What are the features of a Group Health Insurance Policy?

Medical expenses are increasing by the day. The lifestyle of today’s generation means that many people are likely to suffer from lifestyle diseases such as Diabetes, Blood Pressure. The frequency of serious ailments like Cancer, Heart Diseases is also rising. The medical costs to treat such diseases is also very high. Lots of families are suffering from financial stress since they cannot afford quality healthcare. In such a scenario, a quality health insurance plan is becoming indispensable for everyone.

Recognising the need of health insurance coverage for employees, many employers have started offering group health insurance plans to employees. The advantage of a Group Health Insurance Policy for employees is that the insured members can avail quality health insurance coverage at affordable premiums. Employers should compare all the features of a Group Health Insurance Policy before finalising the Policy.

What is a Group Health Insurance Plan?

One of the most common Group Insurance products is a Group Health Insurance Policy or Group Mediclaim Insurance Policy (GMC Policy).

A Group Health Insurance Policy provides health insurance coverage to a group of members as compared to an individual health insurance plan which provides coverage to an individual or a family floater health insurance plan which provides coverage to only family members. Employers usually purchase a group mediclaim insurance policy for employees or other groups such as trade unions or clubs purchase group health insurance policy for their members.

A Group Health Insurance Policy provides reimbursement to the insured for the hospitalization expenses of insured employees and / or their family members on account of illnesses or injuries.

A Group Health Insurance Policy is also known as a Corporate Health Insurance Policy or a Group Mediclaim Policy (GMC Policy).

What are the benefits of a GMC Policy?

The benefits of a GMC Policy are as follows:

1. Lower Premiums
   Due to large group size, group health insurance policies have lower premiums as compared to an individual health insurance policy. The premium per employee or per family is lesser in a Group Health Insurance Policy as compared to a standard health insurance policy.

2. Wider Coverage
   GMC Policy Coverages are often wider with lesser waiting periods v/s an individual or a family floater health insurance policy. Additionally, group mediclaim insurance policy coverage is not restricted to the employees only. It can also cover their parents and children

3. Ability to Customise Cover
   One of the biggest advantage of Group Health Insurance Policy is that the group health insurance policy coverage can be customised to best suit the requirements of the policyholder. The Policy Holder can customise everything from room rent limit to waiting periods and much more.

4. Opt for Multiple Sum Insureds
   Employers can choose different Sum Insureds for different employees based on the designation or rank of the employees in a GMC Policy.

5. Mid Term Policy Addition and Deletion
   A Group Health Insurance Policy allows for additions and deletions of members during the midterm of the GMC Policy. In any organization, there will always be new employees who join and existing employees who leave the organization. Corporate Employee Insurance Plans are designed to process such changes in the employee force by way of endorsements. New employees who join the organization will be covered from the date of joining the company. In case of existing employees who leave the company, premium will be refunded for the unexpired period of the policy, subject to the condition, that such employee or their family member has not made any claim in the policy.Mid Term Policy Addition and Deletions are not possible under individual or family floater health insurance policies and new members can be added or deleted only upon renewal of individual health insurance policy.

6. Tax Benefits: There are multiple tax benefits of a Group Health Insurance Policy as well. The Premiums paid by the employer for a Group Health Insurance Policy are a tax-deductible expense and can be used to reduce the tax liability. Even the claim amounts received by the employees from the Group Health Insurance Company are not taxable.

What are the features of a Group Health Insurance Policy?

A Group Mediclaim Insurance Policy for employees offers the following features:

• Sum Insured: Employers can choose Sum Insured for employees from as low as Rs50,000 per employee to a Sum Insured as high as Rs5 lakhs per employee under a Group Health Insurance Policy. An organization can even opt for different sum insured for each employee.

• Family Definition: One of the key features of a Corporate Health Insurance Policy is the ability to define a family. Some examples of family definition include:
  • Employee only
  • Employee and Spouse
  • Employee, spouse and children
  • Employee, spouse, children and parents

• Room Rent Capping: A Corporate Health Insurance Policy specifies the maximum room rent limit that shall be payable under the policy in the event of a claim. The Room Rent Limit in a Group Health Insurance Policy is usually specified as a percentage of the Sum Insured. Usually, a Corporate Health Insurance Plan will specify a Room Rent Limit of 1% of Sum Insured for a normal room and 2% of Sum Insured in case of ICU room. Employers can also choose to remove the Room Rent Capping Limit under their Corporate Health Insurance Policy.
  It is important to note that if the actual room rent exceeds the maximum limit, the differential amount shall not be paid by the group health insurance policy. In addition to this differential amount, all other expenses (except pharmacy expenses) are also deducted on a pro-rata basis.
  For example, if the insured opts to stay in a room with a daily tariff of Rs. 4000 and the policy allows a tariff of Rs. 2000, then all other expenses shall be allowed in the same proportion i.e. 50%.

• Co-payment: Employer can reduce the premium for their Group Mediclaim Policy by including a Co-payment Clause in their Policy. Under a Co-Payment Clause, the insured person has to bear a certain percentage of the claim expenses under the Group Health Insurance Policy.

• Day Care Treatment: All Corporate Health Insurance Plans cover hospitalization expenses when the insured person is admitted in a hospital for 24 hours or more. However, there are some illnesses which do not require hospitalization of more than 24 hours. Such illnesses can be treated in less than 24 hours. These procedures are known as day care treatments. A Group Health Insurance Plan can be customized to offer coverage for day care treatments as well.

• Pre Existing Diseases Waiting Period: An Individual or a Family Floater Health Insurance Policy usually has a waiting period of 3-4 years for Pre-Existing Diseases. However, employers can opt for Zero waiting period for Pre-existing diseases in a Group Health Insurance Policy. This is another big advantage of Group Mediclaim Insurance Policy for Employees.

• Pre and Post Hospitalization Expenses: A Group Health Insurance Policy pays for hospitalisation expenses of the Insured Person. Additionally, a GMC Policy Coverage can also cover pre and post- hospitalization expenses for the same illness / injury. The pre and post-hospitalization period is specified in the policy terms and conditions. A Corporate Health Insurance Plan offers Pre and Post-Hospitalisation Expenses coverage of 30 and 60 days respectively.

• Maternity Benefit Cover: Maternity Cover in a Group Health Insurance Policy is for maternity claims only. This amount is payable in case an insured person delivers a baby during the policy period.

• Waiting Period for Maternity Claims: Another advantage of a Group Mediclaim Insurance Policy for employees is the option to waive off the waiting period for maternity claims. This is not possible in an individual health insurance policy.

• New Born Baby Cover: New Born Baby Cover is applicable only in case the family definition covers children. Under this cover, the baby can be covered under the Group Mediclaim Insurance Policy right from the date of birth and any expenses incurred towards medical treatment of such baby will be covered under the policy.

• Domiciliary Hospitalization Cover: Usually, Group Health Insurance Policies cover expenses for treatment which is sought in hospitals. However, subject to fulfillment of certain conditions, expenses for treatment taken at home can also be covered under the Domiciliary Hospitalisation Cover of a Group Medical Insurance Policy.

• Cashless Claims Settlement: Most Group Health Insurance Companies have a list of network hospitals where the claim are settled on a cashless basis. Cashless claims settlement means that the Group Health Insurance Company directly settles the medical expenses of the Insured with the hospital. This removes the need for the Insured Employee to pay the hospitalization expenses and later on file a claim with the Group Health Insurance Company.

There are several other features of a group mediclaim insurance policy which an employer should look at before finalising a policy for the company. All these conditions will be considered while computing the premium for the policy. Another important point to note that once the Group Health Insurance Policy Features are finalized and the policy is issued, such terms and conditions can only be changed at the time of renewal of the policy.

How to make a Claim under a Group Health Insurance Policy?

An Insured Employee can make a claim on Cashless or Reimbursement basis with the Group Health Insurance Company. The Insured should follow the steps listed below to make a claim under their Corporate Health Insurance Policy:

Reimbursement Claim

1. Initmate the claim to the TPA or the Insurance Broker as soon as the Insured Member is admitted to the Hospital
2. Collect all the relevant documents like hospital bills, lab reports, ID Proofs, Pharmacy Bills, Prescriptions, Indoor Papers, Discharge Card etc
3. Submit all the documents along with a completely filled and signed claim form to the Insurance Company

Cashless Claim

Filing for a Cashless Claim under Corporate Medical Insurance Policy is very simple. The Insured Employee just needs to show his GMC Policy E-Card to the network hospital. The hospital and Insurance Company will take care of the claim from thereon.

Compare 30+ Group Health Insurance Plans with Qian

A Group Health Insurance Plan is one of the best investments that a Company can make for its employees. The Premiums are affordable and offering employees comprehensive group health insurance coverage can boost employee productivity as well as retention. This article explained the features of a Group Mediclaim Policy in detail.

Qian has tie-ups with top group health insurance providers in India and their experienced team can assist you in comparing 30+ Group Health Insurance Plans. Qian specializes in Group Health Insurance Policy for small businesses. Our dedicated claims settlement team will assist your employees with their claims process as well.

Qian can thus assist you in availing comprehensive health insurance coverages and comparing multiple group health insurance quotes so that you can avail the best package at an affordable price. You can email us at insurance@qian.co.in or call us at 9820619760 to request a free consultation.

1. Group Health Insurance Policy for Employees
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?
19. How much does a Group Health Insurance Policy Cost?
20. Which are the leading Group Health Insurance Companies in India?
21. How to purchase a Group Health Insurance Policy?
22. What are the Documents required to make a claim under a Corporate Health Insurance Policy?
23. Why should I Purchase a Group Health Insurance Policy through an Insurance Broker?
24. Compare Plans from 20+ Group Health Insurance Companies and choose the Best Group Health Insurance Policy in India with Qian!
25. FAQS
26. Testimonials