Group Health Insurance

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The country’s insurance regulator, IRDA, issued an exposure draft on January 19, 2016. IRDA mandated a minimum group size of 20 individuals for group mediclaim policy in their January 19, 2016 exposure draft.

The criteria in the first paragraph apply at the policy’s issuance. However, group mediclaim policy allows family inclusion if the group has fewer than 20 members. Thus, even if your organization has just about 20 employees, you can still offer them group health coverage. In fact, insurance companies can issue micro-insurance policies to groups with as few as 5 members.

In addition to IRDA guidelines, various insurers may impose their own criteria regarding the minimum group size for policy issuance. It’s imperative to explore group mediclaim plans in conjunction with group medical insurance to comprehend factors such as the sum insured and waiting period, ensuring comprehensive coverage tailored to your specific needs.

The Insurance Regulatory and Development Authority of India (IRDA) plays a crucial role in determining the criteria for purchasing group mediclaim policies. This preface explores the guidelines set forth by IRDA, shedding light on the factors that influence the decision of how many employees a company should have for such coverage. IRDA (Insurance Regulatory and Development Authority of India) regulates Group medical policies by setting guidelines, ensuring fairness, and monitoring compliance. It mandates pricing transparency, coverage standards, and claims processing efficiency to protect the interests of policyholders and promote a healthy insurance market in India.

Group Mediclaim Policy for less than 20 members :

Also known as Group Mediclaim Policy, it provides health coverage to a group of individuals, such as employees. There can be a scenario in which your company has less than 20 members (or minimum required).

  • Most employees are contractual or part-time workers, not entitled for group insurance because of non-membership in the group.
  • Another scenario can be the maximum entry age limit. Most insurers limit the entry age for the group health policy to 65 years (as per regulations). Hence, companies with employees above this age might have fewer than 20 members for the policy.

In summary, navigating group or corporate group insurance for fewer than 20 members requires tailored solutions, transparent communication with insurers, and a keen focus on individualized coverage to effectively meet the healthcare needs of smaller employee groups.

Benefits of Group Mediclaim Cover for Larger Groups :

One of the primary reasons for buying group policy is the discount on costs. In comparison to individual policies, a group policy will offer better benefits at lower costs. The premium per member on a group policy can be up to 30% lower than on an individual policy. Also, there are certain benefits available to group health members:

  • Faster claims/query resolution -A larger group size within a Group Health Insurance (GHI) policy leads to expedited claims and query resolutions, enhancing the efficiency and satisfaction of all members.
  • Maternity benefit -A larger group size within a GHI cover results in more comprehensive maternity benefits, catering to the diverse needs of expectant mothers and promoting family well-being.
  • Family coverage- Having a vast number of members in your corporate GHI policy brings the significant advantage of comprehensive family coverage, ensuring the well-being of employees and their loved ones.

The insurer can offer better value adds and discounts to larger groups. Also, Members can add and remove without changing the policy wording multiple times a year. Learn about the seamless cashless claim process and reimbursement claim for group health cover, including coverage for pre-existing diseases. We endeavor to enhance the efficiency and ease of your claims process, ensuring a more straightforward and streamlined experience.

Group mediclaim policies are a crucial part of corporate health insurance, offering coverage for employees’ medical expenses during unexpected medical emergencies. However, it’s essential to understand the terms and conditions of health insurance for your group thoroughly. For comprehensive employee health insurance coverage, employees might also consider supplementing their group policy. This can help bridge potential gaps in coverage with an individual health insurance plan. Insurance providers actively streamline and simplify the claims process for these policy, facilitating policyholders to swiftly and efficiently file and receive reimbursements for medical expenses. This encourages trust and confidence in the insurance sector while ensuring that beneficiaries receive prompt financial assistance during times of healthcare need.

We, at SecureNow, aim to streamline your claims process, making it more efficient and user-friendly for our valued customers. Please visit our Linkedin page for more insights of the policy.

What if Group Becomes Smaller After the Issuance of the Policy?

The limit of a minimum number of insurable employees will apply at the time of issue of the policy. After issuing, the policy requires annual renewal (or renewal after a specified number of years for multiyear policies). Upon renewal, relaxing the limit can result in a reduced premium amount.

Group health plan benefits a diverse group of people, offering health check options and access to network hospitals. Each insured person receives a valuable health card for convenient healthcare.”

Additionally, in case above scenario arises, you should promptly inform your insurance provider. They will help you adjust you company’s health insurance policy accordingly. This may involve updating the policy to cover the reduced number of employees or exploring alternative coverage options. It’s essential to maintain open communication with your insurance provider to ensure your coverage aligns with your current workforce, preventing unnecessary costs and ensuring your employees continue to have appropriate health insurance.

Use of Group Mediclaim Plan

Sanjeev Jain is heading the Human Resource department in E-Pex Enterprise a fast-growing organization. This year alone the firm hired about 12 new people and now boasts a staff of 52 employees. His latest concern is maintaining the energy and motivation of both the old and new staff. Simultaneously, he aims to maximize the retention ratio.

As new employees join, the company’s spend on training programs is growing fast. Sanjeev recognizes that EPex needs skilled staff and the best way to get them is through training. The problem, however, starts after the training as skilled workers are much in demand throughout the industry. Thus, as the HR head of E-Pex, he must come up with initiatives to hit the three objectives including retention.

Sanjeev observes that health is a major concern for everyone. He finds that the group health plans, benefit employees, their families, and the employer. Employees and their families benefit from reduced hospitalization costs, while the company gains tax benefits from premium payments. Additionally, it’s in the company’s interest to focus on employee welfare as it improves relationships and motivates workers. Also, the organization is free from the moral obligation to cover employees’ healthcare expenses during hospitalization.

Additionally, the insurer informs him about potential premium discounts for claim-free years, further reducing costs. Furthermore, the insurer will appoint a relationship manager to EPex, who will look after the administration of the policy.

Sanjeev feels that the relationship manager (RM) will have a lot of work to do. EPex is growing, and they plan to hire about twenty more workers in the next few months alone. The insurer has assured that adding and deleting employees from the policy is a very simple process. The RM will look after this, along with answering any queries on the policy from employees.

In conclusion, the decision of how many employees a company should have to purchase a Group Medical Cover ultimately depends on its unique circumstances and requirements. While a larger group can often yield cost-effective benefits, managing a shortfall of employees is equally essential. Smaller businesses can still find tailored solutions that meet their needs. Remember, regular communication with your insurance provider is key to adjusting your policy when employee numbers change. By carefully assessing your company’s situation and adapting as necessary, you can ensure that both you and your employees continue to enjoy the advantages of group health plans.

Ensure you make an informed choice when securing your mediclaim Insurance. Should you have any questions, don’t hesitate to contact us at +91 96966 83999 or via email at Trust SecureNow to deliver comprehensive group mediclaim policy for employees. Prioritize employee well-being and get peace of mind in times of medical crises.

Group Health Insurance
Group Health Insurance

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.