Group Health Insurance

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

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Whom do you want to insure?

  • Employee, spouse & kids

  • Employee only

What is Group Health Insurance?

Group health insurance policies are tailored to cover a specific group of individuals, often presented as an employment perk. Employers typically offer this benefit to their employees, who may also choose to enrol their family members under the same policy, such as spouses, parents, children, or parents-in-law. The extent of coverage and cost-effectiveness of these insurance plans can vary depending on the specific coverage and plan selected by the employer.

One of the key benefits of group health insurance plans is the instant coverage of pre-existing medical conditions, eliminating 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.

In comparison to 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 seek work-life balance, competitive compensation, 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 inclusivity can foster a profound sense of belonging among employees.

This vision can be realized by taking essential steps, starting with the adoption of 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: Employers: Group policies often provide cost savings as the premiums are spread across a larger pool of employees.

Benefits of Group Health Insurance for Employees:

Below are some advantages of group health insurance for employees:

  • Easy Claims: Group mediclaim insurance policy for employees simplifies claims, making it a convenient process. (Condition: Employees who visit a network hospital can receive a claim settlement without cash transactions. Otherwise, if the employee does not visit a network hospital, they must pay for the treatment and request compensation within the stipulated time frame provided by the insurance company).
  • Family Coverage: A group medical insurance policy 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 group health insurance is a valuable benefit that enhances job satisfaction and loyalty.
  • Day 1 Coverage: Employees receive insurance coverage from the first day of enrollment without the need for medical screening.
  • Preventive Healthcare: Includes coverage for vaccinations, check-ups, and wellness programs, promoting proactive health measures. This not only maintains overall employee health but also aids in early detection, reducing the risk of serious illnesses and associated costs.

Ideal Group Health Insurance Plans in India

Find the key features of various insurance companies offering group health insurance plans in the table below:

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

View Plan

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 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: Corporate group health insurance plans 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: Policyholders can avail of medical care at network hospitals without making upfront payments, reducing financial strain.
  • Added Health Benefits: Employers can provide extra benefits like regular check-ups, mental wellness support and OPD consultations to promote proactive employee well-being.
  • Pre and Post-Hospitalization Coverage: Group mediclaim insurance for employees includes medical expenses before and after hospitalization, offering extensive support..

This encompasses relevant pre-hospitalisation expenses incurred within 30 days before hospitalization and relevant post-hospitalization expenses incurred within 60 days after leaving the hospital.

Group Health Insurance: Inclusions & Exclusions

Here are the common coverage provided under a corporate insurance policy:

  • What is Covered?

    Here are common coverages provided under corporate insurance policy:

    • Pre-existing Diseases: A corporate insurance policy provides coverage for diseases existing before getting enrolled in the policy.
    • Hospitalization Expenses: A corporate insurance policy provides coverage for in-patient hospitalization expenses, including room charges, nursing fees, and doctor's fees.
    • Pre and Post-Hospitalization: Relevant expenses occurring both prior to hospitalization and post-hospitalization are covered. This may include expenses for diagnostic tests and subsequent treatments.
    • Daycare Procedures: Coverage for medical procedures or surgeries that do not require overnight hospital stays is provided under a corporate insurance policy. This may include treatment for cataract, stone removal surgery, chemotherapy, hemodialysis, etc.

    Disclaimer: It's important to note that the coverage and terms may vary from one group health insurance policy to another, so it's crucial to carefully review the policy documents and understand the specific benefits and limitations of the plan provided by the employer or insurer.

  • What is not Covered?

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

    • Cosmetic Procedures: Cosmetic surgeries or treatments, unless necessitated by an accident or covered as a reconstructive procedure.
    • Dental and Optical Care: Under a corporate insurance policy, routine dental and optical care, including check-ups, fillings, and eyeglasses, are often excluded. However, some policies may offer limited coverage for dental and optical treatments.
    • War or Nuclear Risks: Injuries or illnesses resulting from war, nuclear radiation, or related risks are generally not covered.
    • Hazardous Activities: Under the corporate insurance policy, injuries sustained while engaging in hazardous activities like adventure sports or high-risk occupations may be excluded.
    • Self-Inflicted Injuries: Injuries intentionally caused by the insured person are typically excluded.
    • Substance Abuse: Under corporate insurance policy, medical conditions resulting from drug or alcohol abuse may not be covered.
    • HIV/AIDS: Treatment and expenses related to HIV/AIDS may be excluded under corporate insurance policy.
    • Non-Medical Expenses: Non-medical expenses like transportation, accommodation, and personal comfort items during hospitalization are usually excluded under corporate medical insurance.
    • Experimental or Unproven Treatments: Treatments or drugs that are experimental or not widely recognized may be excluded.
    • Injuries from Illegal Activities: Injuries or illnesses resulting from illegal activities or involvement in criminal acts are often excluded under corporate insurance policy.

    Disclaimer: It's essential to carefully review the policy documents and understand the specific exclusions and limitations of the group health insurance for employees provided by your employer or insurer to ensure you have a clear understanding of what is and isn't covered.

Group health insurance

Optional Coverage Extensions/Add-ons

Here are some of the extended coverage provided under the corporate health 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: Additional coverage is provided by the corporate policy if the existing sum insured is exhausted. However, to avail of this feature, the employee must pay an extra premium.

Eligibility Criteria to Purchase Group Health Insurance

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

However, some group 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 health insurance plans 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 not only fulfilled the eligibility criteria but also enabled the company to provide comprehensive health coverage for all employees and their dependents.

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

Follow the steps below to get a cashless claim under group health insurance 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 group health insurance plan.

  • Follow the steps below for a reimbursement claim under the group health insurance plan.
  • Step 1: Notify the insurance provider within 24 hours of being hospitalized.
  • 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 is suggested to 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 in this case while making a claim are:

  • Completely filled & duly signed claim form with the claim amount.
  • 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. In case it is not applicable then treating doctor justification would be needed.
  • Doctor's justification to rule out the influence of intoxicating substances would be needed.

Note: Please be informed that the above-mentioned documents are a tentative list. The final confirmation will be given by the insurance company post-registration & meticulous scrutiny of the complete set of documents.

Why Buy a Group Health Insurance Policy from PolicyBazaar?

There are several advantages of purchasing group health insurance from Policybazaar. They are as follows:

  • Purchase Assistance: Policybazaar provides you with competitive quotes from various insurance companies, enabling you to select the most suitable option for your needs. 
  • Endorsements: Policybazaar serves as a single point of contact for all endorsement-related matters, eliminating the need to directly contact the insurer.
  • Claims: Policybazaar's claim handlers will guide and assist policyholders in expediting the claims process, ensuring assistance in claims resolution.
  • Renewal: Policybazaar facilitates the renewal process, making it convenient for policyholders to continue their coverage seamlessly.
  • Instant Quotes: We offer instant quotes from multiple insurance providers, allowing you to compare and choose the best option quickly and efficiently.
  • · Dedicated Relationship Manager: When you buy group health insurance from Policybazaar, you get a dedicated relationship manager to support you throughout your policy. They assist with queries, claims, and renewals, providing personalized guidance at every stage.

Group Health Insurance: Frequently Asked Question

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

    The difference between group health insurance policy for employees and individual health insurance policy is mentioned in the table below:

    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 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 organization, which includes both employee and financial strength. An individual health insurance policy is majorly dependent on the age of the individual, his/her health condition, age, etc.
    Pre-medical tests are not conducted in a group health insurance plan by the insurance provider. Most insurance providers perform pre-medical check-ups before issuing a policy to an individual.
  • Is coronavirus covered in Group Health Insurance?

    Some group health insurance plans provide coverage for coronavirus. However, you should check with your employer or insurer for the same.
  • Who can be covered in a group health insurance policy?

    All employees who are more than 18 years old and below 70 years old and are employed with a company are eligible to get coverage for a Group Health Insurance policy. In addition to that, they can add their dependent children who are between 3 months to 25 years old, spouses and sometimes even parents.
  • Is it possible to issue the policy if there are fewer than 7 employees?

    Yes, if the number of employees is less than 7 but the total number of individuals, 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 decided?

    The premium of a Group Health Insurance policy is decided according to the number of employees in an organization, the average age of employees, the number of dependents and location.
  • What are the various waiting periods in Group Insurance?

    Group Health Insurance often eliminates waiting periods seen in individual policies. Typical waiting periods include:
    • 30 Day: Covers accidents and emergencies; can be waived.
    • 1 Year: For diseases like cataracts, kidney stones; can be waived.
    • 2-4 Year: For certain pre-existing conditions; varies by insurer.
    • 9 months: For maternity benefits; can be waived by the company.
  • What is room rent capping in Group Insurance (Group Mediclaim)?

    Room rent capping in employee health insurance (Group Mediclaim Policy) involves setting a limit on the type of hospital room that can be used. Typically, this cap is set at 1% of the sum assured. Costs exceeding this cap are borne by the insured. This measure helps control expenses and ensures clarity in healthcare billing. However, the room rent cap can be removed by opting for higher room rent limits while purchasing the policy.
  • Can room rent be customized under the group insurance policy?

    Yes, room rent can be customized 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 group insurance for employees varies from one insurer to another.

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

    The decision to include a pre-existing disease waiver in group insurance for employees depends on various factors, including the demographics of the group to be covered and the 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. It also depends on the group's policy terms and the willingness to incur additional costs. Some group members may become eligible for this benefit only after several years with the policy, and it typically comes at an extra expense.

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

    Yes, maternity benefits can be added to a Group insurance policy for employees. However, it's important to note that maternity coverage typically comes with a maximum claim limit specified in the policy.
  • When should maternity benefits be recommended?

    Maternity benefits can be suggested in the following scenarios:
    • When Adding Dependents: If the client is adding the spouses and children of employees, maternity benefits can be recommended. It provides coverage from day one without any waiting period. There is also an option to include a 9-month waiting period. Maternity coverage includes both pre and post-natal expenses.
    • For Female Employees: If the organization employs female staff members, maternity benefits can also be suggested. Similar to the previous scenario, it offers coverage from day one with the option of a 9-month waiting period, and it covers pre and post-natal expenses.
  • 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 or the head of the group pays an additional premium to get it covered under the policy. Moreover, please note that all companies do exclude external congenital diseases.
  • What is the facility for a health check-up under a group medical insurance policy?

    Certain health insurance plans 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)
    • Active employee data, including employee information.
  • Is it possible to purchase group medical insurance policy for specific employees?

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

    Insurance policies, especially Group Health Insurance (GHI), 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 rates for Group Health Insurance (GHI) policies are determined based on 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 instance, if an employee's age is approximated as 35, but their actual age, determined later by the date of birth, is 36, the age bracket changes, leading to a corresponding change in the premium amount.

  • Can this policy provide coverage for dependents?

    Yes, this policy 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 c overage 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.
  • Is vaccination covered in Group Health Insurance?e?

    Yes, the covered newborns receive vaccinations as part of the Group Health Insurance policy's terms and conditions..

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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
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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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