Group Health Insurance & Group Mediclaim Policy for Employee

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Advantages of Group Health Insurance

Better Benefits

Our group health insurance plan offers pre-existing diseases and maternity from day 1. Medical checkups are not needed, waiting periods are waived, and exclusive benefits like corporate floater offered.

Lower Cost

Affordable group health insurance cover for employees and their families. Costs are much lower than health insurance bought individually because we negotiate bulk discounts with insurers. That's why we cover over 5000 clients.

Customised Cover

We can customize employee health insurance policy to your budget and requirements. For example, parents, spouse or upto 3 children can be included. Maternity cover or OPD benefits can be introduced.

Guaranteed Issue

All employees and their dependents are assured cover, even if they have medical conditions such as diabetes, blood pressure under our group insurance plan. No medical test or prior claim history is asked for.

Benefits of Group Health Insurance

Pre-existing Diseases Covered From Day 1

Our employee mediclaim insurance covers pre-existing diseases immediately. This is a major differentiator because standard family floater insurances have a waiting period of 2 to 4 years
No medical check-ups are required to determine an individual's coverage eligibility
Cover available even to members with chronic ailments such as diabetes or hypertension.

High Maternity Benefits for Normal and C-Sec

Maternity benefits are particularly valued by young employees. To attract talent, firms in service sectors such as IT, E-Commerce or outsourcing offer high cover for pregnancy and delivery related expenses
Separate limits can be set for normal, caesarean sections or ectopic pregnancies
New born babies can be covered immediately without the standard 90 day waiting period.

Wider Coverage with No Disease Limits

The standard waiting period of 1 to 4 years for diseases such as cataract, hernia, piles, joint replacements, and cyst removals can be removed. All surgeries can be covered immediately after the premium is paid
Standard medical exclusions such as for internal congenital diseases can be removed
Sub-limits and copay on specific diseases can be removed to allow full indemnity.

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FAQs

In general, group health insurance covers complete hospitalisation expenses such as room charges, doctor & nursing fees, medical equipments & appliances cost, medicine cost for employees and their dependents. Policy can also be customized to add maternity benefits, corporate buffer, higher room-rent limits, wiaver of waiting periods on various diseases, baby day 1 cover, Out-patient expenses (OPD), etc as well.

Hospitalisation costs are based on the type of room availed. Same surgery or treatment costs more if you avail a single AC Room as compared to a twin sharing room. If your policy has a room rent capping, your hospitalization expenses will be settled as per proportion to the actual room rent eligibility. While buying group mediclaim insurance, an employer can also customise the room rent limits based on the requirements.

Individual health policies offers maternity benefit have a waiting period of 3-4 years. In health insurance the waiting period means the insured should be at least be enrolled in the policy for certain period mention in the policy. Under group mediclaim insurance this condition of waiting period can be waived off. This would mean that, the insured can claim the maternity benefit from Day 1 itself.

A pre-existing disease is an ailment present before the inception of the insurance policy. For instance, many of the cardiovascular diseases or diabetes is classified under pre-existing diseases. Basically, any condition, ailment, or injury for which you had signs or symptoms, or were diagnosed, and received medical treatment, within specified period before taking insurance policy.

A copay is the share of claim that is to be borne by the insured as per the % limit mentioned in the policy copy. Standard copay ranges from 10 to 20%. Policies with copay ought to have lower premiums as insured pays a part of the claim from his pocket which results in less utilisation of the sum insured. Several corporates have a copay for claims related to parents to manage costs.

Premium of group health insurance is based on several factors including size of group, average age of group, type of occupation, type of coverage and benefits opted, and lastly the employer’s claim history. As every factor can result in change of overall policy premium rates, hence all the factors are deeply analysed by our experts along with client's requirement to choose the appropriate plan.

You can minimize cost of employee group health insurance through better negotiation, signing-up for multiple years, restricting covers, and choosing a cost efficient insurer. Also our team of experts will aslo help you with choosing the best suitable plan based on your budget and requirements. There are few coverages which do not effect the policy premium like ambulance charges, addition/deletion of employees, etc.

In case of group mediclaim policy for employees, only employer can claim the premium paid for the group health insurance policy as a tax deduction. An employee is not entitled to income tax exemption under the group health insurance provided by an employer. Only under individual health insurance bought diretly by an employee will get a tax exemption under Section of 80 D of the income tax.

As the pre-existing medical ailments are already covered under our group mediclaim insurance, the existence of these ailment to any employee will not have any effect on the premium. Although, there is an option to remove the pre-exisiting cover from your plan which will reduce the premium. But, it is not recommended to do that becuase coverage of pre-existing diseases from day 1 is one of the key element of group health insurance.

Once, you have finalised the insurer and benefit structure you want to go with then you can make the premium payment through net banking or cheque in favor of the choosen insurance company. Tenure of group mediclaim policy will be of one year and premium needs to be paid for the entire year at once. Going further, for addition of lives in the policy you would need to maintain a minimum balance in a CD account with the insurer.

Yes. Cashless claims service will be available at all network hospitals of the respective insurer. Typically, each insurer has more than 3000 hospitals on their network across the country. You can download the network hospital list for any insurer from our download section. To avail the cashless facility, you need to show your insurance cashless card at the TPA helpdesk in any of network hospital.

Yes, under group health insurance policy, insurance company reimburses expenses even if the insured member does not use the network hospital. To get your reimbursement, you need to submit your medical bills along with other documents as specified by the insurance company. After submission of all the documents, insurance company typically takes 30 days to review the documents and transfer the claim amount.

Reimbursement is not provided beyond the sum insured specified in the Group Health Insurance Policy. You could consider an additional benefit called, Corporate Buffer, which could be utilized by an employee if his or her sum assured gets exhausted. This additional lumpsum cover is taken by an employer to help cover the major illnesses like cancer, and also to avoid a huge financial distress to an employee.

Yes, hospitalization costs are covered from day 1 of the policy period. Standard waiting periods like of 30 days, disease wise waiting period of 1,2 & 3 years, waiting period on pre-existing diseases are all waived off in our group health insurance policy. However claims need to be submitted as per set guidelines by the insurer in order to get the claim passed timely.

Documentation plays very important role while making the claim. If we submit the correct documents, claim get settled easily. Few common documents while filing the claim in case of group health insurance policy are respective claim form signed by hospital/doctor, investigation report, final bill with breakup, medical reports and doctors prescription. All the documents needs to be submitted in original.

As stated above in the coverage section, an employee health insurance plan covers all the pre-exsiting diseases from day 1. Hence, an ongoing chemotheraphy of a cancer patient will be paid for all the sesissions of chemo. Important point to note here is that insurance company will only pay upto the sum insured alloted to an employee & his family in the group insurance bought by the employer.

While buying group health insurance policy for employees, employer select the specific plan to offer their employees. Individual firms may customize the benefits for group insurance plans. Tenure of the plan is of one year and premiums are paid upfront. If an employee leaves the firm or joins in new, the same is endorsed under the policy by charging or refunding the premium on pro-rata basis.

Indian insurance regulator, IRDA, in an exposure draft issued on January 19, 2016, specified that the minimum number of employees in the group should be 20 for the purpose of a group health insurance policy. However, micro insurance policies can be issued to a group with as small as 5 members. Essentially, companies of various size from small startups to large MNCs can cover their employees under group health insurance.

Group mediclaim insurance is beneficial for both, employer as well as employees. As a part of employee welfare, group health insurance helps the employer to attract new talent, foster retention of employees, maximize productivity, increase employee satisfaction, and maximize after tax compensation. Offering group insurance to your employees will help you benchmark within your industry.

No. While selecting group mediclaim insurance for employees, employer has to decide upon, insurance company, type of coverages, add-ons, and other important terms & conditions offered in the plan. Additionally, the coverage offered under the group mediclaim insurance is different than the individual health policy, and the way that premium rates are determined is also different.

Insuropedia

What are the advantages of a Group Health Insurance?

A group health insurance offers coverage to a group of people, as members of a society or employees of a company. The organization can either self-design a plan or choose a pre-planned insurance policy from the insurer.

The policy is beneficial for both employees and employers. Let’s have a look at the benefits:

What is covered Under Group Health Insurance?

Group health insurance offers many benefits to employees, or its members, covered under the policy. Complete hospitalisation expenses incurred by an employee on self and dependents like spouse, family, and parents, are covered under a group health insurance.

Group health insurance policy is provided to incentivise employees.

What are features available for group health insurance for employees?

Medical and hospitalization expenses of the employees are covered by the group health insurance policy. Employees are the most valuable assets of a company and employers try their best to secure employee satisfaction in the form of various facilities.

Group health insurance is one of the facilities provided by the employer

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