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A group health insurance policy is a type of insurance that offers medical coverage for several individuals. Organisations often purchase such an insurance policy to provide medical coverage to their employees. Group health insurance policies are typically very affordable. Learn more about this in the following sections.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Features of Group Health Insurance Policy

Here are a few features offered by the Group Medical Health Insurance Plan:

  • Employees can seek cashless claim facilities at any of the insurer’s network hospitals

  • Some Group Health Insurance plans also cover pre-existing illnesses after the completion of the waiting period

  • Group Health Insurance policies may also extend coverage to the dependents of the insured

  • Certain Group Health Insurance policies also cover ambulance costs

  • Employers can claim health insurance tax benefits under section 80D of the Income Tax Act, 1961

Advantages of the Group Medical Insurance

Group Health Insurance offers numerous advantages for both employers and employees. It covers maternity and outpatient (OPD) benefits, promoting preventive care for employees. Additionally, it includes wellness sessions and other health-related coverages, making it a valuable investment. Read on to learn more about their benefits.

1. For Employers

Here are a few benefits of the Group Health Insurance Policy for the employers:

  • Improves Employees’ Retention

In a competitive job market, retaining talent can be challenging. Offering comprehensive health coverage to employees and their families increases the likelihood of them remaining with the company.

  • Offers Value for Money

A Group Medical Health Insurance policy is comparatively more affordable than Individual Health Insurance plans. Hence, the employer can offer a wide range of features at a nominal price to the employees.

  • Tax Benefits

Employers can take advantage of the tax benefits of Group Health Insurance under section 80D of the Income Tax Act, 1961.

2. For Employees

The following are a few benefits of the Group Health Insurance Policy for the employees:

  • Extensive Coverage

A Group Health Insurance plan covers a range of pre-existing health conditions This implies that the employees will not have to worry about their sudden hospitalisation costs during any kind of medical emergencies.

  • Preventive Care

Many group medical insurance plans include coverage for preventive care services such as regular check-ups, vaccinations, screenings, and wellness programs. This encourages employees to prioritise their health and catch any potential health issues early, leading to better overall health outcomes.

  • Family Coverage

In many cases, group medical insurance extends coverage to employees' families, including spouses and children. This ensures that employees' loved ones also have access to necessary medical care when needed.

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Inclusions & Exclusions Under Group Health Insurance Policy

Here are a few details about the inclusions and exclusions of a Group Health policy:

Inclusions

Exclusions

Accidental hospitalisation

Pre and post-natal expenses

COVID-19 hospitalisation

Pre-existing diseases waiting period

Illness related hospitalisation

Hospitalisation without a doctor's recommendation 

Health checkup

Claims made before the waiting period

Daily hospital cash cover

Medical conditions due to drug or alcohol abuse

Psychiatric assistance

 

Critical illness 

 

Maternity 

 

Road ambulance

 

Organ donor expenses

 

Ayurvedic/homoeopathic treatment 

 

Infertility treatment

 

Surgeries

 

How Does a Group Health Policy Work

When a company chooses a Group Health Insurance policy for its employees, it typically covers the premium expenses. The purpose of securing Group Medical Health Insurance is to ensure employees have access to healthcare benefits and financial protection for medical treatments.

 

Under this plan, the basic coverage and sum insured remain uniform for all corporate employees. However, employees may opt to include additional beneficiaries, such as their spouse, children, and in certain cases, elderly parents, by paying a higher premium.

Who Should Purchase a Group Health Insurance Policy

Here are the types of organisations that should purchase the Group Medical Insurance Policies for their employees:

1. Small Businesses & New Startups

Recently launched businesses having a minimum of 15 team members should consider a Group Health Insurance plan. This will not only cover employees against medical emergencies but also enable firms to save money on taxes. 

 

Furthermore, there's no need for concern regarding expenses, as Group Health Insurance plans are tailored to fit the company's financial capacity and the robustness of its workforce.

2. Medium-sized Enterprises 

Medium-sized companies may also provide Group Health Insurance to financially safeguard their employees from medical emergencies. This will not only increase employees' motivation but also help retain them for a longer period of time. 

3. Big Ventures 

Employees at large, well-established startups anticipate perks like health insurance as a part of their compensation. Hence, if your firm employs 1,000 people or fewer, offering a Corporate Group Health Insurance Plan not only offers them peace of mind but also enhances your company's reputation.

Factors to Consider While Getting Group Health Insurance

Here are a few factors that the employers must consider before purchasing the Group Health Insurance Policies:

1. Significant Benefits

A Group Health Insurance plan's main goal is to offer healthcare advantages to employees to reduce their financial strain during any kind of medical emergency. 

 

Therefore, when selecting a Group Health Insurance plan for your employees, the type of benefits included should be the first element you must look for. 

2. Premium Amount

It is critical to consider the cost of your Group Health Insurance Policy and whether it is a reasonable offer or not. Consider the advantages associated with the lower premiums rather than choosing them at random.

3. Communication Effectiveness 

While choosing Group Health Insurance, ensure that it justifies the medical needs of your employees. Make sure that when they are in need, employees are able to receive a positive interaction with the relevant person. Insurance companies frequently employ third parties as mediators. In this situation, you should make sure that the third-party administrator assists your employees properly.

4. Service Advantages

When selecting healthcare insurance, the quality of services provided is paramount. The insurance coverage you choose effectively must address medical needs with utmost care and consideration. Hence, before finalising a Group Health Insurance Policy for your employees, meticulously evaluate and compare the services offered by various health insurers.

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Group Health Insurance vs Employee Health Insurance

Group Health Insurance and Employee Health Insurance are essentially synonymous. Both terms refer to health insurance provided by employers. These insurance coverages aim to offer medical benefits to employees, enabling them to cover expenses such as hospitalisation, medical treatments, and surgeries. However, to ensure a smooth claims process and avoid any complications, it's essential to review the specific services the policy offers.

How to Claim for the Group Health Insurance

Here are a few steps you can follow to claim your Group Health Insurance Plan:

  1. Get in touch with your insurer to register the claim

  2. Fill up the claim application form

  3. Upload the necessary documents/medical bills

  4. Wait for the insurer to assess your application

  5. Check your claim status online or contact your insurer for more details

Documents Required When Making a Claim

The following are a few documents that play a vital role in getting your health insurance claim approved:

  • Duly filled and signed claim application form

  • Final investigation report

  • Doctor’s prescriptions

  • Medical reports

  • FIR (if any) 

  • Hospital and pharmacy bills

  • Hospital discharge summary

  • Any other related document

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FAQs on Group Health Insurance

Which group health insurance policy for employees in India is the best?

Several reputable insurance firms provide Group Health Insurance plans. However, you should examine the plans provided by various insurers to choose the one that best suits the needs of your employees.

Is Group Health Insurance Policy free of cost for employees?

Yes, most employers provide free Group Health Insurance Policy to their employees.

Can I buy Group Health Insurance online?

Yes, a Group Health Insurance Policy can be purchased online. However, you should always purchase it from reputable insurance providers or aggregators such as Bajaj Markets.

Do I need to buy an Individual Health Insurance if my company offers a Group Health Insurance Policy?

Yes, you should preferably have health insurance because the highest sum insured supplied by a Group Health Insurance Policy is typically minimal. Moreover, if you are in the process of changing employment and have a medical emergency, you will no longer be protected by the Group Health Insurance Policy.

Can couples have a Group Health Insurance Policy?

Yes, a couple who operate a family business are eligible for the Group Health Insurance Policies.

How is the premium amount of the Group Health Insurance Policy determined?

A Group Health Insurance premium is estimated based on the number of employees, their ages, location, and the number of dependents you wish to cover under the applicable plan.

What is the waiting period for group health insurance?

The waiting time for Group Health Insurance plans is typically 30 to 90 days, depending on the insurance carrier and its terms and conditions.

Does Group Health Insurance cover pre-existing illnesses?

Yes, Group Health Insurance plans cover pre-existing diseases after a waiting period of a specific period.

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