Comparison of Group and Individual Health Insurance

S No.BenefitsIndividual Health PlanGroup Health PlanFlaws in Individual Health PlanRemarks/Advantage of Group Plan
1Coverage forEmployee onlyEmployee only
2Pre Existing illnessCovered after 4 yearsCovered from day 1Employees who do not have continuous health insurance for 4 years will denied claims for pre-existing ailmentsFor example, if someone has high BP or diabetes then all related claims in individual insurance will be denied. This is the main reason for claim declines. This issue does not occur in group mediclaim since pre-existing diseases are covered.
31/2/4 year Waiting periodApplicableWaived & disease covered from day 1No claims payble in case of Diseases like cataract, hernia, hysterectomy, Kidney stone, piles, Gall bladder, knee replacement etc for specified no. of years(1 ,2 & 4) as in planNo claims payble in case of diseases like cataract, hernia etc in existing policy while they are covered from day 1 in proposed plan.
430 days waiting periodApplicableWaived & disease covered from day 1No claims payable in first 30 daysAny illness other than trauma cases are not covered for 1st 30 days within the existing policy while it is covered from day 1 in the Proposed plan.
5Maternity benefitsNot Available in most of the plansCovered from Day 1 :  for normal 25K and for C-Sec 35KNo claims payable for maternity casesMaternity claims not at all covered in  existing plan however it is payable after first 9 months from the start of the policy in proposed group plan
6Newborn baby coverCovered after 90 daysCovered from day 1Any complication in the baby’s health at the time of birth is not payableAt the time of child’s birth, complications like jaundice are frequent & the treatment expensive. Those expenses are not covered in existing policy, however they are payable in the proposed plan
7Addition of new employeesFull year premium requiredPro-rata premium  is charged  until the end of the policy periodPro-rata premium  is not chargedAdministration is simple because there is a single renewal date for all the employees.
8Deletion of employeesNo refund in  case an employee leaves the organizationPartial refund possible when an employee leavesNo amount is refunded to the corporate when employee leaves the organizationPartial refund possible for employees who resign.
9Dedicated Relationship ManagerNo dedicated managerDedicated RM who supports claims and servicingNo claims & servicing manager
10Room rent capping1% of Sum Assured for Normal & 2% in case of ICUNo sub-limits for room rent & ICU – single AC room can be usedLesser room rent elligibility resulting in payment of additional amount from your own pocketA better quality of hospitals can be chosen and single room used in the case of this group policy. These features are not available in individual policy
11Pre/post hospitalization expences30 days pre & 60 days post  are covered30 days pre & 60 days post  are covered
12Ambulance ChargesRs. 1000/- per incidentRs. 1000/- per incident

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