Workers Mandatory Health Insurance

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Group Health Insurance For Workers

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Advantages of Group Health Insurance for Workers

Comprehensive Cover

The group health insurance plans that we provide offer pre- & post- hospitalisation expenses. Prior medical checkups are not needed, waiting periods are waived off, and COVID-19 is covered in these.

Low Cost

These policies offer affordable premiums for workers including contract workers, temporary employees and Management Trainees, at significantly lower costs than individual health insurance policies.

Customized cover

Your cover can easily be customized by us as per the budget available and your actual requirements. Finalise your selection from the multiple options that we offer, for sums insured and co-payment.

Universally Accepted

The Workers Health Insurance policies offered by us meet the mandatory requirements as required by the Ministry of Home Affairs (Govt.of India) circular no. 40-3/2020-DM-I(A), dated 15th April 2020.

Benefits of Group Health Insurance for Workers

Pre-Existing Disease Cover from Day 1

Workers' Mandatory Health Insurance policies can cover pre-existing diseases immediately, i.e. from the commencement date of the policy, to help with your workers' treatments
Cover is available for members suffering from chronic diseases, such as diabetes or hypertension
No prior medical check ups are required for obtaining coverage for a group

Comprehensive Cover

A Workers Mandatory Health Insurance policy offers maternity benefits for normal & caesarean deliveries - these and other benefits can be confirmed before buying the policy
This policy can provide cover for COVID-19 as well (after an initial waiting period of 15 days)
Day-care treatments and pre- & post-hospitalisation expenses are covered

No Disease Wise Limits

The standard waiting period of 1 to 4 years for diseases can be removed. All treatments (except in the first 15 days for COVID-19) can be covered after the premium is paid
The co-pay requirement on treatments can be removed and full indemnity coverage can be built in
There are no sublimits that operate on the covers for specific diseases

FAQs

This policy covers the hospitalisation expenses for treatment taken in a government or private hospital, doctors' fees, ICU expenses, day-care treatments, pre- & post-hospitalization expenses, and maternity expenses. Moreover this policy also offers coverage for COVID-19 treatment.

The list of standard exclusions for Workers' Mandatory Health Insurance varies from insurer to insurer. Generally the list includes Mediapersons, Doctors & Lawyers.

A co-pay is the percentage share of the claim that is to be borne by the insured, as per the policy. For a Workers Mandatory Health Insurance policy, a co-pay option can be chosen as per the requirements and budgets. Co-pay options are available from 0 to 50% on the basis of the number of lives.

Room rent capping indicates the maximum daily room charges payable in the policy. Room rent also includes nursing and RMO charges. In the Workers' GHI policy, the room rent is generally capped between 1-2% of sum assured for normal room & 2-4% for ICU, per day.

Premium for a Workers' Mandatory Health Insurance depends on various factors which includes the size of the group, the chosen co-pay option, and the coverages opted for - such as for pre-existing diseases, maternity, and COVID-19.

Yes, the pre-existing disease cover affects the premium, as pre-existing medical ailments are generally not covered under a Workers' Mandatory Health Insurance. There is an option to add pre-existing disease cover in your plan by paying a little extra, which is recommended, because coverage of pre-existing diseases from day 1 is one of the key elements of a good health insurance policy.

Yes, maternity benefits affect the premium a little as these are generally not covered under a workers' mandatory health insurance. There is an option to add the cover for maternity benefits in your plan by paying a little extra.

Yes, hospital daily room rent charges affect the premium if the cover opted for is more than the standard plan's offering for your insurer. Higher room rent covers (offered by some insurers) can be opted for, by paying a nominal extra premium.

This is the period in which a claim is to be notified to the insurance company so that it is duly processed by them. Standard claim intimation for a Workers' Mandatory Health Insurance policy is within 24 hours of hospitalisation, but may vary from insurer to insurer.

The period in which all the claim related documents are to be submitted to the insurance company so that it is processed. The standard claim submission period for a workers' mandatory health insurance policy is within 7 days from the date of hospital discharge.

In order to ensure that claims get paid one should intimate the claim in time to the respective insurance company. All the required claim related documents should be submitted with the claim form to ensure timely payment.

Cashless facility can be provided but through the agreed list of network hospitals, nursing homes or day-care centres, subject to pre-admission authorization by your TPA.

To buy a Workers' Mandatory Health Insurance policy, the minimum member count is 7 and the maximum is 1000.

Workers, including contractual workers, temporary employees and Management Trainees can be covered under a Workers' Mandatory Health Insurance Policy.

Members should be in the age range of 18 years to 70 years to buy a Workers' Mandatory Health Insurance.

Yes, additions or deletions are allowed on pro-rata basis under a Workers' Mandatory Health Insurance Policy.

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Workers Mandatory Health Insurance

Benefits of Group Health Insurance for Workers

Pre-Existing Disease Cover from Day 1

Comprehensive Cover

No Disease Wise Limits

FAQs

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