Group Health
Insurance

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Group Health Insurance Advantage

Better Benefits

Group Health insurance provides significantly better benefits than individual health insurance. For example, employees or group members do not require a medical checkup, waiting periods for existing diseases can be waived off, premiums are lower, maternity expenses or corporate floaters can be added to the cover. Group Health Insurance is an excellent tool to attract and retain talent for organisations.

Lower Cost

In group insurance policies, the risk is spread over a large group of individuals and that helps reduce the premium cost due to the economies of scale. However, the premium can be highly variable for group health insurance due to claim ratio and number of employees/members added to or removed from the cover.

Customised Cover

You can customise the policy according to your needs. You can add more benefits apart from the basic policy provisions already available in any mediclaim policy. For example, parents can be covered, day care treatments can be increased, accidental cover rider and maternity benefits can be increased. This flexibility allows the group health insurance to be tailored to your budget with your specific requirements.

Guaranteed Issue

As there is no medical checkup prior to the issuance of the policy and no waiting period clause for pre-existing ailments, the issue of group health insurance is assured. Group mediclaim is administratively much easier to place and you need not spend time in medical checks or in dealing with the aftermath of insurance getting rejected.

Benefits Overview of Group Health Insurance

Pre-existing Diseases Covered

Our group insurance waives of the waiting period for pre-existing diseases
Each individual is fully covered irrespective of their personal medical history
Medical history of an individual has no bearing on their future coverage
No medical check-up done for individuals to determine eligibility for coverage
Coverage applicable for chronic ailments such as diabetes

Maternity benefits With ZERO Waiting Period

Our group health insurance policies cover maternity benefit for employees and their spouse
Maternity benefits are covered immediately with no waiting period
Avail pre and post natal expenses along with delivery expenses
New born baby will also be covered immediately without the standard 90 day waiting period
Internal congenital diseases are covered

No disease Wise restrictions

All diseases are covered from day one, without standard waiting period of one to four years
Common surgeries like Cataract, Hernia, Piles, Knee Replacement are covered from day 1
No waiting period on critical ailments
Full sum assured available for all diseases
No copay on specific ailments

How does Group Insurance work?

How to get a quote?

To get the tentative quotation for the Group health insurance of your employees, please follow the below mentioned 5 easy steps:-

Step 1: Enter your contact details & click on next.
Step 2: Choose Sum Insured and put number of employees to be covered.
Step 3: If you want to cover dependents of Employees also, put the number of dependents to be covered.
Step 4: If you want to get the quotes for the renewal of your Group Health Insurance Policy, please mention the claim ratio & click on next.
Step 5: Compare the multiple quotes provided on the portal.

Documents required to book the policy?

Following documents are needed to avail group health insurance:

Duly filled, signed and stamped Proposal Form
Complete data of Employees and dependents.
Payment details
Declaration Form
Reports as required by the Insurer
Any other Document as required by the insurer

How to file a claim?

Cashless claims are filed directly by the network hospital with the TPA (Third Party Administrator) of the group health insurer or the insurer. They need to submit the following documents for the claim:

At the initial stage:

Pre-Authorization Form
Investigation Reports
ID proof of the patient
Health Card of the Patient
Doctor’s Note

At the time of Discharge:

Discharge summary
Final bill with breakup
All investigation reports

In the case of reimbursement claims following documents will be needed:

Claim Acknowledgment Number
Duly Filled and signed Claim Form
Original Discharge Card or Discharge Summary
Final hospital bill with breakup
Investigation Reports
Original Copies of Relevant Medical Bills
Prescription Details by the Treating Doctor
Cancelled cheque of the Employee along with filled ECS form
Pre & Post Hospitalization Bills supported with prescription/advice of treating doctor

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Cost-effective
Insurance

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Quick Turnaround

Cover notes are issued within hours of request. This documentation is sufficient for any contractual requirement.

Strong Claim Support

We manage all aspects of your claim - from preparing documentation to follow-up with the insurer.

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We will advice you on risk management best practices.

Policy Administration
System (PAM)

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Mediclaim Rating

A comprehensive, fact-based rating of all the individual health insurance products in the market. This is the benchmark for comparing health insurance.

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PROPOSAL FORMS

CLAIM FORMS

POLICY WORDINGS

NETWORK HOSPITAL LIST

FAQs

What is the period of coverage under Group Health Insurance Policy?

In general, the period of coverage for each policy is 1 (one) year.

Will medical costs be reimbursed from day one of the coverage?

Yes, hospitalization costs are covered from day 1. A standard waiting period of 30 days is waived in our policy. However claims need to be submitted as per set guidelines.

Are medical tests required to get this policy?

No, in a Group Medical Policy, medical underwriting is not done for each individual separately; hence there is no need to undergo any medical test.

What happens when the limit of expenditure is exhausted under a Group Health Insurance Policy?

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.

Will I get cashless facility under the group medical insurance policy?

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.

Will my claims reimbursed even if I do not get myself treated at a network hospital?

Yes, 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.

How many employees a company should have to buy a Group Health Insurance Policy?

Country’s insurance regulator, IRDA in an exposure draft issued on January 19, 2016, specified that the minimum number of persons 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.


PROPOSAL FOR GROUP MEDICLAIM POLICY	OPTION 1: NO CO-PAY NO ROOM	OPTION 2: NO CO-PAY	OPTION 3: WITH CO-PAY AND ROOM RENT CAP
TOTAL PREMIUM (RS. EXCLUDING TAXES)	₹ per annum	₹ per annum	₹ per annum
	Email Buy	Email Buy	Email Buy
Total Employees
Total Lives
Coverage
Family Floater Sum Assured
Pre-existing Diseases Cover
Disease Specific Waiting Period
Maternity Benefit
Waiting Period on Maternity
Maternity Limit (Normal and C-Sec)
New-born Cover Within Family Sum Insured
Capping On Normal Room Rent	Single AC Room	2% of Sum Insured	1% of Sum Insured
Capping On ICU Room Rent	No Capping	3% of Sum Insured	2% of Sum Insured
No Co-pay			20% Co-Pay for Parents and 10% for other than parents
Family Definition
Pre-hospitalization OPD Costs
Post Hospitalization OPD Costs
Cashless Facility in > 3000 hospital
Emergency Ambulance Charges
Day Care Surgeries
Limit on Cataract Treatment
No Disease-wise Capping
Internal Congenital Diseases
Terrorism
Claim Conditions
Addition / Deletion of Lives
Minimum 24 Hours of Hospitalization
Addition / Deletion of Lives
Claim Intimation Time
Claim Submission Time
Exclusions
External Congenital Diseases
Hospitalization For Diagnostic and Observation
Treatment Received Outside India
Non-allopathic Treatment
External Devices
Note : These are indicative prices. Insurance is the subject matter of solicitation.