ImageGroup Insurance Policy - Benefits, Features, Coverage & Claim Process

The Benefits of Group Insurance Policy

Superior Benefits

Several benefits provided under a group insurance plan are either not available in an individual insurance or are available with restrictions e.g., pre-existing diseases cover from day 1.

Low Cost

A group insurance plan leverages economies of scale to offer better coverage for a relatively lower premium than an individual insurance. Costs could be upto 50% lower than individual plans.

Customized cover

Group insurance plans allows a cdompany to customize insurance benefits. For example, you can cover maternity benefits in a group health insurance plan with or without a waiting period.


Easy Administration

Buying and maintaining a group insurance plan is siginificantly easier than managing multiple individual plans for employees. For example, waiver of medical underwriting for individuals.

Quick Guide to Group Insurance

What is Group Insurance

A group insurance is a master plan that covers members of a particular group. Group insurance policies are mostly bought by employers for their employees. Group insurances are created to provide better protection at reduced cost as the provider’s cost is spread across a large number of policyholders. Group insurance can also be bought by organizations to cover their customers, borrowers and channel partners.

Types of Group Insurance Policies for Employee

Following are some common types of group insurance policies:

  • Group Health Insurance: a type of insurance that provides health coverage to the group members and their dependents (if covered) under the policy. It generally covers hospitalisation expenses, day care charges and ambulance charges amongst other medical expenses.
  • Group Life Insurance: this is a type of group insurance that provides death benefits to the members of the group for a stipulated time period. If a member of the group dies then the nominee of the group member receives compensation. But this insurance does not provide benefits if the insured survives the maturity period.
  • Group Personal Accident Insurance: this is a group insurance that covers the group members for death or permanent disability due to accidents.
  • Group Travel Insurance: group travel insurance covers a group of people travelling together against any unforeseen contingencies, both medical and non-medical. So, group policies for employees can be any of these or even a combination of these policies.

Features of Group Insurance

  • Group insurances plan cover all members of the group and provide them with standardised cover, irrespective of the size of the group
  • Group insurances policy can cover the members along with their dependents, if included in the coverage
  • Coverage for pre-existing ailments, maternity for employee/spouse and a wide range of diseases
  • Reimbursement of claims if treated in non-panel hospitals
  • Additional coverage for medical practitioner charges, ambulance charge, room rent/ICU charges, etc.
  • A group insurance ceases to exist when a member leaves the group

Key insurers that provide Group Insurance Plans for Companies

Some key insurance companies excelling in group insurance include: ICICI Lombard, LIC of India, The New India Assurance Company and National Insurance. For certain lines of businesses, group insurance contributes around 50% of the total premium.  Insurance.

Eligibility Criteria for Group Insurance

Eligibility criteria varies by insurance companies. Some of the common eligibility criteria are:

  • Members have to be active and full-time members of the group, especially in the case of employee-employer policies
  • Minimum age of entry is 18 years and the maximum age varies between 65-69 years
  • The minimum number of group members also varies. Some group insurance plans want a minimum of 7 members in a group and a few require at least 50 members

How to buy best group insurance policy online

Following are the steps involved in online purchase of group insurance:

  • Quotation – SecureNow provides an option to buy group insurance policy online. Enter basic details about your group size and get instant quotes on our website.
  • Member data collection – Requisite data of the insured is collected to be able to provide appropriate cover and benefits via the group insurance policy. Standard data items include: the name and date of birth of the concerned member.
  • Payment – We provide options to pay via our payment gateway or NEFT transfer directly to the insurer’s bank account.
  • Card and certificate distribution to insured members – All members will get a certificate of insurance or an e-card on SecureNow App.

Claim Documents Required for Group Insurance

Group Health Insurance

  • Duly filled group health insurance claim form
  • Doctor’s statement showcasing line of treatment
  • Original medical bills
  • Hospital bills and receipts, original
  • Discharge summary

Group Life Insurance

  • Duly filled group life insurance claim form
  • Post-mortem certificate in case of accidental deaths
  • Death certificate of the member
  • Cancelled cheque for death benefit disbursement

Group Personal Accident Insurance

  • Duly filled group personal insurance claim form
  • Copy of police FIR report
  • Certificate of disability, leave from employer, doctor’s reports- in case of disability
  • Death certificate, post-mortem report - in case of death of the member

Group Travel Insurance:

  • Duly filled group travel insurance claim form
  • Copy of member’s passport
  • Copy of boarding pass and baggage slips
  • Identity proof of member
  • Copy of FIR report - in case of theft
  • Property Irregularity Report (PIR) from airlines - in case of baggage loss
  • Cancelled cheque and NEFT details

Claim Process of Group Insurance Policy

Under group insurance claim can get settled by an insurer in two ways:

Cashless Claims - cashless claim means, a policyholder, need not pay the bill as the insurance company will settle it with the hospital (as part of claim settlement), as it is a network hospital. Policy holder may have to sometimes pay a nominal amount though.

Reimbursement Claims -In case of treatment undertaken in a non-network hospital, a patient and policyholder, settle the hospital bill on your own and then submit the health insurance claim application to his/her insurance company for applicable reimbursement.

The insurance company must be informed about the emergency at the earliest. Below listed documents should be submitted to the insurer, including for the claim process:

  1. Duly filled in claim form.
  2. Certificate insurance.
  3. Hospital certificate/details of lost or damaged content
  4. FIR (In case of accident, baggage theft or other similar incidents)
  5. Death certificate.
  6. Identity, address proof of the nominee of the insured.

The insurer will verify, through it’s in-house claims processing department, the claim as per the coverage available under the group insurance scheme

Many insurance companies may rope in TPAs, which are separate organizations, to help in managing the claim settlement process. Their work is usually related to facilitate coordination between policyholder and the insurer for claim settlement.

Types of Groups that Can be Covered under Group Insurance

There are two types of groups that can be covered under Group insurance: 

  • Formal Groups (Employer-Employee) – This group is mainly working professionals in companies or organisations, wherein the employer purchases the group insurance plan to provide them coverage in case of financial emergency. 
  • Informal Groups (Non-employees) – These groups include members from cultural, social or welfare associations. Generally, this type of group insurance is purchased by head of association or collectively by people belonging to the same interest group. Any informal group such as users of a website, mobile app, etc. can also offer group insurance to its customers.

Group Insurance policies are also broadly classified into two types basis who is contributing the premium amount:  

  • Non-contributory Group Insurance – In this type of group insurance plan employer pays the premium for the employee's insurance cover.  
  • Contributory Group Insurance – It is a type of group insurance plan where the group members pay the premium (partially or fully) to be benefitted by the insurance cover.

Group insurance policy comes with lot of advantages, but the biggest one is the cost savings. Grouping individuals together allows insurance companies to provide much lower rates to companies.  

Why is Group Insurance Required?

The main advantage of a  group members plan is that it spreads risk across a pool of insured individuals. This benefits the group members by keeping premium amount low, and insurers can better manage risk when they have a clearer idea of who they are covering. In a group insurance, all the members of a pre-existing group are provided uniform or graded cover through a single or master policy issued by the insurers. In respect of housing, car or personal loan, such a scheme proves to be a source of tremendous relief to the surviving members of the family.

  • Generally, the organization individuals are working for will cover the expenses
  • The cover could be broadened to include the entire family
  • Pre-existing diseases are generally covered from day one
  • Usually, the plan does not mandate a waiting period
  • No medical check required at the time of policy issuance
  • Maternity Benefits are covered under the plan
  • Covers insured Covid-19 related hospitalizations
  • There are many plans where OPD treatments are covered as well
  • Plan has started covering mental health and fitness – two crucial aspects of individuals’ health
  • Group insurance now a days also covers a range of value-added wellness needs – including telemedicines
  • Digital access to healthcare needs and a dedicated support team
  • Claims get processed faster, with negligible chance of rejections by Insurers For aforesaid reasons, getting a Health Care cover from a company is the most effective way of having your loved ones covered all the times.

For aforesaid reasons, getting a Health Care cover from a company is the most effective way of having your loved ones covered all the times.

Factors that Affect Group Insurance Premium

The main advantage of a  group members plan is that it spreads risk across a pool of insured individuals. This benefits the group members by keeping premium amount low, and insurers can better manage risk when they have a clearer idea of who they are covering. In a group insurance, all the members of a pre-existing group are provided uniform or graded cover through a single or master policy issued by the insurers. In respect of housing, car or personal loan, such a scheme proves to be a source of tremendous relief to the surviving members of the family.

  • Group insurance premium amount can be affected by the size of a group, that is, larger the group lower will be the premium.
  • Average age of the group members can also affect the premium. Lower the average age of group lower the premium.
  • Workers engaged in doing high-risk jobs such as factory workers, construction workers, healthcare workers and airline staff will have to pay higher premiums.
  • An informal group such as housing societies or cultural associations located in natural calamity-prone areas are considered high risk groups and will have to pay higher premiums.
  • The claim history of the employer and the group admin will also play an important role in deciding the premium amount. Higher the previous claim ratio, higher will be the premium amount.
  • If the buyer adds a rider or an add-on the policy, then the premium amount will increase, if the buyer removes any rider then the premium will decrease.

Group Insurance Premium Calculation

Below is the list of factors that influence the premium of a Group Insurance plan:

  • Average Age – In this method average age of the people being insured is considered to determine the premium. Generally, young people have better immunity and pose fewer health risks compared to the older generation, As a result, the premium would be on the lower side for younger people.  
  • Type of Job – While some jobs have a huge element of risk, others are risk-averse. Hence, the nature of the job is a critical factor in determining the insurance premium. The higher the risk associated with the job performed by the employees, higher will be the premium required to insure them.
  • People Covered – The limits of coverage and deductibles of Group Health Insurance Plans can be widened with respect to the people covered by the policy. For example, there are policies that not only cover employees their immediate family members, like spouses, Parents and even cover in-laws.
  • Sum Insured – It is the monetary limit up to which the insurer can cover the health-related expenses of the employee. The employer and the insurance company can decide on the sum insured of the policy that is applicable across all employees.
  • Add-on Covers – Besides a standard Group Insurance Policy that is generally offered to the employers, an employee can enhance the policy’s coverage by picking suitable group health add-on covers including OPD Coverage, Consumables Cover, etc.
  • Claim History – This is taken into consideration to calculate premium while renewing the policy from the same insurer. In case multiple claims have been raised during the policy period, the insurer might revise the chargeable premium while renewing the policy.

Documents required for group insurance policy

  • Proof of identity – Ration card/Voter ID/Driving License/ Passport/Aadhaar Card.  
  • Proof of Address – such as Aadhaar Card/Telephone Bill/ Electricity Bill/Ration card/PAN Card/Driving License. Registration certificate of the bike. 

What is Covered and not covered under group insurance

  • Depending upon the insurance plan and agreed policy document; besides traditional hospitalization coverage, there are many plans that cover pre and post hospitalization expenses for a certain period, maternity benefits, certain procedures such as chemotherapy, eye surgery and tonsillectomy, that require less than 24 hours hospitalization. 
  • Plans like term insurance in an organisation aims to provide a financial guarantee by paying compensation to the employees who suffer bodily injuries due to accident. It does not cover Injuries arising from a civil or foreign war.
  • Provide comprehensive financial support against the high treatment costs associated with disability or accidental injury. It does not however cover temporary or permanent Injuries from a civil or foreign war.
  • The policy covers the statutory liability of an employer in the event of death or injury to workers caused by an accident during employment.
  • Organisation’s public liability policy exempts policyholders from any claim from member of public for personal injuries, loss of or damage to property that occur as part of their business activities in your business premises.
  • Organisations or associations covered under travel insurance plan have protection for an individual or group travelling together, from medical or travel issues. alcohol

Why buy group insurance from SecureNow

SecureNow’s expertise is more than just about insurance policies. Our training and experience focus not only on specific types of insurances, but also risk management. We can help you to get the right group insurance plans, by actively working as an advisor or negotiator on your behalf. It doesn’t cost you anything extra to use our services.

We as an insurance broker;

  • Listens and understands your group insurance requirements.
  • Help you to find the right policy, one that suits your business requirements.
  • Offer objective and impartial advice that is appropriate your insurance needs and fits your budget.
  • Help you understand the insurance plan, its coverage and exclusions, honestly and clearly.
  • Maintain a transparency with regard to all costs of your policy.
  • Provide clear information help you with the paperwork.
  • Assist you with filing a claim and efficient service from the insurance company.

Frequently Asked Questions

A group member can claim the entire amount as tax deduction under Section 80D, provided the amount does not exceed the maximum deduction of Rs 1 lakh. The employee cannot claim any tax benefit for the premium amount paid by their employer on behalf of them.
Group insurance policies build a better employee-employer relationship, as it conveys the message that an employer really cares for the employees’ health and well-being. Group insurances bring physical and mental relief for the employees and increase their productivity thereby helping in employee retention.

Group Insurance covers insurance needs of a defined group of people including professionals, employers-employees, co-operative societies, amongst others. Group Insurance may offer life cover, health cover, and/or other types of personal insurance.

Amongst many benefits of group insurance, chief benefit is a life cover made available to members irrespective of age, gender, socio-economic background or profession, so long as they belong to the group that is applying for insurance.

Group insurance policies are often able to provide effective coverage at a lower premium than individual policies can. The premium may be paid entirely by the policyholder, or it may be paid jointly by the policyholder and the insured. If the insured contributes money toward the premium, the plan is considered contributory, else it is non-contributory.
The head or group administrator enters into the group insurance contract with insurer. It is a single or master contract with the insurance company which covers the insurance needs of all the group members. All the members are issues a certificate for proof of insurance. In order to be eligible to buy a group insurance policy, there should be minimum of 20 employees in the organisation. However, organization can include dependent family members of the employees to achieve this minimum number of persons.
To buy group insurance, you can either contact the group insurance company or take help from corporate insurance advisors like SecureNow. Under group insurance the company also covers all new employees who may join the organization after it buys the group insurance plans.

Insuropedia

How can I structure a Group Insurance Policy for employees?

Depending on the homogeneity of the group members the organization may even have to purchase different policies for different work groups in the organization. Employee compensation structure can follow any of the three approaches given below: Flat Structure: All employees are given a similar kind of cover, irrespective of their role
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Can You Buy a Group Insurance Policy for Your Group/Association?

You can buy a group insurance if there are members who are gathered together with a common purpose or engage in a common activity. Further, there are some other guidelines that should be considered to buy a group insurance, like: 1. Most of the group insurance policies about the employer-employee However, the group insurance
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What is Relevant Information in Group Insurance Proposal?

The following information is considered relevant for a group insurance proposal:-
  • Nature of Business
  • Nature of Activities of Employees
  • Location of the workers
  • Age of Employees
  • Any previous or existing group insurance employees are covered with
  • Any other historical incident which indicates the kind of risk faced by
Read More

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