What is covered under GMC that individual insurance doesn’t cover?

What is covered under GMC that individual insurance doesn’t cover?

Life is uncertain. Unforeseen events like sudden illness, accident and death may occur anytime in anyone’s life. Such unfortunate events can leave the person and his/her family shattered emotionally, physically as well as financially. Specifically, when it comes to illness and accidents, hospital bills can mount in no time as the healthcare is becoming extremely expensive. Treatment for a minor illness in a private hospital in India could burn a hole in the pocket. Hence, it becomes crucial to have an adequate health insurance coverage for the entire family. Considering the importance of health benefits, employers today are providing group mediclaim coverage (GMC) to their employees as a key employee benefit package.

What is Group Mediclaim Coverage (GMC)?

Group Mediclaim Coverage (GMC) is a medical insurance plan designed to provide protection to group of people with common need by offering the similar benefits to all the members of the group against medical uncertainties. Group that can avail mediclaim coverage for its member can be a corporate, association, social group or any financial and non-financial institutions with more than 20 members. 

Group size can vary. Depending on the nature of business, average age group of employees, income range, group size and benefits availed under the policy, premium rate of group insurance scheme for employees may vary. 

What is covered under Group Mediclaim Coverage (GMC)?

There are various benefits offered by Group Mediclaim policies covering most of the healthcare uncertainties that employees may face. Following are some of the advantages of group insurance.

  • Hospitalisation expenses: Expenses related to in-patient hospitalisation exceeding 24 hours is covered under the policy. Expenses include room rent, boarding charges, nursing fees, intensive care unit expenses, surgeon fees, anaesthetist fees, medical practitioner fees, specialist charges and consultant fees, charges incurred for blood, oxygen, operation theatre and surgical appliance, chemotherapy, dialysis, cost of prosthetic devices, x-rays and diagnostic test charges etc.

 

  • Pre and post hospitalisation expenses: Expenses incurred during few days (as per the policy terms) prior to hospitalisation are covered under the policy. Also, expenses incurred during few days (as per the policy terms) after the hospitalisation are covered under the policy. 

 

  • Domiciliary hospitalisation charges: domiciliary hospitalisation refers to treatments taken at home which in the normal course would require care and treatment at a hospital. Treatments taken at home due to immobile condition of patient or non-availability of bed at hospital are considered to be domiciliary hospitalisation. Expenses incurred for domiciliary hospitalisation of more than three days are covered under group mediclaim policies.

 

  • Day care procedures: Day care procedures refers to treatments or surgical procedures undertaken in a hospital or at a day care centre for less than 24 hours due to technological advancement. Expenses incurred for such treatment are covered under group insurance schemes.

 

  • Alternative treatments: Many group insurance policies cover expenses incurred for alternative treatments such as Ayurvedic and homeopathic medicines. 

 

  • Add-on covers: There are various additional benefits can be availed under group mediclaim coverage (GMC) insurance. By paying additional amount of premium, employee can avail coverage for elderly parents, spouse and children. Maternity expenses are usually covered under the policy for spouse. Waiver of waiting period, dental treatments, eye treatments, contact lenses and spectacles cost can also be covered additionally under the group mediclaim policy. Some policies can even cover ambulance charges and out-patient department (OPD) treatments. Click here to know how group mediclaim policies can be customised

Along with the coverage benefits, group mediclaims are the cost effective ways of availing the health protection. Cashless hospitalisation facility available with huge network of hospitals included by the insurance companies makes the life easier for insured employees. Insured will also have a choice to seek medical treatment at non-network hospitals and get the amount reimbursed by the insurance company later. Many group mediclaim policies also provide an option to enhance the sum insured for needy employees, specifically to those whose coverage is already exhausted.

Group mediclaim coverage (GMC) insurance policies have certain advantages over individual health insurance plans. Let’s take a look at the key coverage differences observed in both the policies.

Group insurance vs individual insurance

Group mediclaim insurance policyIndividual health insurance policy
Medical check-ups are ideally not required to seek group mediclaim coverage. Even for parents above 60 years, coverage can be availed without medical check-upThough many individual health insurance plans are offered without medical check-ups these days, there are age limit. After a certain age and also depending on the medical history, medical check-up would be needed.
Pre-existing ailments are covered without any waiting periodPre-existing ailments are covered only after a certain months/years of waiting period is over.
Maternity coverage is usually provided with waiting periods waived offMaternity coverage is provided to the insured only after the specified waiting period is over.
In most of the group mediclaim policies, new born children are covered from day one.Most of the policies cover the new born child only after the completion of 90 days from date of birth.
Group mediclaim insurance policies do not get expensive with the age of an employeeIndividual health covers get expensive with the age of the insured.

 

A good group mediclaim insurance policy chosen by employer can work like a strong employee retention tool. It gives the employees a sense of protection against various health uncertainties. It’s always important to have an adequate health insurance coverage for the entire family especially when the medical care expenses are rising high. Click here to buy a various types of group insurance plans.

 

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