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What is the difference between GMC and GPA Policy?

Sep 26, 2023

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Group Health Insurance Policy

What is the difference between GMC and GPA Policy?
Contents

Today, employees play a huge role in the success of an organisation. A well-motivated workforce helps the organization reach new heights and is a big competitive advantage for the company over their competitors. Thus, employers must do everything in their power to keep employees happy and motivated.

One way to do that is to take care of employees during their tough times such as illness, injury or disabilities. A GMC Policy and a GPA Insurance Policy is an excellent way to taking care of the medical expenses of employees.

What is a GMC Policy?

The full form of GMC Policy is Group Mediclaim Cover. A Group Mediclaim Insurance Policy for Employees is a health insurance plan which covers the hospitalization expenses of employees. Usually, employers purchase a GMC Policy for their employees.

A GMC Policy is also known as a Group Medical Insurance Policy or a Group Health Insurance Policy.

What are the benefits of a GMC Policy?

  1. The main advantage of a GMC Policy is that the premium per person for a GMC Policy is much lesser than the premium per person of a comparable Individual Health Insurance Policy. This is because a Group Health Insurance Policy insures a greater number of people in a single policy as compared to a individual or a family floater health insurance policy.
  2. Another benefit of a GMC Policy is that it is customizable. The employer can customize the features of a GMC Policy as per his requirements and budget. Group Mediclaim Coverage like Room Rent Capping, Co-Payment Clause, Maternity Coverage and Sum Insured can be customized to fit the employer group health insurance requirements.
  3. Another big advantage of a GMC Policy is that it offers tax benefits for employers. The premiums paid for a GMC Policy are a tax-deductible expense for the employers. You can read our blogpost to understand the Tax Benefits of a Group Mediclaim Policy in detail.

What are the coverages in a GMC Policy?

Group Mediclaim Coverage includes the following:

  1. Hospitalisation Cover: A GMC Policy provides cover for hospitalization expenses incurred by the employees for hospitalization period of more than 24 hours.
  2. Pre and Post-Hospitalisation Coverage: Group Mediclaim Coverage also includes coverage for pre and post-hospitalisation expenses, usually for 30 days and 60 days respectively
  3. Pre-Existing Diseases: Another advantage of a Group Mediclaim Insurance Policy is that Pre-Existing Diseases can be covered without any waiting period while Individual Health Insurance Policies have a waiting period of 3-4 years.
  4. Maternity Coverage: A GMC Insurance Policy can also provide cover for Maternity Expenses without any waiting periods. This is another benefit of a Group Health Insurance Policy as Individual or Family Floater Health Insurance Policy have a waiting period of 3-4 years for Maternity Expenses
  5. New-Born Baby Coverage: A GMC Policy provides coverage for New Born Baby from Day 1 while individual health insurance policies can provide coverage for new born baby from subsequent renewals

Our Blogpost on features of Group Health Insurance Policy discusses these Group Mediclaim Coverages in detail.

What are the exclusions in a GMC Policy?

There are certain exclusions in a GMC Policy as listed below:

  1. Diseases, Illnesses or Injuries directly attributable to war, invasion etc are excluded from coverage in a GMC Policy
  2. Dental Treatments are also excluded from GMC Policy Coverage
  3. Congenital External Disease or Intentional Self Injury (Including Suicide attempt) are not included in the Group Mediclaim Policy Coverage
  4. Any form of illness or injury arising from consumption of alcohol, drugs are excluded from GMC Policy Coverage
  5. Any form of Infertility Treatments are also excluded from Group Mediclaim Coverage

What is a Group Personal Accident Insurance Policy?

The full form of GPA Policy is Group Personal Accident Policy. A Group Personal Accident Insurance Policy insures a group of people and provides financial protection in case the insured person suffers from accidental death or disability.

What are the coverages in a GPA Insurance Policy?

A Group Personal Accident Insurance Policy offers the following coverages:

  1. Accidental Death: A Group Personal Accident Insurance Policy provides 100% of Sum Insured as compensation in case the Insured suffers from accidental death.
  2. Permanent Total Disability: A GPA Insurance Policy Coverage also includes coverage for permanent total disability and Permanent Partial Disability.
  3. Temporary Total Disability: A Group Personal Accident Insurance Policy Coverage also includes coverage for Temporary Total Disability such as a Fracture in which case Bed Rest becomes compulsory. In such a case, a GPA Insurance Policy will pay the Insured Person a weekly benefit which is specified as a % of Sum Insured.

In addition, the scope of GPA Policy Coverage can be extended by opting for multiple add-on covers which are available on payment of extra premium.

What are the exclusions in a Group Personal Accident Insurance Policy?

The exclusions in a Group Personal Accident Insurance Policy are as follows:

  1. A Group Personal Accident Insurance Policy excludes injury or death caused due to attempted suicide or self-injury
  2. A GPA Insurance Policy also excludes any form of natural death due to any cause other than an accident
  3. GPA Insurance Policy Coverage also excludes death or injury caused due to participation in a war
  4. GPA Policy Coverage also does not include death or injury caused due to Drug Use or under the Influence of Alcohol

What is the difference between GMC Policy and GPA Insurance Policy?

  1. Coverage: A Group Mediclaim Policy for Employees is a health insurance policy which offers cover for hospitalization expenses while a Group Personal Accident Policy Coverage for accidental death and injuries.
  2. Coverage Territory: A GMC Insurance Policy does not offer worldwide coverage while a GPA Policy offers worldwide coverage.
  3. Customisation: A GMC Policy can be customized with regards to features such as Sum Insured, Room Rent Capping, Sub -Limits, Co-Payments while a GPA Insurance Policy cannot be customized.
  4. Claim Admissible: A GMC Claim is admissible if the Insured is hospitalized for more than 24 hours while a GPA Claim requires the Insured Person to suffer from an accidental death or disability for claim to be admissible
  5. Insured Person: A Group Medical Insurance Policy usually covers employees, spouse and dependent children while a GPA Policy provides coverage to employees only.
  6. Add-On Covers: A Group Medical Insurance Policy offers the add-on covers like Domiciliary Hospitalisation Cover, Emergency Ambulance Cover, Maternity Benefits while a GPA Policy offers add-covers such as Loss of Income, Emergency Medical Expenses etc.

The following table highlights the difference between a GMC vs GPA Policy:

Group Mediclaim Policy Group Personal Accident Policy
Coverage Hospitalisation Expenses incurred by employees on account of illness or injury Accidental Death or Disability
Admissibility of Claim Claim is admissible if employee has been hospitalized for 24 hours or more. Hospitalization for less than 24 hours is also covered Claim is payable if employee suffers the following due to accident: 1. Death 2. Permanent Total and Partial Disability 3. Temporary Total Disability
Who is covered Employees and their dependents Employees Only
Customisation A GMC Policy can be customized wrt to Room Rents, Sum Insured, Sub-Limits, Coverages A GPA Insurance Policy cannot be customized
Add-Covers A GMC Policy offers following add-covers: 1. Domiciliary hospitalization cover 2. Emergency ambulance cover 3. OPD Benefit 4. Maternity Cover A GPA policy provides the following covers on payment of additional premium: 1. Emergency Medical Expenses cover 2. Dependent Children Education Benefit 3. Loss of Income benefit
Coverage Territory Under a GMC Policy, the insured person has to take treatment in India only. No claim will be payable if such person opts for treatment outside India Under a GPA policy, if the insured employee suffers from accident or injury outside India, even in such a case, the compensation amount will be payable by the insurer

Final Take

A Group Medical Insurance Policy and a Group Personal Accident Insurance Policy constitute an important benefit package that employers can offer to their employees. Qian is an experienced insurance broker for Group Health Insurance and Group Personal Accident Insurance Policy. We have tie-ups with top Group Health Insurance Providers in India and we can assist you with competitive quotes and quick claims settlement for your GMC and GPA Policies.

You can reach out to the Qian Team for any query regarding Group Health Insurance and Group Personal Accident Insurance Policy at 📧 insurance@qian.co.in or call 📞 022-35134695. We can assist you in choosing the best GMC Insurance Companies and GPA Insurance Providers.

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  2. What is Group Health insurance?
  3. What is an Employee Group Health Insurance Policy?
  4. What does a Group Health Insurance Policy cover?
  5. What is not covered under a Group Health Insurance Policy?
  6. How is a Group Health Insurance Policy different than an Individual Health Insurance Plan?
  7. What are the Key Features of a Group Health Insurance Policy?
  8. What are the add-on covers available under a Group Health Insurance Policy?
  9. What is the impact of Room Rent Limit on the claim amount payable under the Group Health Insurance Policy?
  10. Should employers opt for a Pre-Existing Disease Coverage from Day 1 in Group Medical Insurance Policy for employees?
  11. Does a Group Medical Insurance Policy provide Maternity Benefits?
  12. What are Waiting Periods under a Group Health Insurance Policy?
  13. What are the benefits of Group Health Insurance Policy for Employers?
  14. What are the benefits of Group Health Insurance Policy for Employees?
  15. Why should you purchase an Employee Group Health Insurance Policy for your organisation?
  16. How many employees do you need to purchase a Group Health Insurance Policy?
  17. Who is eligible for Group Health Insurance for Employees?
  18. Are Employer Group Health Insurance premiums Tax-Deductible?
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