Group Health Insurance Policy

Group Mediclaim Insurance Policy for Employees

In matters like these, the least that an employer can do is to offer health insurance plans as a part of additional benefits to their employees. This health plan offers adequate health coverage to the employees and extends the benefits of the policy to their families as well. 

So, if you are an employer who is looking to get the employees good health insurance coverage, you might want to consider a group mediclaim plan for employees.

What is Group Mediclaim Policy?

A group mediclaim policy is a healthcare coverage provided to the people belonging to a specific group/community. It is also known as group health insurance for employees as it is often offered to employees by their organisation.

There are several variations to group health insurance so that employers can customise the plan according to the needs of their employees. Some group mediclaim plans cover the employee as well as their family members. The type of group plan to be chosen completely depends on the employer.

Benefits of Group Mediclaim Policy

A group mediclaim plan offers benefits to both the employee as well as the employers. Here, take a look!

Employer Benefits of Group Mediclaim Policy

• Increases employee retention: With so many job offers available in the market, employee retention can be difficult.  However, if you (the employer) are providing adequate health coverage to your employees and their families, the chances of your employees staying in the company increases.

• Motivates employees: We all know that the medical costs are off the roof. Because of this reason, many people in India are reluctant to buy health insurance for themselves and their family. Having their company provide the same will motivate the employees to consider buying a health plan to secure themselves and their loved ones.

• A wide range of benefits at a nominal cost: A group mediclaim policy is comparatively affordable than individual health insurance plans. Hence, the employer can offer a wide range of features at nominal premium costs to the employees.

Employee Benefits of Group Mediclaim Policy

• Coverage for pre-existing diseases: The employees enrolled under the group mediclaim plan can get coverage for pre-existing diseases, ailments, or injuries, only after completing 36 months of continuous coverage. Also, know that you have to disclose the pre-existing diseases, ailments, or injuries in the proposal form when enrolling for the policy.

• An extensive coverage: While a group mediclaim plan covers the pre-existing health conditions, it also covers a wide range of diseases under it.

Now, let us take a look at some features of group mediclaim plans available in India.

Features of Group Mediclaim Policy

The following is a list of common features offered by Group Mediclaim Plans.

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

• Some group health insurance plans also cover pre-existing illnesses after the completion of the waiting period (as stated by the insurer)

• Group mediclaim policy for employees also extended coverage to the dependents of the insured (spouse, children, and parents)

• Some policies also cover ambulance cost

• Some policies offers reimbursements of fees for specialists and other medical practitioners in case of follow check-ups

• Tax benefits with deduction under Section 80D of the Income Tax Act, 1961

Inclusions of Group Mediclaim Policy

The following are the common things covered under the group mediclaim policy.

• Preventive health check-up

• Hospital cash benefit

• In-patient hospitalisation treatment

• Pre- and post- hospitalisation

• Road ambulance

• Daycare procedures

• Organ donor expense

• Sum insured reinstatement benefit

• Ayurvedic/Homeopathic

• Hospitalisation expense

Exclusions of Group Mediclaim Policy

Some of the common things that are not covered under group mediclaim plans are as follows –

• Some plans do not offer coverage for parents of the employee

• The validity of group mediclaim plans for the employees is limited. It is generally valid until the employee is working at the company and has to be renewed every year.

• Congenital diseases and the expenses incurred in the treatment of HIV/AIDS is not covered

•  Any medical complications arising due to the use/abuse of alcohol or drugs

Group Health Insurance Claim Process

The process to claim on group mediclaim policy is the same as that of most other health insurance plans. Just follow the steps given below:

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

2. Fill and sign the claim application form

3. Upload the necessary documents/medical bills

4. Wait for the insurer to assess your application

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

Documents Required When Making a Claim

The following list of documents play a vital role in approving your health insurance claim.

• Duly filled and signed claim application form

• Final investigation report

• Doctor’s prescriptions

• Medical reports

• In case of accident, the police FIR

• Cash memos and itemised bills

• Hospital discharge summer and suggest line of treatment (if any)

• Any other related document

The Bottom Line

The group mediclaim policy offered by your employer is a good way to cover the medical expenses of you and your loved ones. But a group mediclaim plan is not sufficient at times. Hence, it is advisable to buy a comprehensive health insurance plan that provides extensive coverage. 

In case you are looking for a health insurance plan that covers you and your family, browse Health Insurance Plans available on Finserv MARKETS, and choose a policy that best suits your requirements.