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What is Group Health Insurance Policy?

A group health insurance policy is a type of health insurance that offers coverage for healthcare-related expenses for a large group of individuals. Such an insurance policy is often purchased by organisations to provide medical coverage to their employees on a large scale. Group health insurance policies are typically very affordable, allowing organisations to provide coverage for a large number of individuals at nominal costs. In addition to covering the employees in a company, this type of health insurance plan provides medical coverage to their families as well. Most group health insurance plans also begin to cover pre-existing conditions and illnesses after the expiry of a predetermined waiting period. 

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How does a Group Health Policy Work

When a company chooses to take a group health insurance policy for its employees, the firm is responsible for paying the premium amount. The reason behind taking group health insurance for employees is to provide them with healthcare benefits and financial safety in terms of medical treatments.

 

The basic plan and sum insured would be the same for all employees because the group health insurance plan would be purchased for all corporate employees. However, employees have the option to add extra beneficiaries, such as their spouse, children, and, in some circumstances, their elderly parents, in exchange for a higher premium payment.

Features of a Group Health Insurance Policy

The following is a list of common features offered by group health insurance 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).

  • Some group health insurance policies also extend coverage to the dependents of the insured (spouse, children, and parents).

  • Some policies also cover ambulance costs.

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

Advantages of Group Health Policies

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

Benefits of Group Health Insurance for Employers

  • Improves 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 increase.

  • Offers Value for Money

A group health 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.

Benefits of Group Health Insurance for Employees

  • Coverage for Pre-Existing Diseases

The employees enrolled under the best group insurance policy can get coverage for pre-existing diseases, ailments, or injuries after completing 36 months of continuous coverage.

  • An Extensive Coverage

While a group medical plan covers pre-existing health conditions, it also covers a wide range of diseases under it. Employees won't have to worry about sudden hospitalisation costs during medical emergencies.

  • Peace of Mind

Employees can rest assured that in case they contract a severe illness that requires hospitalisation, their expenses are covered.

Inclusions & Exclusions of a Group Health Policy

Below are the 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 doctor recommendation 

Health checkup

Claims before 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/homeopathic treatment 

 

Infertility treatment

 

Surgeries

 

Why is Group Health Insurance Required

Job benefits such as paid leaves, group health insurance, travel reimbursement, etc. have become important factors that potential employees gauge while looking for job opportunities. With the rising cost of private healthcare, all employees wish to remain insured against any expenses that could arise out of medical emergencies. Thus, to attract qualified and competent employees, companies offer group insurance coverage. This also allows employers to retain their employees for longer periods, improving productivity. Lastly, the employer also gets tax benefits for providing group health insurance to their employees.

Who Should Purchase a Group Health Insurance

Following are the types of organisations that should purchase group health insurance for their employees:

1. Small Businesses & New Startups

Recently launched businesses having a minimum of 15 team members should consider enrolling in a group health insurance plan. This will not only cover your employees but also enable you to save money on taxes. 

Additionally, you are not required to get worried about the expenses as group health insurance plans are created based on the company's ability to pay and the strength of its workforce.

2. Medium-sized Enterprises 

Medium-sized companies may also provide group health insurance to safeguard their staff from medical emergencies. This will not only increase your employees' motivation, but it will also help you keep them around for a longer period of time. 

3. Big Ventures 

Employees at the large, well-established startup anticipate perks like health insurance as part of their compensation. Therefore, if your firm has less than or equal to 1,000 employees, you should provide them with a corporate health insurance plan that will not only provide them peace of mind but also improve the reputation of your company.

When purchasing a Group Health Insurance policy in India, what should employers look for

While taking group health insurance policies for their employees, there are certain factors that you must look for:

1. Significant Advantages

A group health insurance plan's main goal is to offer healthcare advantages to employees in order to reduce their economical strain during any medical emergencies. 

Therefore, when selecting the finest group health insurance plan for your employees, the type of benefits included in the plan should be the first element you must look for. 

2. Premium Amount

It is critical to consider the cost of your group health insurance and if it is reasonable given the features provided. Consider the advantages associated with lower premiums rather than choosing them at random.

3. Communication Effectiveness 

While choosing group health insurance, ensure that it justified the medical needs of your employees. Make sure that when they are in need, your employees have a positive interaction with the relevant person. Insurance companies frequently employ third parties as mediators. In this situation, you should always confirm if the particular third-party administrator is assisting your employees well or not.

4. Service Advantages

When it comes to healthcare insurance, offered services are the foremost thing that people look for. Everybody wants insurance coverage that will handle medical issues with the highest care and consideration. Therefore, before choosing a group health insurance plan for your employees, carefully assess and compare the service of other health insurers.

5. Regional Coverage

Another factor to consider when selecting a group health insurance plan is whether it covers the entire nation and if it does, how many network hospitals are dispersed around the country, and so on.

Group Health Insurance vs Employee Health Insurance

While people are often confused between group health insurance and employee health insurance, you must note that both are the same. The two can be used interchangeably for health insurance covers offered by corporate companies.

Both insurance coverages are taken to provide medical benefits to the employees. Working professionals can use this insurance coverage to pay hospitalisation bills, medical treatments, surgeries, and other medical things. However, you must go through the offered coverages in order to avoid difficulties and make a successful claim. 

How to Claim Group Health Insurance

The process to claim a group health insurance policy is the same as any other health insurance plan. 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

  • 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?

    The majority of reputable insurance firms provide group health plans. However, you should examine the plans provided by various insurers in order to choose the one that would be most advantageous for your employees.

  • ✔️Is group health insurance free for employees?

    Yes, most employers provide free group health insurance to their employees.

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

    Yes, since group health insurance is purchased in bulk, it is less expensive.

  • ✔️Can I buy group health insurance online?

    Yes, group health insurance may be purchased online. However, it is advisable that you should always purchase it from reputable insurance websites or aggregators such as Bajaj Markets.

  • ✔️Do I need to buy 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. Furthermore, if you are in the process of changing employment and have a medical emergency, you will no longer be protected by group health insurance.

  • ✔️Why is group health insurance crucial?

    This type of insurance is a group health insurance coverage issued to a group of people. This is also known as a corporate health insurance plan. This plan enables businesses to obtain health insurance for their employees at a lower cost than individual insurance coverage. Moreover, to attract qualified and competent employees, companies offer group insurance coverage. This also allows employers to retain their employees for longer periods, improving productivity. Lastly, the employer also gets tax benefits for providing group health insurance to their employees.

  • ✔️Can individuals purchase a group health insurance plan?

    A group of people can purchase group health insurance, but an individual cannot.

  • ✔️Can couple have group health insurance?

    Yes, a husband and wife who operate a family business are eligible for group health insurance policies.

  • ✔️Does group health insurance cover maternity?

    Yes, employees are entitled to maternity benefits for themselves or their spouses under group health insurance coverage.

  • ✔️Is covid covered under group health insurance?

    Yes, COVID-19 treatment is covered under a group health insurance policy.

  • ✔️How is a group health insurance premium 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 is typically 30 to 90 days, depending on the insurance carrier and its terms and conditions.

  • ✔️What are a group health insurance's limitations?

    Despite the fact that group health insurance benefits both the employer and the employee, one of its biggest drawbacks is that, in the case of an employee, the coverage might not be sufficient to meet all medical requirements because most group health insurance plans are constrained and pragmatic in nature.