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What is Group Health Insurance 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 of 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.

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Group Mediclaim Insurance Policy for Employees

In this modern fast-paced society, people experience a lot of stress that can lead to unhealthy food choices and poor lifestyle choices. A combination of these factors like disrupted sleep schedule, dependence on junk food, etc can lead to many health complications.

 

Fortunately, most companies provide corporate health insurance covers to their employees free of cost or for a highly discounted price. These health plans offer adequate health coverage to the employees and extend 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.

Advantages of Group Health Policies

There are multiple benefits of a group health insurance policy, for both employees and employers. You can take a look at these benefits below:

Benefits of Group Health Insurance for Employers

  • 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 families. 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 more affordable than individual health insurance plans. Hence, the employer can offer a wide range of features at nominal group health insurance premium costs to the employees.

  • Employers can take advantage of the tax benefits of group health insurance under Section 80D of the Income Tax Act, 1961.

  • Can help the organisation boost its productivity by providing motivation to the employees in the form of Health Insurance Plans.

Benefits of Group Health Insurance for Employees

  • 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.

  • Employees can save more money or use the money for other purposes as they do not need to purchase health insurance for themselves.

  • It will improve the mental well being of the employees since they know they will be covered against medical emergencies with company health insurance.

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

Features of a 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 extends coverage to the dependents of the insured (spouse, children, and parents).

  • Some policies also cover ambulance costs.

  • Some policies offer reimbursements of fees for specialists and other medical practitioners in case of follow-up medical exams.

  • Health Insurance tax benefits with deduction under Section 80D of the Income Tax Act, 1961.

Why is Group Health Insurance Required?

Over the past few years, job benefits such as corporate/group health insurance, paid leaves, reimbursement for travel, internet, etc. have become some important factors that potential employees consider when looking for employment opportunities. With the rising cost of private healthcare, all employees wish to remain insured against any expenses that arise out of medical emergencies. Thus, to attract qualified and competent employees, companies offer group insurance services.

 

This also allows employers to retain their employees for longer periods of time, improving productivity. Moreover, as group insurance is usually bought in bulk for a large number of employees, companies can get it at affordable rates. Some group insurance plans also allow employees to customise or upgrade their plans at a small cost. Lastly, the employer also gets tax benefits for providing group help insurance to their employees.

Inclusions of a 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 expenses

  • Road ambulance cover

  • Daycare procedures

  • Organ donor expenses

  • Sum insured reinstatement benefit

  • Ayurvedic/Homoeopathic treatments

  • Hospitalisation expense

Exclusions of a 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 the 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 are not covered.

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

How to Claim Group Health Insurance?

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

 

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

 

Step 2: Fill out and sign the claim application form.

 

Step 3: Upload the necessary documents/medical bills.

 

Step 4: Wait for the insurer to assess your application.

 

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

Documents Required When Making a Claim

The following list of documents plays 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 an accident, the police FIR

  • Cash memos and itemised bills

  • Hospital discharge summary

  • Any other related document

The Bottom Line

The group mediclaim policy offered by your employer is a good way to cover your and your family’s medical expenses. However, a mediclaim policy may not be enough as its scope is limited when compared to individual or family health insurance. 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 through Health Insurance Plans available on Bajaj MARKETS, and choose a policy that best suits your specific needs.

Best Health Insurance Plans Available at Bajaj MARKETS

FAQs on Group Health Insurance Policy

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

    Most reputed insurance companies offer group health plans, but you should research the plans offered and select the plan that is the most suitable for your organisation’s needs.

  • ✔️Is group health insurance free for employees?

    Yes, most companies offer group health insurance to their employees free of cost.

  • ✔️Is group health insurance cheaper than individual health insurance?

    Yes, group health insurance is usually much cheaper on a per head basis as it is purchased in bulk.

  • ✔️Can group health insurance be bought online?

    Yes, you can buy group health insurance online, but make sure you only buy from reputed insurance websites or aggregators like Finserv MARKETS. 

  • ✔️Do I need to buy individual health insurance if my company offers a group health insurance policy?

    Yes, ideally you should have your own health insurance in place, as the maximum sum insured offered by a group health insurance policy is usually low. Moreover, if you are in the middle of switching jobs and a medical emergency happens, you will no longer be covered by group health insurance.