Group Health Insurance

Group Medical insurance covers a large number of people under a single policy. It is usually offered by employers or organizations to its members. The content or specifics of Group Mediclaim policies differ from one organization to another. However, the general inclusions are:

  • Hospitalization related expenses
  • This includes treatment expenses incurred during stay in the hospital as well as during the pre and post hospitalization period. The number of days considered in the pre and post hospitalization period varies basis the policy provider.
  • It covers expenses such as room charges, operation theatre cost, doctor’s fees, nursing expenses etc.
  • Cost of medicines, diagnostic tests, therapy, surgical appliances is also included
  • Many policies cover expenses incurred for day-care procedures or domiciliary treatments (when facility of hospital admission is not available)
  • Cashless Treatments

Each insurance provider has a list of network hospitals. Medical treatment in these hospitals can be done through the cashless mechanism.

  • Special services

Policy holders can get many add-on benefits. This is at the discretion of the employees. Some of them include ambulance transportation costs, annual health check-ups, etc.

  • Pre-existing ailments

Individual insurance policies usually do not cover pre-existing illnesses. Or else they have a waiting period of about 2-3 years for their inclusion. Group mediclaim policies, on the other hand, have better coverage in case of pre-existing diseases. 

  • Maternity Benefits

Most of the personal insurance plans do not take care of maternity related expenses. However, Group Insurance policies cover these maternity expenses. They have a pre-defined limit for various expenses related to pregnancy or childbirth. 

  • Benefits for family members

The group mediclaim plans benefits extends to the family members (or dependents) of the primary policy holder as well. Newborns are covered from the day of birth. 


What are the advantages of Group Mediclaim Insurance for the employees?

Quality healthcare costs have gone up dramatically in recent times. According to a report published in India Today, healthcare inflation in our country has increased at twice the rate of the overall retail inflation. It increased from 4.39% in 2017-18 to a whopping 7.14% in 2018-19. This alarming increase looks even more scary when compared with the average retail inflation of 3.4%. 

Group Health Insurance policies can be a life-saver in today’s times of expensiveness.

Here are some of the benefits of Group Mediclaim from the point of view of the recipients i.e. employees:

  • Lower Costs

Insurance premium costs and the number of people covered have an indirect correlation. Higher is the number of people covered under one plan, lesser is the cost of insurance. Group Mediclaim plans have the wholesale benefit with them. As one single policy covers a large number of people, the insurance premium is significantly lower than those of individual plans. 

Additionally, the premium cost is mostly borne by the employer (wholly or partially). As a result, it becomes a highly cost-effective deal for the employees.

  • Higher Coverage

The scope or entitlements in case of Group Mediclaim insurance is comparatively better than those offered in individual policies. This is due to the economies of scale associated with group policies. Hence this policy provides a wide range of coverage to the employees.

  • Immediate Cover

Employees get covered under their company’s Group health plan from the day of joining itself. Generally Individual health plans have a 30-day wait period for non-accidental expenses. However, such clauses are not there in case of group plans. 

Also, there is hardly any paperwork involved when compared to personal health insurance plans.

  • Medical Tests

Usually health insurance plans require the policy holders (or beneficiaries) to get their medical examinations done. This does not apply to group mediclaim plans. Employees do not need to get physical check-ups done in order to get covered under such health plans.

  • Pre-existing illnesses

Pre-existing ailments usually are a part of the exclusion list in individual health insurance policies. Alternatively, there is a long wait period (between 24 to 36 months) involved for them. 

Most of the group mediclaim policies these days’ cover pre-existing diseases. This becomes a huge relief for the employees and their families. Even if there are any conditions attached to coverage of such ailments, the terms are better than those in personal health plans.

  • Customized Offerings

Companies have the flexibility to tailor the offerings of the employee group mediclaim policies as per the needs or demographics of their workforce. Special benefits such as accidental death rider, zero or reduced capping limit on treatment expenses, inclusion of day care procedures, expenses for external appliances such as hearing aid, spectacles, etc. can be included in these plans.

Basically the employer can choose offerings which are desired by the majority of their employees.

  • Top-Up Facility

In many group mediclaim policies, one can increase their sum insured by paying a nominal additional premium. Not only can employees feel more relaxed and secured with the increased coverage, they do so by paying a significantly lower amount. The group health insurance rates are about 25% cheaper than the personal health plans. 


Final Words

If you are a salaried individual, a group insurance scheme for employees can significantly help in securing your and your family’s financial health. Ensure that you read the policy document in detail and get your queries resolved from the HR Department. Many insurance providers also appoint a SPOC to each company buying employee mediclaim insurance. They can also assist in resolving your doubts or completing any paperwork in case of a medical emergency.

However, do not rely only on group health insurance plans only. They should be over and above your individual health insurance policies. This is because you remain a beneficiary only till you are employed with the concerned organization. So, do not forget to secure your well-being (physically and mentally) in a holistic manner.

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