Group Health Insurance

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A group health insurance policy, not only covers the members of the group but their families as well. In the group insurance segment, a family means and can include the insured person, their legal spouse, legal & dependent children, legal & dependent siblings and dependent parents or dependent in-laws.

Some group mediclaim insurance policies cover parents under 60 only if they are dependent on the insurance proposer. Other group mediclaim policies cover siblings as well.

Also the family members which can be covered under a group health insurance policy may vary from one insurer to another. Therefore, it is necessary to carefully read the policy document to know which family members are covered and which are not.

Usually, in most of the cases, the group medical insurer extends health coverage to the family members at free of cost, however some policies may levy premium. For instance, if you want to cover your senior citizen dependent parents also in your group health insurance policy, you might require to pay the extra premium.

It is strongly recommended to cover your family members, including parents, under a group medical insurance policy even if it means shelling out extra premium.

Individual health insurance companies might not be interested in offering health policies to your parents. Also, even if they offer the policy, they might charge a high premium. So, it is worthwhile to get your family members covered under group health cover.

Case Study: 1

It was the first job of Ravish Sharma in Pune. After having a successful stint in Chennai, Ravish decided to move to Pune to be with his senior citizen parents. As a software engineer, Ravish was drawing a handsome salary along with perks.

One of the benefits offered by his employer was group health insurance. As per the policy, his medical expenses were covered by the employer. In addition to this, the employer also agreed to cover his family members under the policy.

In this case, Ravish’s family included his parents only, and therefore, the insurer agreed to cover his parents. As Ravish’s parents were above 60, the group insurer insisted on a high deductible limit.

In the insurance segment, the deductible is the amount that you have to pay from your pocket before the insurer settles the remaining claim amount.

Considering the age of his parents and the fact that individual health insurance policies would prove costly, Ravish decided to cover his parents under corporate health insurance even if it means paying the deductible.

In this case, the group health insurance company agreed to cover both Ravish and his senior citizen parents under a single policy.

Case Study: 2

After working for three years in J.S IT as a senior technical analyst, Mrs. Jyoti Kumari joined a new company, L.K Solutions. Along with her attractive salary package, her new employer was offering her a  group health insurance policy as well.

On her induction day, the HR Manager said, “We understand how costly our medical treatments have become currently. Though we wish all of you good health; we can’t deny the fact that ailments come unannounced. We are offering a group medical insurance policy which you can use to get coverage against medical expenses. The good news is that we not only cover you, but your family members as well.”

Jyoti got excited to know that her group health insurance policy would not only cover her, but also her family members. On the personal front, she was living with her husband, their two-year old son and a niece who was staying with them to pursue her higher education.

When the HR executive asked her to fill the details in the insurance form, Jyoti gave details of all her family members, including her niece. However, the insurer refused to give cover to her niece.

A group health insurance policy covers family members, but in this case, Jyoti’s niece was not part of her family, even though she was staying with her for the last five years. For the insurance purpose, the insurer considered only her husband and son as her family.

Similarly, in the case of Jyoti’s colleague, Rahul, the group health insurance company agreed to cover his parents who were dependent on them. His parents fell within the definition of group mediclaim insurance policy and therefore, got covered under the insurance plan.