Group Health Insurance

Group Health Insurance

What is group health insurance?

Group health insurance is a medical benefit plan offered to a group of people. This group can be of employees working in an organisation or members of a society or an association.

The plan offers coverage to this group against hospitalisation expenses for medical treatment. Medical insurance policy acts as a financial cushion during such stressed times. 

Generally group health insurance is offered by employers to their employees in order to provide health cover. Hence, it is also referred to at times as a corporate health insurance policy. The policy also offers coverage to the employees’ family members – spouses, children, dependent parents or in-laws etc.

Group mediclaim insurance is considered one of the best employee benefits offered by any organisation. This is because it covers expensive hospital treatments needed by employees to recover from illness.

What is group health insurance

 

What are the advantages of group health insurance?

When an organisation offers group health insurance to its employees, it benefits both the employer and employees.

Employees are an important asset for the company. Healthy employees contribute effectively to the organisation’s growth. More and more companies are today focusing on employee wellbeing.

In today’s employee-centric environment, group health insurance has thus become an essential offering from most organisations. It plays a crucial role in attracting and retaining talented employees. It sends a message to employees that employers care about them and consider them as a part of the family. 

Corporate health insurance also helps in increasing the wellbeing and hence the efficiency of employees, hence positively contributing to company’s growth. Also as the whole family gets medical benefits, it makes them loyal to the company. 

This insurance comes at a very affordable premium as compared to individual health cover. In addition to this, employers also get a tax deduction under the Income Tax Act. Hence, corporate health insurance is advantageous for both employer and employees. 

Advantages of Group Health Insurance

Advantages for the Employer:

  • Improves Employee Retention: In a competitive environment where companies are offering attractive benefits, employee retention is always difficult. Also, employees value jobs which provide them a sense of financial security. Benefits like group health insurance covering employees and their families can offer such security. This will increase employee retention as they will feel more attached to an organisation. 
  • Motivates Employees: A motivated employee is a more productive employee. In today’s scenario where medical costs are enormously high, having group health insurance motivates the employees. As this policy helps employees to undergo good quality treatment without worrying about expenses, the productivity of employees can also be expected to increase.
  • Tax Benefits: When employers provide health insurance plans to their employees, they get the tax benefit under the Income Tax Act. Hence this policy helps them reduce their tax liability
  • Lower Premium: Employee health insurance comes at lower premiums as compared to the individual health insurance. Also the benefits offered by the policy are better as compared to individual plans.  

 

  • Improves employees’ mental wellbeing: Due to the financial pressure of hospital expenses, many employees get stressed. This may lead to lower productivity levels. Having health insurance for employees will safeguard them from such instances resulting in improvement of their mental wellbeing.  

 

Advantages for Employees:

  • No prior medical check-up: One of the major advantages of group health insurance is that employees do not have to undergo a medical test. The health check often becomes a barrier when buying an individual health insurance policy. Group health insurance is issued irrespective of the medical condition of any member of the group. 
  • Pre-existing Disease Cover: Unlike an individual health plan where there could be waiting periods of up to four years, group medical insurance covers pre-existing diseases from Day 1 of the policy issuance. Hence there is no waiting period for any pre-existing disease.
  • Maternity Benefits: Group health insurance offers high maternity benefit cover. It offers coverage for both normal and C-section deliveries. It also offers coverage for new born babies in addition to standard maternity cover.

 

Advantages for employer and employees

What are the features of group health insurance?

There are a wide range of group health insurance policies available in India. Different policies offer different features to the insured. Some of the common features of employee health insurance plans are listed below:

  • Group health insurance covers pre-existing diseases from the first day 
  • This health plans also offer maternity and newborn baby cover
  • Employee health insurance offers cashless facilities and direct settlement of medical bills.
  • Employee health insurance provides cover for daycare facilities, room rent and ambulance charges
  • Some group health insurance policies cover OPD expenses and nursing fees of hospitals
  • Employee health insurance policies also provide feature of pre and post hospitalisation expense cover

 

Features of Group Health Insurance

 

What is covered under group health insurance?

Some of the common group health insurance policies inclusions are as below:

  • Treatment and hospitalisation expenses related to the illness or injury.
  • Pre-existing disease –  covered from Day 1 
  • Maternity expenses covered including normal and C-section deliveries
  • Newborn infant cover from the first day of delivery
  • Domiciliary hospitalisation expenses
  • Day care treatment costs
  • Pre and Post-Hospitalisation charges cover
  • Room Rent expense cover
  • Ambulance and ICU charges 
  • Doctor and nursing fees during hospitalisation
  • COVID-19 hospitalisation expenses
  • Some plans offer coverage for AYUSH treatment, organ donor expenses and infertility treatments
  • OPD expenses and cost of diagnostic tests
  • Some plans also offer the coverage for critical illnesses

 

What are the exclusions of group health insurance?

Below is the list of common group health insurance exclusions:

  • Alternative therapies including ayurveda, naturopathy, homeopathy etc are excluded from the policy
  • Cosmetic treatments are not covered
  • Expenses related to treatment of AIDS or HIV
  • Any injury that occured due to criminal activity or under the influence of alcohol or drugs is not covered
  • Congenital diseases and other related ailments
  • Expenses related to hospitalisation outside the policy’s geographical limit 
  • Self-inflicted injuries like say for a suicide attempt are not covered by the policy
  • Expenses related to rehabilitation treatment due to addictive conditions

 

How to file a claim under group health insurance?

Group health insurance offers reimbursement as well as cashless claim settlement. The claim filing process followed by most insurance companies is :

  • Intimate the health insurance company about the claim by calling their toll free number or emailing their customer support
  • Procure claim form with the help of customer care or download it from the website 
  • Collect all the documents required while filing the claim
  • Submit the duly filled and signed claim form
  • Attach all the documents as requested by the insurance company
  • In case of a cashless claim, submit the health card to the TPA department in the network hospital. In such a case, the claim will be settled directly with the hospital.

Group Health Policy Claim Process

 

Documents required for filing the claim

While filing the claim, the insurance company will require certain documents. Providing the right documents will speed up the approval and settlement of claims. The list of required documents are:

  • Duly filled claim form signed by the hospital authority
  • Doctor’s prescription
  • Medical and test reports
  • Cash memos
  • Medical bill with item breakup
  • Consultation summary
  • Discharge certificate 
  • Police report in case of accident
  • Additional document as requested by the insurance company

The policyholder has to submit the original documents to the insurer for a claim submission. Providing fraudulent documents may result in claim denial.

 

Why is group health insurance important?

Nowadays, companies are focusing more on employee benefits in order to acquire talented employees. Hence most of the employers are offering medical insurance coverage to its employees as a part of benefit. 

Group health insurance has gained importance these days because of the benefits it offers to companies and its employees. 

  • Comprehensive coverage: Group health insurance offers wider coverage to employees as compared to their individual policy. Some benefits include wider maternity coverage, no waiting period etc. which are generally not offered by individual health policies.
  • Generates goodwill for the company: Employees value employers who take care of them. If the employer offers medical coverage to their employees, they feel comfortable and it generates a sense of trust. This also increases the goodwill of such employers in the industry.
  • Affordable premiums: As group health insurance works on risk pooling, the premium is lower as compared to the individual health insurances. Also, as the premium is paid by the employer, this coverage is valued most by the employees.

 

Which is the right insurer to buy a Group Health Insurance?

There are many health insurance companies available in India. Hence choosing a right insurer while buying the policy becomes critical.

While selecting the group health insurance company, their benefits, premium, and claim settlement ratio should be considered. Having a wide network of hospitals also acts as an added advantage while selecting the policy.

Below table shows the highlights of different group health insurance companies in India:

 

Insurance CompanyClaim Settlement RatioCover for COVID-19Network / Cashless HospitalsWaiting Period for Pre-exisiting DiseasesMaternity Benefits
Bharti AXA General Insurance Co. Ltd.98.50%Yes4500+NoYes
IFFCO Tokio General Insurance Co. Ltd.96.50%Yes4200+NoYes
The New India Assurance Co. Ltd.95.90%Yes1200+NoYes
The Oriental Insurance Co. Ltd.94.30%Yes4300+NoYes
Reliance General Insurance Co. Ltd.94%Yes4000+NoYes
Care Health Insurance (Religare Health Insurance)92.50%Yes5400+NoYes
Max Bupa Health Insurance Co. Ltd.92%Yes3500+NoYes
Manipal Cigna Health Insurance Co. Ltd.89.50%Yes4500+NoYes
Bajaj Allianz General Insurance Co. Ltd.88.35%Yes6500+NoYes
National Insurance Co. Ltd.85.50%Yes6000+NoYes
HDFC Ergo General Insurance Co. Ltd.83.66%Yes10000+NoYes
ICICI Lombard General Insurance Co. Ltd.79.98%Yes6500+NoYes
Star Health and Allied Insurance Company Limited78.50%Yes9800+NoYes
Royal Sundaram General Insurance Co. Ltd.77.30%Yes3000+NoYes
Universal Sompo General Insurance Co. Ltd.75.90%Yes4000+NoYes
SBI General Insurance Co. Ltd.52.10%Yes3000+NoYes
Cholamandalam MS General Insurance Co. Ltd.50.10%Yes8000+NoYes
Edelweiss General Insurance Co. Ltd.NAYes2500+NoYes
DHFL General Insurance Ltd.NAYesNANoYes

 

Below is the infographic which explains how to select the insurer basis on various factors:

 

Selection of Group Health Company

How to renew group health insurance?

There is no doubt that group health insurance is considered as one of the important benefits. Although this policy offers wider cover, it comes with a specific duration. So it is important to renew group health insurance in time so as to enjoy the continued coverage of the policy. 

However, the premium may change at the time of renewal. This is because the renewal premium depends upon the modified coverage, copayments opted, average age of the group’s members, and the past claim history. 

Renewing group health insurance policy is very easy and can be done online as well as offline. In case of renewals, the organisation just has to provide the number of members to be included in the group and the required amount of coverage.

Additional Read: How does renewal pricing work for group health insurance?

Once the required information is provided to the insurer, they provide quotes along with the benefits. Based on the comparison of quotes and coverages, employers can renew the group health insurance by paying the premium online or by NEFT/cheque.

 

Who should buy the group health insurance?

Any organisation with 10 or more employees can buy group mediclaim insurance. In some cases it can be as few as 7 employees. Such companies can be:

  • Startups
  • Small Companies
  • Medium sized enterprises
  • Large corporates

 

How can Securenow help to buy group health insurance?

Group health insurance is the most essential benefit offered by an organisation to its  employees and their families. Group health insurance helps the organisation in many ways from mitigating employee’s health risk to the employee retention. 

Also, rising healthcare costs has made it essential to buy this corporate health insurance plan. This is because it helps in safeguarding the employees against the financial insecurity arising from illness and injury. 

Moreover, the insurance also helps companies to attract new talent in this highly competitive market. Hence, offering comprehensive health insurance coverage will help the organisation achieve its goal of employee satisfaction. 

All the group health companies available in India offer customised group health cover. Also the premium rates are very affordable for these plans. These rates depend on the size of the organisation, coverage opted, add-ons etc. Out of these wide range of options , choosing the right policy is very critical. 

Securenow is an award winning insurance broker and provides a range of group insurance plans from various top insurers. We significantly strive for the better benefits and better pricing in order to provide the best plan in the market. One can compare and choose from various group health insurance quotes online or instead schedule a call back.

Why Securenow

Video url – https://www.youtube.com/watch?v=8ZBh7XjtWNI

 

FAQs about Group Health Insurance in India

1. Who may be covered under group health plans?

All the individuals who are employed with an organisation can be covered under group health plan. In addition to that, the company can also cover employee’s spouse, children and dependent parents or in-laws by paying a little extra premium.  

2. Is coronavirus covered under group health insurance?

Most group health insurance companies offer coronavirus cover. However, one should check the coverage with the insurer before buying the policy.

3. What are the limitations of group health insurance?

While group health insurance offers various benefits to the organisation and its employees, it has one limitation. The plan is a standard generic cover providing similar benefits to each member of the group. Unlike individual health insurance, this insurance is not customisable for each member of the group.

4. How is the group health insurance premium calculated?

A group health insurance premium is calculated on the basis of employee strength, profile of employees, their age and coverage opted. The premium will increase if the employer opts to cover employees as well. Click here for details.

5. Is internal congenital disease covered under group mediclaim insurance?

No. Internal congenital disease is not covered under group mediclaim insurance. This is excluded by most of the health insurance companies. Although some companies do offer this coverage as an add-on under the policy.  

6. What is copay in group health insurance?

Copay, also referred to as copayment, is a form of cost sharing structure in health insurance policies. This means whenever the claim is raised, some portion of the claim amount has to be paid by the insured. The remaining amount is then settled by the insurance company. Copayment clause is generally opted by the policyholder in order to keep the premium low. Click here to know more.

Still have some questions on other aspects of group health insurance? Want to know more about copayment, specific waiting period, and room rent capping? Watch our ‘Head to Head’ Episode – Group Health Policy to understand all the various features of the policy. 

Head to Head Video