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 and 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. Employers should compare all the features of a Group Health Insurance Policy before finalising the Policy.

What is a Group Health Insurance Policy?

A Group Health Insurance Policy provides reimbursement to the Insured Employees for all the hospitalization expenses incurred on account of illnesses or injuries during the Policy Period. The Insurance Policy insures all the employees of an organization under a single Health Insurance Plan. The benefit of a Group Health Insurance Policy is that the Insured Members can avail quality Health Insurance Coverage at lower premiums as compared to a regular Health Insurance Policy. A Group Health Insurance Policy is also known as Corporate Health Insurance Policy or a Group Mediclaim Policy.

What are the features of a Group Health Insurance Policy?

A Group Health Insurance Policy offers the following features:

1. Family Coverage: A Group Health Insurance Policy provides coverage to employees of an organization. Group Health Insurance Plans can be extended to cover family members of employees, including their Spouse, Children, Parents, and Parents-In-Law
2. Coverage for Pre-Existing Diseases: A Group Health Insurance Policy provides coverage for Pre-Existing Diseases without any Waiting Period. Coverage for Pre-Existing Diseases without any Waiting Period is a big advantage of Group Health Insurance Policy as compared to regular Health Insurance Plans which have a Waiting Period of 3-4 years .
3. Room Rent Capping: A Group Health Insurance Policy specifies the maximum Room Rent Limit that is payable under the Policy in the event of a Claim, which is usually specified as a percentage of the Sum Insured. Usually, a Corporate Health Insurance Plan specifies 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.
4. Co-Payment: Some Group Health Insurance Policies have a Co-payment Clause which states that the Insured has to bear a certain percentage of the Claim Amount from his own pocket. Employer can reduce the premium for their Group Mediclaim Policy by including a Co-payment Clause in their Policy.
5. Day Care Procedures: A Group Health Insurance Policy also provides coverage for Daycare Procedures which do not require hospitalization of more than 24 hours due to medical advancements.
6. Pre and Post Hospitalization Expenses: In addition to Hospitalisation Expenses, a Group Health Insurance Policy also covers Pre- and Post-Hospitalization Expenses of the Insured, usually for 30 and 60 days respectively. This means that expenses incurred before hospitalization and after discharge, such as diagnostic tests, doctor consultations, pharmacy bills are also covered under the Insurance Policy.
7. Maternity Benefit Cover: A Group Health Insurance Policy also provides coverage for Maternity Expenses without any Waiting Period. Maternity Coverage is especially helpful for female employees and spouse of the Male Employees. Coverage for Maternity Expenses from Day 1 is a big advantage of Group Health Insurance Policy as compared to regular Health Insurance Plans which have a Waiting Period of 3-4 years.
8. Domiciliary Hospitalization Cover: Usually, Group Health Insurance Policies cover Hospitalisation Expenses for treatment which is sought in hospitals. However, some Policies also provide cover for Domiciliary Hospitalisation, that is expenses incurred for medical treatment availed at home.
9. Cashless Claims Settlement: Group Health Insurance Companies have a list of network hospitals where the Claims are settled on a Cashless Basis. Cashless Claims Settlement means that the Insurance Company settles the bill directly with the hospital. This means that the Insured does not need to pay the hospital bill out of his own pocket and later on file a claim with the Insurance Company for Reimbursement.
10. 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 depending on the budget and requirements.

What are the benefits of a Group Mediclaim Policy?

The benefits of a Group Mediclaim 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, thus making it more affordable.
2. Wider Coverage: A Group Mediclaim offers wider Coverage with lesser waiting periods v/s an Individual or a Family Floater Health Insurance Policy. This
3. Ability to Customise Coverage: The features of a Group Health Insurance Policy, such as Room Rent Limit, Waiting Periods and other benefits can be customized to best suit the requirements and the budget of the Policyholder.
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 Group Health Insurance 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 Policy. In any organization, there will always be new employees who join and existing employees who leave the organization. A Group Health Insurance Policy allows for addition and deletion of members during the midterm of the Policy, thereby making the administration of the Insurance Policy quite simple.
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 for the Employer and can be used to reduce the tax liability. Additionally, the claim amounts received by the employees from the Group Health Insurance Policy are not taxable.

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

The Claim Process under a Group Health Insurance Policy is very simple. An Employee can avail a Claim, either on Cashless Basis or Reimbursement Basis under the Policy. The Insured must follow the steps listed below to make a Claim under their Group Health Insurance Policy:

Reimbursement Claim

1. Initmate the claim to the TPA or the Insurance Broker as soon as the Insured Person 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 Group Medical Insurance Policy is very simple. The Insured Employee just needs to show his Health Insurance Card to the network hospital. The hospital and Insurance Company will take care of the claim from thereon.

Compare Group Health Insurance Quotes 20+ Insurance Companies 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 offer employees comprehensive coverage, which can boost employee productivity as well as retention. Qian has tie-ups with top Group Health Insurance Providers in India and their experienced team can assist you in comparing 20+ 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 quotes so that you can avail the best package at an affordable price. You can reach out to us via email at insurance@qian.co.in or call us on 022-35134695 to request a free consultation. We would be glad to assist you.

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