Group Health Insurance / Group Mediclaim Policy

Group health insurance, also called corporate health insurance, extends coverage to the employees of an organization. The group medical policy covers relevant pre-hospitalization, post-hospitalisation expenses, pre-existing diseases, etc.

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What is Group Health Insurance?

Group health insurance policies typically cover a specific group of people, usually the employees of an organization. It is often provided as an employment benefit. The covered employees can also choose to enroll their family members, such as spouses, parents, and children, under the same policy. The coverage and cost-effectiveness of these plans depend on the specific plan chosen by the employer.

A key benefit of group health insurance is instant coverage of pre-existing conditions, with no waiting periods. These plans also cover a broad spectrum of medical needs, including treatment for common illnesses, maternity benefits, and daycare treatment. Moreover, it also includes wellness benefits, among other valuable features.

Unlike individual health insurance policies, which frequently impose non-negotiable waiting periods and may be linked to high premiums, employer-sponsored health insurance is viewed as a crucial and valuable benefit, not just a desirable perk.

Why is Group Health Insurance Required?

The Problem

Building a great team is a challenging endeavour, but retaining them poses an even greater difficulty. When employees decide to leave, questions often arise about what could have been done differently. Most employees want work-life balance, fair pay, and health benefits, and they tend to depart when they perceive a lack of appreciation.

The Solution

To establish an exemplary workplace, the focus should be on implementing human-centric policies. Creating a corporate culture centred on care, innovation, and acceptance can foster a profound sense of belonging among employees.

Employers can bring this vision to life by taking essential steps, starting with adopting Group Health Insurance for employees. Such a move not only offers protection against unexpected situations but also contributes to increased employee satisfaction and, consequently, higher retention rates.

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Benefits of Group Health Insurance for Employers

Below are some advantages of group health insurance for employers:

Employee Retention Demonstrating care for employees through health insurance enhances their view of your organization, reducing turnover.
Tax Benefits# Contributions to group health insurance may qualify for tax deductions, providing financial benefits.
Cost Efficiency Group mediclaim insurance policies often achieve cost savings by spreading premiums across a large number of employees.

Benefits of Group Medical Insurance for Employees

Below are some advantages of group health insurance for employees:

Easy Claims Group medical insurance policy for employees simplifies claims, making it a convenient process. 
Family Coverage A group medical insurance for employees might also cover their family members. However, it’s up to the company to decide if they want to include the employee's spouse, kids, and parents. 
Enhanced Satisfaction Access to a group health insurance policy is a valuable benefit that enhances job satisfaction and loyalty.
Day 1 Coverage^ Employees receive insurance coverage from the first day of enrollment without medical screening.
Preventive Healthcare Includes coverage for vaccinations, check-ups, and wellness programs, promoting proactive health measures. This maintains employee health and aids in early detection, reducing the risk of serious illnesses and associated costs.

Note: Employees who visit a network hospital can receive a cashless claim settlement. Otherwise, if the employee goes to a non-network hospital, they must pay for the medical treatment themselves. However, they can request reimbursement from the insurance company within the given time frame.

Ideal Group Health Insurance Plans in India

Find the key features of various insurance companies offering medical insurance for employees in the table below:

Insurance Company Claim Settlement  Ratio Network Hospitals
Aditya Birla Group Health Insurance 94% 6000 and above

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Bajaj Allianz Group Health Insurance 98% 6500 and above

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Care Health Group Health Insurance 98.25% 9500 and above

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Cholamandalam MS Group Health Insurance 92% 8100 and above

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Digit Group Health Insurance 96% 5900 and above

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ICICI Lombard Group Health Insurance 94% 9500 and above

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Kotak Mahindra Group Health Insurance 96% 4800 and above

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Magma HDI Group Health Insurance 96% 7000 and above

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ManipalCigna Group Health Insurance 90% 6500 and above

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Niva Bupa Group Health Insurance 96% 8500 and above

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Raheja QBE Group Health Insurance 95.2% 7000 and above

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Reliance Group Health Insurance 98% 7300 and above

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Royal Sundaram Group Health Insurance 98% 2200 and above

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SBI Group Health Insurance 97% 6000 and above

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Tata AIG Group Health Insurance 93% 6300 and above

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Zuno (Formerly Edelweiss) Group Health Insurance 95% 2500 and above

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See more plans
Note: *Policybazaar for Business does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer

Key Features of Group Health Insurance

Here are a few distinctive features of a group mediclaim insurance policy for employees:

  • Ancillary Expenses: Corporate Health Insurance for employees includes costs like ambulance expenses.
  • No Medical Screening: Health insurance for corporates allow enrollment without requiring medical screenings.
  • Cost-Effective Protection: Employer-employee insurance offers a more economical alternative compared to personal health insurance plans.
  • Cashless Treatment: Insured employees can avail of medical care at network hospitals without making upfront payments, reducing financial strain.
  • Added Health Benefits: Employers can offer extra benefits like regular check-ups, mental wellness support, and OPD consultations. These services help boost employee well-being.
  • Pre and Post-Hospitalization Coverage: Corporate health insurance for employees includes medical expenses before and after hospitalization, offering extensive support. This covers relevant expenses incurred 30 days before hospitalization and 60 days after discharge.

Group Health Insurance: Inclusions & Exclusions

  • What Does a Group Health Insurance Policy Cover?

    Here are common coverages provided under medical insurance for employees:

    • Pre-existing Diseases: A corporate insurance policy, a type of group insurance policy, provides coverage for existing diseases before enrolling in the policy
    • Hospitalization Expenses: Medical insurance for employees covers in-patient hospitalization expenses, including room charges, nursing fees, and doctor's fees.
    • Pre and Post-Hospitalization: The policy covers expenses incurred before admission to the hospital and after discharge. This may include expenses for diagnostic tests and subsequent treatments.
    • Daycare Procedures: The corporate insurance policy covers medical procedures or surgeries that don't require overnight hospital stays. This may include treatment for cataract, stone removal surgery, chemotherapy, hemodialysis, etc. 

    Note: It's important to note that the coverage and terms may vary from one group health insurance policy to another. Therefore, it's important to carefully review the policy documents and understand the specific benefits and limitations of the plan.

  • What Does a Group Mediclaim Policy Not Cover?

    Common exclusions under group health insurance policies in India often include:

    • Cosmetic Procedures: Cosmetic surgeries or treatments unless required by an accident or covered as a reconstructive procedure.
    • Dental and Optical Care: The policy does not cover routine dental and optical care. However, some policies may offer limited coverage for dental and optical treatments.
    • War or Nuclear Risks: The health insurance for corporates doesn't cover Injuries or illnesses resulting from war, nuclear radiation, or related risks.
    • Hazardous Activities: The policy excludes medical emergencies resulting from engaging in hazardous activities like adventure sports or high-risk occupations.
    • Self-Inflicted Injuries: Injuries that the insured person deliberately causes are not covered.
    • Substance Abuse: The health insurance for corporates excludes medical conditions resulting from drug or alcohol abuse.
    • HIV/AIDS: The group health insurance scheme does not cover treatment and expenses related to HIV/AIDS.
    • Non-Medical Expenses: The policy does not cover non-medical expenses like transportation, accommodation and personal comfort items during hospitalization.
    • Experimental or Unproven Treatments: The corporate insurance policy excludes treatments or drugs that are experimental or not widely recognized.
    • Injuries from Illegal Activities: The policy doesn't cover injuries or illnesses resulting from illegal activities or involvement in criminal acts
Group health insurance

Group Health Insurance Add-Ons

Here are some of the extended coverage provided under the group medical insurance for employees:

  • Maternity Coverage: Pregnancy coverage with a capping on expenses at the time of childbirth.
  • Waiver of Maternity Waiting Period: The option to waive the standard 9-month waiting period for maternity coverage.
  • Coverage for Newborns within Maternity Limit: Inclusion of newborn babies under the maternity coverage limit.
  • Outpatient (OPD) Coverage: Comprehensive coverage for outpatient medical expenses.
  • Corporate Buffer: The corporate health insurance policy provides additional coverage if the existing sum insured is exhausted. However, the employee must pay an extra premium to avail of this feature.

Qualifying Criteria to Purchase Group Health Insurance

A company with a minimum of 7 employees is eligible to purchase a group health insurance policy.  

However, corporate health insurance plans can be acquired even if the company has fewer than 7 employees. To qualify for such plans, the company must extend insurance coverage to the dependents of its employees, ensuring that the total life count reaches 7.

Example: A growing tech company recently expanded its team to five employees. Recognizing the significance of employee benefits, they decided to purchase a corporate health insurance policy for their team. Initially, with only five employees, they did not qualify for a group health insurance plan. 

However, some insurance companies extended an offer to the company, allowing them access to group mediclaim policy if they added just two more people, who can even be dependents of their employees. To meet this requirement, the company decided to include the dependents of all five employees. This strategic move fulfilled the eligibility criteria and enabled the company to provide comprehensive health coverage for all employees and their dependents.

Learn Your Claims Process: Cashless & Reimbursement

Learn how to secure financial support during medical emergencies whether it's cashless or reimbursement claim.

  • Cashless claim
  • Reimbursement claim

How to Get a Cashless Claim Under Group Health Insurance? - Planned Hospitalization

Follow the steps below to get a cashless claim under a corporate health insurance policy for planned hospitalization.

  • Step 1: Fill up the pre-auth form at the network hospital at least 48-hours in advance.
  • Step 2: TPA registers the claim on the same day in case of a network hospital and authorizes the cashless claim within 2 hours 
  • Step 3: On the day of hospitalization, be present with your health card number and a photo ID card
  • Step 4: At the time of discharge, the insurance company will settle the claim directly with the hospital.

How to File a Reimbursement Claim Under a Group Health Insurance Plan? - Unplanned Hospitalization

Follow the steps below for a reimbursement claim under the health insurance for corporates.

  • Step 1: You must notify your relationship manager within 24 hours of hospitalization.
  • Step 2: Submit the claim form and all required documents within 30 days after the discharge. 
  • Step 3: Collect all the original hard copies of bills, reports and discharge summaries.
  • Step 4: The insurer will process the claim after checking the claim-related bills and treatment documents. 
  • Step 5: Provide a cancelled cheque for bank details to transfer the amount.
  • Step 6: The insurer will process the claim within 15-21 days of providing all the details subject to their terms and conditions.

Note: The policyholder should keep a copy of all the documents and claim forms with him/her.

Documents Required for Making a Claim under Corporate Medical Insurance

Documents always play a major role in the approval of the claim. The list of documents required while filing a claim are:

  • Original detailed discharge summary.
  • Original final hospital bill with a detailed cost-wise breakdown of all the components included.
  • Original payment receipt against the final hospital bill.
  • Original investigation reports and pharmacy bills along with doctor advice.
  • Valid photo ID of the patient and the employee
  • Hospital registration certificate/declaration from the hospital mentioning the number of beds with available facilities, duly signed & stamped on the hospital letterhead.
  • Original invoice and sticker of implant, in case it is applicable.
  • Name printed cancel cheque of insured /self-attested bank statement with IFSC code/copy of the front page of passbook with beneficiary detail.

Documents Required in Case of an Accident Claim:

  • Copy of MLC/FIR, if any. If it is not applicable, the treating doctor must provide an explanation.
  • The doctor needs to confirm that harmful substances were not a factor.

Note: The above-mentioned documents constitute a tentative list. The insurance company will give the final confirmation after registration and meticulous scrutiny of the complete set of documents.

Why Buy a Group Health Insurance Policy via Policybazaar for Business?

Some of the advantages of purchasing corporate health insurance from Policybazaar for Business are as follows:

  • Purchase Assistance: Policybazaar for Business offers competitive quotes from various insurance companies. This enables you to select the most suitable option for your needs.
  • Endorsements: Policybazaar for Business serves as a single point of contact for all endorsement-related matters. This helps in avoiding the need to directly contact the insurer.
  • Claims: Our claim handlers will guide and assist policyholders in expediting the claims process, ensuring assistance in claims resolution.
  • Renewal: We facilitate the renewal process, making it convenient for policyholders to continue their coverage seamlessly.
  • Instant Quotes: We provide immediate quotes from various insurance providers. This allows you to compare and choose the most suitable option quickly and efficiently.
  • Dedicated Relationship Manager: When you buy corporate health insurance from Policybazaar for Business, you get a dedicated relationship manager. They assist with queries, claims, and renewals, providing personalized guidance at every stage.

Group Mediclaim Policy: FAQs

  • How is a group health insurance policy different from an individual health insurance plan?

    Below is a table comparing group health insurance for employees and individual health insurance.
    Group Health Insurance Individual Health Insurance
    The company is the direct point of contact for a group health insurance plan. In the case of individual health insurance, an individual is the point of contact.
    The employer holds the authority to cancel the group health insurance policy. In an individual health insurance policy, the individual policyholder has the authority to cancel the policy.
    A corporate medical insurance policy is valid until the employee is with the respective organization. An individual health insurance policy is valid until an individual pays the premium for his/her policy.
    A group health insurance plan majorly depends on the strength of the company. This includes both employee and financial strength. An individual health insurance policy majorly depends on the age of the individual, his/her health condition, age, etc.
    Pre-medical tests are not conducted in a group health insurance plan. Most insurance providers perform pre-medical check-ups before issuing a policy to an individual.
  • Is corona virus covered in Group Health Insurance?

    Some group health insurance plans provide coverage for corona virus. However, you should check with your employer or insurer for the same.
  • Is it possible to issue the group mediclaim policy with fewer than 7 employees?

    Yes, if the number of employees is less than 7 but the total number of lives, including dependents, exceeds 7, then the insurance company will issue the employee medical insurance in India.
  • How is the premium of a Group Health Insurance calculated?

    The insurance company decides the premium of a Group Health Insurance policy based on the:
    • Number of employees in an organization,
    • Average age of employees,
    • Number of dependents
    • Location
  • What are the various waiting periods in Group Medical Insurance?

    Health insurance for corporates often eliminates waiting periods seen in individual policies. Typical waiting periods include:
    • 9 Months Waiting Period: Under the group health insurance plan that includes maternity benefits, there is a 9-month waiting period before a claim can be raised. However, the company can waive this waiting period, providing coverage from day 1.
    • 1 Year Waiting Period: Group health insurance typically excludes high-incidence diseases such as Gallbladder, Cataract, and Kidney stones. The insured must serve a 1-year waiting period before raising a claim. However, the company can waive off this waiting period if desired.
  • What is room rent capping in Group Health Insurance (Group Mediclaim Policy)?

    Room rent capping limits the type of hospital room that the patient can use. Typically, the insurer sets this cap at 1% of the sum assured, and the insured bears the costs exceeding this cap. This measure helps control expenses and ensures clarity in healthcare billing. However, one can remove the room rent cap by choosing higher room rent limits when purchasing the policy.
  • Can room rent be customized under the group health insurance policy?

    Yes, the option for room rent customization is available in the Group Health Policy. There are several options available for customization, including:
    • Proportion of Sum Assured (1%, 1.5%, & 2%)
    • Single AC room (irrespective of the costs)
    • No room rent capping at all

    *Note: Room rent customisation in medical insurance for employees varies from one insurer to another.

  • Is it advisable to opt for a pre-existing disease waiver in group health insurance for employees?

    Including a pre-existing disease waiver in group mediclaim insurance depends on the group's demographics and desired benefits. For example, if the group primarily comprises young individuals without significant medical histories, the importance of this benefit may be relatively lower.

    However, if the group consists of members with an average age of 40, including parents, the significance of this benefit increases.

  • Can maternity coverage be included in a group medical insurance policy for employees?

    Yes, you can add maternity benefits to your employee's group health insurance policy. However, it's important to note that maternity coverage typically comes with a maximum claim limit specified in the policy.
  • Why is the maternity benefit important?

    Maternity benefits are important in India for multiple reasons. They provide essential medical care and financial security for mothers during pregnancy and childbirth. This ensures the health of both mother and child.

    The Maternity Benefit Act, 1961 mandates these benefits, protecting women's rights and promoting workplace equality. Additionally, these benefits help retain female employees by allowing mothers to care for their newborns during the early months.

  • Is internal congenital disease covered under a group medical insurance policy?

    It is a standard exclusion for most insurers. However, this exclusion can be waived if the employer pays an additional premium.
  • What is the facility for a health check-up under a group medical insurance policy?

    Health insurance for corporates offer coverage for regular health check-ups, typically provided once every four years. This valuable benefit serves as an added service for corporate customers.
  • What information is needed to generate employee medical insurance quotes?

    To obtain insurance quotes from various insurance companies, the following information is required:

    For Fresh Cases: For new policy proposals where the client is purchasing the policy for the first time, the following employee data is necessary and should be provided in the Excel template provided:

    • Employee Code
    • Employee Name
    • Relation (Self, Spouse, Child, or Parent)
    • Date of Birth
    • Gender
    • Sum Insured for all employees and their dependents, if applicable.

    For Renewals or Market Rollovers: For policy renewals or market rollovers, we need the following:

    • Copy of the previous year's policy
    • Claims dump
    • Claims Management Information System (MIS)
    • oActive employee data, including employee information.
  • What information is needed to generate employee medical insurance quotes?

    Generally, insurance companies do not provide coverage to specific employees.
  • Why is data required for group medical insurance policy quotes?

    Insurance policies, especially Medical Insurance for Employees, are tailored to specific factors like age demographics, gender distribution, location, and sum insured. Underwriters calculate premiums based on these variables. Without accurate data, it's impossible to assess the risk properly and provide accurate quotes. By providing precise information, we can offer you the most suitable and competitive quote.
  • Why is the date of birth required, and why can't the quote be provided based solely on age?

    The insurance company determines the rates for Group Health Insurance (GHI) policies on the basis of specific age brackets. If you provide an approximate age instead of the date of birth, the premium estimate may not be accurate. This is because the premium varies depending on the age bracket of the employees.

    For example, if the employer estimates an employee's age as 35. Later, learns that the employee's age is 36 by their date of birth. This will result in age bracket changes, leading to a corresponding change in the premium amount.

  • Can group health insurance policy provide coverage for dependents?

    Yes, a group insurance scheme offers various family definitions to accommodate different coverage needs::
    • Employee Only: This option covers only the employees of the company.
    • Employee and Spouse (ES): This choice provides coverage for both employees and their spouses.
    • Employee, Spouse, and Kids (ESK): This category includes coverage for employees, spouses, and children.
    • Employee, Spouse, Kids, and Parents or Parents-in-Law (ESKP): This option extends coverage to employees, spouses, children, as well as parents or parents-in-law.
  • What is the impact of room rent on the claim amount payable?

    When the policyholder selects a room above the policy's tariff limit, the insurer will proportionally reduce the claim amount. The policyholder must then pay the difference.
  • Is vaccination covered in Group Health Insurance

    Yes, the covered newborns receive vaccinations as part of the Group Health Insurance policy's terms and conditions..
  • What is the difference between ESIC and a group health insurance plan?

    ESIC (Employees' State Insurance Corporation) is a compulsory government-operated measure. It offers medical benefits to specific employees depending on income thresholds and industry categories.

    In contrast, a group health insurance plan is voluntary and provided by employers. It offers medical coverage to their employees. Unlike ESIC, employee group insurance plans provide greater flexibility in coverage options and benefits.

  • Who pays the premium for the group mediclaim policy?

    In most cases, the employer pays the premium for the group medical insurance policy. However, some companies may choose to share the cost with their employees or offer the option for employees to contribute towards enhanced coverage for themselves or their family members. ..

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Policybazaar for Business - Group Health Insurance - Customer Reviews
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4.4/5
Based on 189 reviews
4.4
out of 5
Based on 189 reviews
38 users
136 users
15 users
0 users
0 users
3.8 April 09, 2023
Mansi
Excellent Support
It was easy to buy insurance from PolicyBazaar website and customer support was also amazing to clear all the doubts.Thankyou. Highly worth it.
Dehradun
4.3 April 01, 2023
Mahesh
Necessary Investment
It is a good and necessary investment. Thanks PB.
Lucknow
4.3 March 24, 2023
Surya
Provides Satisfactory Results
I purchased Group health insurance at policybazaar recently and i am so much satisfied with the plan. The application process was smooth and efficient, making the typically tedious task of getting insurance surprisingly hassle-free.Thanks PB.
Bareilly
3.8 March 16, 2023
Naveen
Helpful In Making Decisions
When it came to selcting the right Group Health Insurance, Policybazaar offered an impressive range of options from reputable insurers. I appreciated the comprehensive details avalable for each policy which helped me to take the better decisions. Thankyou.
Delhi
4.3 March 15, 2023
Rajesh
Increases Clients Expectations
I recently had the pleasure of securing a Group Health Insurance policy throug PolicyBazaar and I must say the Entire process exceeded my expectations! From start to finish, their service werw great. Thankyou.
Delhi
3.8 March 02, 2023
Ravi
Great Experience
I got great deals on PolicyBazaar website. Highly recommend.
Pune
4.3 February 17, 2023
Diljeet
Excellent Purchase
It was a excellent purchase at PolicyBazaaar. Thankyou team.
Coimbatore
4.3 February 04, 2023
Satya
Prompt Services
Policybazaar's efficient claims process was impressive. In case of any medical emergencies, my employees were able to get their claims settled swiftly, allowing them to focus on their health and recovery without worrying about financial aspects.Thankyou
Chennai
4.3 January 22, 2023
Abhishek
Budget Friendly Purchase
Thankyou PolicyBazaar for providing such a great plan at affordable premium rates. It was a budget-freindly purchase.
Delhi
4.3 January 09, 2023
Abhash
Multiple Range Of Benefits
I purchased Group health Insurance which offered me plans with affordable rates Thankyou PB.
Pune

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  • Disclaimers+

    *Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer.

    ^ The pre-existing diseases are only covered as per insurer T&Cs.

    #Tax Benefits are subject to changes in tax laws.The benefits mentioned are as per insurer T&Cs and are available with or without extra cost depending on the plan and insurer chosen .Therefore, to learn more about the benefits in detail, contact the HR department of your company or check the insurance policy documents.. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.Policybazaar is registered as a Composite Broker | Registration No. 742, Registration Code No. IRDA/ DB 797/ 19, Valid till 09/06/2027, License category- Composite Broker.
    *Savings of 65% are based on the comparison between the highest and lowest premiums provided by different insurance companies for Rs 5 lakh cover for 50 employees falling in the age group ranging between 19-55 years with room rent limits of 1% and 2% of sum insured for normal and ICU rooms respectively and does not include PED and maternity coverage. Premium starting from
    +₹110/Employee/Month for ₹1 Lac Sum Insured covering Health & Wellness Needs (excluding GST), Premium may vary on the basis of coverage type & add-ons, All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
    By clicking on "View Plans Instantly" you agree to our Privacy Policy and Terms Of Use and also provide us a formal mandate to represent you to the insurer and communicate to you the grant of a cover.
    The details of insurance coverage, inclusions and exclusions are subject to change as per solutions offered by insurance providers. The content has been curated based on the general practices in the industry. Policybazaar is not responsible for the factual correctness of these details.

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