Group Medical insurance covers a large number of people under a single policy. Usually offered by employers or organizations to its members. The content or specifics of Group Mediclaim Insurance policies differ from one organization to another. However, the general inclusions are:
Hospitalization related expenses
- This includes treatment expenses incurred during the 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 costs, doctor’s fees, nursing expenses, etc.
- The cost of medicines, diagnostic tests, therapy, surgical appliances may also include
- Many policies cover expenses incurred for day-care procedures or domiciliary treatments (when the facility of hospital admission is not available)
Cashless Treatments
Each insurance provider has a list of network hospitals. Done Medical treatment in these hospitals through the cashless mechanism.
Special services
Policyholders 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 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 extend to the family members (or dependents) of the primary policyholder as well. Covered newborns 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 scarier when compared with the average retail inflation of 3.4%.
Group Health Insurance policies can be a lifesaver in today’s times of expense.
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. Covered the higher the number of people under one plan, the 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 mainly 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 the 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
Covered employees 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 the case of group plans.
Also, hardly involved any paperwork when compared to personal health insurance plans.
Medical Tests
Usually, health insurance plans require the policyholders (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, the inclusion of daycare procedures, expenses for external appliances such as hearing aid, spectacles, etc. can be included in these plans.
Basically, the employer can choose offerings that 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, but they also 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.
About The Author
Mayank Sharma
MBA Finance
He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.
