%

N/A

7300 and above

Religare Health Insurance

No Waiting period

55%

N/A

7400 and above

Tata AIG General Insurance

N/A

78%

Lifelong

6300 and above

United India General Insurance

N/A

110.51%

Lifelong

7000 and above

Universal Sompo General Insurance

N/A

92%

N/A

4000 and above

Disclaimer: *Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer. The data for shown in the above table are for IRDA Annual Report 2018-2019.

Some of the Group Health Insurance Plans in India

Aditya Birla Group Activ Health Plan

This group medical insurance policy provides extensive coverage to members of a group and can be easily customized by the insurance provider or even the employer to meet the group members adequately. Pre and post-hospitalization expenses and daycare treatments are covered under this group mediclaim insurance policy for employeesIt also provides coverage for maternity-related costs and has no waiting period for critical illnesses like diabetes, heart disease, hypertension, and asthma.

Aditya Birla Group Activ Secure Plan

This group policy scheme offers lump sum benefit on the occurrence of diverse health events under the plans like: 

  • Group Personal Accident Cover
  • Group Critical Illness cover
  • Group Hospital cash benefit 

Chola MS Group Health Plan

This custom group mediclaim policy offers coverage to employees and their family members in unforeseen illness and hospitalization scenarios. The Chola MS Group Health Plan is issued without a medical examination. This policy scheme covers more than 141 minor surgeries that require less than 24 hours of hospitalization. Coverage under this group insurance scheme option can opt for Rs 30,000 up to Rs 10 lakh.  

Digit Group Health Insurance Program for Corporates

This group medical insurance policy from GoDigit provides coverage for accidental hospitalization, illness-related hospitalization, critical illness, and maternity benefit with newborn baby care, restoration of the sum insured. The Digit Group Health Insurance policy scheme also includes psychiatric illness cover and daily hospital cash cover. The premium for this insurance plan option starts at Rs 1500 per employee and does not have any age-based copayment. 

Future Generali Group Health Insurance (Revised) Plan

This group mediclaim policy for employees is known to provide extensive coverage, including the expenses incurred due to treatments like dialysis, chemotherapy, radiotherapy, eye surgery that require less than 24 hours of hospitalization. The policy offers pre and post-hospitalisation cover benefits for 30 and 60 days respectively. Some of the policy benefits also include domiciliary hospitalization cover, day care treatment, optional covers etc.

Future Health Protect Group Policy

This unique policy scheme protects against cortical illnesses, loss of a job, and personal accident. A maximum of 20 Critical Illnesses can be covered under this policy. 

HDFC ERGO Group Health Insurance Plan

This corporate medical insurance plan provides coverage to all the members under a single policy and is known to have quite cost-effective premium rates. The premium required to be paid for HDFC ERGO Group Health Insurance Plan would largely depend on the overall group size. In addition to its prime coverage benefits, this policy scheme also offers certain optional benefits such as maternity benefit, the inclusion of pre-existing disease, reimbursement of health check-up expenses, extended coverage to the family including spouse, dependent children, and dependent parents and other in-patient expense cover. 

IFFCO-Tokio Group Mediclaim Insurance

This group health insurance policy covers all enrolled members at once and has much lower premium rates than individual policy schemes. The IFFCO-Tokio Group Mediclaim Insurance scheme option provides coverage from day 1 people get enrolled under this plan and includes in-patient hospitalisation cover, daycare treatment and domiciliary hospitalization coverage, in addition to cover for pre-hospitalization and post-hospitalization costs.

Kotak Group Health Care Plan

This group medical insurance policy offers customized health insurance coverage at affordable prices. The Kotak Group Health Care policy scheme option covers in-patient treatment, pre and post-hospitalization costs, daycare treatment, domiciliary hospitalization, emergency ambulance, donor expenses, and includes optional coverage for alternative treatment, daily cash benefit, and home nursing. 

Kotak Group Secure Shield

This group insurance for employees offers a lump sum benefit on the occurrence of particular critical illnesses, as well as in the case of death or disability due to an accident. 

Kotak Group Accident Care

This group mediclaim plan option has been designed to meet the medical costs that may arise due to unforeseen accidents. It also provides coverage in the scenario of death or disability resulting from an accident. 

Liberty General Group Health Insurance

This group insurance for employees is quite flexible and provides customized coverage. Having an entry age of 18 years to 65 years, the Liberty General Group Health Insurance policy scheme is a single-year renewable contract that can cover employees under a single policy. The coverage sum ranges from Rs 50,000 to Rs 10,00,000 under this plan. 

ManipalCigna ProHealth Group Insurance Policy

This group insurance for employees has been designed to offer medical coverage to members of the group in the scenario of hospitalization due to any illness or injury. The sum insurance options available under this plan range from Rs 5, 000 up to Rs 1 crore, and it provides coverage for 7 inbuilt benefits under base cover and 41 benefits under optional covers. The base cover of the ManipalCignaProHealth Group Insurance Policy includes: in-patient hospitalization expenses cover, post-hospitalization medical expenses cover, day care treatment cover, road ambulance cover, pre-hospitalization medical expenses cover, domiciliary hospitalization cover, donor expenses cover etc. 

ManipalCigna Global Health Group Policy

This corporate medical insurance policy scheme is meant for the employees and their families whilst working/traveling for work across India and overseas. This policy scheme provides comprehensive health protection for in-patient hospitalization expenses, daycare, and outpatient expenses, and includes customized optional covers.  

Oriental Health Group Mediclaim

This group mediclaim policy is meant to group/institution/corporation/association body with more than 50 members. An expansive range of hospitalization cover is provided under the Oriental Health Group Mediclaim policy scheme, including the expenses related to medicines, blood, oxygen, anesthesia, OT Charges, medicines and drugs surgical appliances, chemotherapy, dialysis, radiotherapy etc.  

Reliance Group Mediclaim Insurance Policy

This group insurance for employees has much more cost-effective premium rates than typical individual health plans and covers against all illnesses and injuries from the very next day of policy purchase. Meant for employees aged 18-60 years, the coverage of the Reliance Group Mediclaim Insurance Policy includes pre-existing diseases, maternity benefits, room rent charges, pre-hospitalisation expense for 30 days and post-hospitalization expense cover for 60 days, road ambulance charges, day care procedures etc.

Religare Group Care Insurance Plan

This group mediclaim insurance policy for employees provides people with the flexibility to design a policy that suits the needs of their employees and offers a wide range of sum insured options from Rs 50,000 to Rs 10 lakh. Additional benefits like wellness initiatives and complementary annual health check-ups are included under this policy scheme as well. The prime coverage benefits of this plan are- in-patient hospitalization, day care treatment, pre-hospitalization and post-hospitalization, ambulance cover, no pre-policy medical check-up, a wide range of sum insured options, newborn cover from Day 1 etc.

Royal Sundaram Group Health Insurance for Corporate

This group mediclaim insurance policy for employees offers a comprehensive health insurance package to employees of a company and their family members. In addition to the typical coverage, the insured individuals also gain access to 24-hour helplines, free ambulance referral facilities, as well as cover for outpatient treatment in certain cases under this policy option. 

SBI Group Health Insurance Policy

This group mediclaim policy includes medical practitioner and specialist fees as well as room, board, and nursing charges for the 1% of sum insured to max Rs 1500/- per day for Normal Room. The coverage for this policy scheme includes expenses incurred for Anesthesia, blood, Oxygen, Operation Theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X-rays, dialysis, chemotherapy, radiotherapy, cost of pacemaker, prosthesis/internal implants etc.

TATA AIG Corporate Health Insurance

This is a cost-effective group mediclaim policy for employees that provide quite comprehensive coverage. The TATA AIG Corporate Health Insurance is a tailor-made policy with a choice of benefits, as well as 24x7 worldwide cover. The sum insured for this policy scheme is based on salary or category. 

United India Group Health Insurance Policy

This corporate medical insurance plan provides coverage to the employees at quite affordable premium rates. The list of coverage under this United India Group Health Insurance policy includes hospitalization expenses including pre and post hospitalization cover, ambulance cover etc.

Universal Sompo Group Health Insurance Policy

This group medical insurance policy is designed for employees in the manufacturing and trading sectors or social sectors and members of clubs/societies/institutions/associations. Treatments undertaken only in nursing homes or hospitals in India are covered in this policyThe coverage under the Universal Sompo Group Health Insurance Policy includes expenses like in-patient hospitalisation expenses such as room rent, nursing expenses, medicine costs, OT/ICU cost, charges for oxygen and blood etc.

Claim Process for Group Health Insurance

Here are the typical steps that people would be required to follow to claim group health insurance plans: 

  • Insured should contact the relevant insurance company as soon as possible to make a claim. Their contact details can easily be found on their official website. 
  • The insurance provider's customer care desk representatives shall guide the claimant through the process of the claim, as well as inform them about all of the documentation they shall need for this procedure. 
  • The insured individual can then download the relevant claim form by visiting the official online platform of the insurance company or asking for any other way to acquire it to the company's customer care professionals.
  • The claimant must then fill and sign the claim form properly, along with all the needed documents. 
  • The claim form and the documents should then be sent to the insurance company.
  • The insurance provider would go through the claim form and the documents and decide to approve/ deny the claim on its basis. 

Documents Required for Buying Group Health Insurance Policy

The following documents will be required for buying a group medical insurance policy 

  • Age proof, for example- Birth certificate,10th or 12th mark sheet, Driving License, Passport, Voter ID
  • Identity proof, for example- Driving License, Passport, Voter ID, PAN Card, Aadhar Card
  • Address proof, for example- Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport
  • Passport Size Photo  

Frequently Asked Questions 

Written By: Paisawiki - Updated: 10 July 2020
Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
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