Group Health Insurance

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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 policy is one of the facilities provided by the employer. Also, due to the features provided by this policy, its benefits are valued by the employees. Following are the features available for group health insurance for employees:

No-waiting period:

An employee can avail the coverage of the group health insurance plan from the first day of his service in the firm. The best group health insurance plans do not have the waiting clause. The benefit of a no-waiting period is that the employee can immediately avail the expenses for even the chronic diseases like diabetes and knee related problems.

Cashless hospitalization at network hospitals:

The cashless hospitalization facility is the most important facility offered by the group health insurance policy. This means that the employee does not have to go through the tiring tasks of paperwork.

The facility of network hospitals includes the facility to avail the reputed healthcare centres. The insured can avail discount due to such facility. The employee can avail the top-class facilities provided by the reputed hospitals in the network.

Pre-and post-hospitalization charge:

Pre-hospitalization expenses are incurred when the insured is prescribed to conduct specific tests or investigations before getting hospitalized. Examples of such expenses are a blood test, urine test and X-rays.

After the patient is discharged, he may require conducting certain tests to ascertain the progress of his health. Thus, post-hospitalization charges are incurred by an individual after he or she is hospitalized and it includes charges like diagnostic charges, consulting fees and medicine costs.

A group health insurance policy, covers for pre-and post-hospitalization charges for a specific period as per mentioned in the policy document.

Read More: How to File a Claim Under Group Health Insurance Policy?

Coverage for Pre-illness:

In the group health insurance policy, there is no need of getting a prior health check-up. All the previous illnesses and the medical expenses arising out of it are covered under it. Some group insurance policy also covers for the critical illnesses, but it depends on the plan selected by the employer. Hence it is essential to know what the policy covers.

Coverage for dependents:

Apart from the employee himself, the group health insurance plans offer coverage to the depending members of the employee’s family like his spouse, children and parents.

Coverage for ancillary charges:

Ancillary charges can include the ambulance charges. Group health insurance for employees also covers such charges.

Case Study:

A well-known shipping company located in Gujarat with a workforce of 75 employees had been in business for many years. To protect its employee base, the company had brought a group health insurance coverage for all the employees. The coverage offered by this policy for each employee was rupees 3,00,000. This policy also offered the coverage for the dependent family members of the employee.

Anil was a logistic manager in the company and was working since last eight years. From day one he availed the benefits of his group health insurance policy.

Read More: How does Subrogation Apply to Group Health Insurance?

While in the company, he suffered from an Asthma attack. He was rushed to the hospital by his colleagues. The attack was minor, and Anil recovered within four days. He was discharged on the sixth day. His total medical expenditure was 80,000 rupees.

He was also advised to carry out some test by the physician to check the recovery. He carried out the same as prescribed. This was the post-hospitalization expense incurred by Anil.

Anil approached his employer to cover the medical expenses which were included under his group health insurance policy.

The policy given by the employer had several features and covered all the medical expenses of Anil including:

  • Ambulance charges
  • Hospitalization bill

Post-hospitalization expenses