Group Health Insurance

Health Is Wealth is a very famous saying, and everyone tries different methods to maintain their wellbeing. However, life never follows a fixed pattern and thus, bodily injury or sudden illness can occur to anybody and may leave one both financially and physically stressed. Therefore, it is always good to have a medical insurance policy for such situations.

There are various different types of health insurance policies available in the market and group health insurance is one. A group health insurance plan is used to provide risk coverage to the people who belong to a specific group. Generally, this policy is given by employers to employees.

Group health insurance policies come in different variations and every organization can customize a plan according to the requirements of its employees. There are some group health insurance plans that cover the families of the insured people as well. So, it entirely depends upon the organization what kind of group health insurance plan it selects.

When the group health insurance is provided by the employer, then both employee and employer are supposed to be the beneficiary. This is because; the plan addresses both the parties of a group.

Advantages of Group Health Insurance Policies

Employees are the treasured part of any organization. These days more and more companies are becoming employee-centric and corporate health insurance has emerged as one of the most preferred benefits to lure new talent. It plays a crucial role in influencing the psychology of an employee. It makes him feel part of a company and thus, it curtails employee attrition rate and unrest in labor unions. Moreover, it increases their productivity which increases profitability of a business. Special insurance schemes where families are also covered for benefits make employees faithful towards their employers. Moreover, by offering coverage to your employees, you become eligible to get tax deductions under Income Tax Act. So group health insurance policy is a win-win situation for both employees and employers. The group health insurance policy for employees is advantageous for both employer and employee:

Advantages for Employers:

• Helps in Employee Retention: In this modern era when there are a lot of jobs in all the fields, employee retention has become a difficult task. However, if the employer provides benefits like health insurance coverage to all its employees and his/her families as well, then the chances of an employee staying in the company increase.   
• Tax Benefits: As mentioned above both employer and employees are the beneficiaries in a health insurance plan for the group, thus the employer also gets tax benefits for providing such policies to its employees.
• Motivated Employees: Today, when the medical costs are at its peak, having a health insurance plan, motivates employees.
• Better Benefits in Low Cost: Health insurance for employees provide better benefits in comparatively lesser cost than individual health insurance policy.

Advantages for Employees:

• Pre-Existing Disease is Covered from Day 1: Unlike any individual health plan, a group health insurance policy starts covering pre-existing diseases from the day an employee joins the organization. In this way, there is no waiting period for any pre-existing disease.
• An Extensive Range of Coverage with No Limited on Diseases: Apart from covering pre-existing diseases, a group health insurance plan for employees provides a wider coverage with no limit on diseases.
• Larger Maternity Coverage: A wider maternity cover is one of the best advantages given to young employees. Most of these plans provide coverage for both C-section and normal deliveries. Some plans as well cover the newborn babies without a standard 90 days of maternity cover.

Top Companies Offering Group Mediclaim Insurance Policy in India

In the below grid, find the highlights of the different insurance companies providing group mediclaim policy:

Disclaimer: The ranking of the insurance company is not in any specific order. The data for shown in the above table are for 2017-2018.

Let us discuss the key highlights of the plans offered by the above-mentioned insurance providers:

1. Star Health- MediClassic Insurance Policy 

The key highlights of the policy are: 

• Non-allopathic treatment is covered up to a predefined limit.
• Cover for pre-hospitalization costs that have occurred 30 days before hospitalization and for a predefined point of confinement of time in the event of after hospitalization.
• Cover for day-care procedures.
• Cover for expenses if in case you have been admitted in the hospital for a minimum 24 hrs inclusive room charges, boarding charges, expenses of the specialist, consultation, ambulance, and so forth. 

2. ICICI Lombard- Group Health Insurance Policy 

The key highlights of the policy are: 

• Can be customized relying on the requirements.
• Cover for medical expenses if the individual has been hospitalized for at least 24 hrs.
• Cover for a 30 days pre-hospitalization and 60 days post-hospitalization.
• Cover for 9 major critical illness.
• The plan additionally offers cashless facility at any of the selective accomplice hospitals. 

3. Future Generali- Group Health Insurance 

The key highlights of the policy are: 

• Cover for each treatment-related cost, for instance, blood, diagnostic, dialysis, chemotherapy, surgical appliances, and so forth.
• It provides a completely cashless facility for the employees and hassle-free documentation and bills.
• Cover for every one of the costs acquired from the time an individual is hospitalised it gets discharged, for example, medicine and drugs cost, consultation fees, and so on. 

4. HDFC ERGO- Group Health Insurance Policy 

The key highlights of the policy are: 

• Cover for pre and post-hospitalization expenses.
• Cover for domiciliary hospitalization and day-care expenses.
• Cover for costs identified with a hospitalization brought about by sickness or an unfortunate accident.
• Cover for medical treatment expenses such as diagnostic materials, blood, x-ray, oxygen, and so on. 

5. Reliance Group Mediclaim Insurance Policy 

The key highlights of the policy are: 

• Coverage for pre and post-hospitalization costs for a specified number of days.
• It provides coverage for hospitalization expense, which includes charges for room, operation theatre, fees of a medical practitioner, anaesthetist, nursing expenses, and so on.
• Coverage for expenses related to medicines and drugs, diagnostic expenses, which includes blood, anaesthesia, oxygen, and so on, surgical appliances, radiotherapy, X-rays, dialysis, artificial limbs and organs, consumables, etc.
• Coverage under domiciliary hospitalization wherein the patient is being administered at home due to lack of accommodation in the hospital, the patient is restricted from shifting to the hospital given the medical condition.
• Coverage if in case the patient is hospitalized for more than 24 hours at a stretch.
• Provides value-added benefits such as family floater clause, one-day cover for maternity, pre-existing illness, etc.
• Cashless claims across network hospitals. 

6. Oriental Group Mediclaim Insurance Policy 

The key highlights of the policy are: 

• Cashless treatment across network hospitals.
• The benefit of daily cash allowance depending upon the sum insured.
• Expenses incurred in case of hospitalization for a minimum period of 24 hours.
• Expenses incurred towards domiciliary hospitalization wherein the condition of the patient is such that the patient cannot be moved towards the hospital or when there is no room in the hospital.
• Medical expenses incurred under pre-hospitalization for a period of up to 30 days before the date of admission.
• Medical expenses incurred for a period up to 60 days from the date of discharge from the hospital. 

7. Bajaj Allianz Group Mediclaim Policy 

The key highlights of the policy are: 

• It offers coverage for pre-existing diseases, nursing charges, ambulance charges, charges for operation theatre, organ transplant, dialysis, radiotherapy and so on.
• Coverage against expenses related to day-care procedures.
• Expenses incurred in the process of pre and post-hospitalization.
• The benefit of cashless claim settlement at network hospitals.
• Round-the-clock assistance.
• Quick disbursement of claims with an in-house Health Administration Team.
• Availability of individual and floater cover.
• Tax Benefit under section 80 D of the Income Tax Act. 

8. IFFCO Tokio Group Mediclaim Policy 

The key highlights of the policy are:

• Expenses incurred towards various hospitalization charges are covered.
• Provides coverage for diagnostic expenses, consumables and medicine and drugs.
• Coverage for pre and post-hospitalization costs.
• Coverage for day-care treatment and domiciliary hospitalization.

Features of Group Health Insurance Plans

There are several group health insurance policies available in the market. Listed below are some common features present in all employee health insurance plans.

• Employee health insurance companies typically cover medical benefits for insured (self), spouse, children and dependent parents
• Some health insurance providers cover pre-existing illness and maternity as well
• Employee health insurance offers cashless hospitalization at network hospitals
• Group health insurance can cover ancillary charges such as ambulance costs too.
• Some employee health insurance policies provide fee reimbursements of specialists and other medical practitioners for follow checkups

Why Is Group Health Insurance Required?

Employees are the treasure of any organization and thus the companies provide various facilities to give them a healthy work environment. These days organizations are becoming more employee-centric than before and hence they offer health insurance plans to its employees. Some of the reasons why group health insurance plans are required and beneficial for both employers and employees are:

• Wide Coverage and Better Benefits: Most of the group health insurance plans provide wide coverage and elaborated benefits to the policyholders.
• Option to Get Customize Cover: The health insurance policies for groups give the option to customize coverage. For example, an employer can take a plan that provides maternity cover or OPD coverage.
• Affordable Premiums: Comparing individual health insurance plan with group health insurance in terms of premiums shows groups health plan as affordable. This is because the premiums that one has to pay in respect of coverage that one gets is always higher in group health plans.

Group Health Insurance Inclusions

The common inclusions that most of the group health insurance plans provide to its policyholders are:

• Pre-existing diseases are covered from day one.
• Maternity cover is provided in all the group health insurance plans; however, some has a waiting period of 9 months whereas some do not.
• The infant is covered from the day of his/her delivery.
• Some plans also cover ambulance charges.
• Pre and post-hospitalization expenses.
• Domiciliary and daycare expenses.
• Fees of a medical practitioner and specialists.
• Room rent and nursing charges.
• Anesthesia, oxygen, blood, OT charges, medicines, drugs, and cost of diagnostic such as x-ray, etc.
• Some plans also cover radiotherapy, chemotherapy, pacemaker cost, etc.

Group Health Insurance Exclusions

The common exclusions that all the plans under this category have been:

• Some policies do not cover the parents of the employee.
• Non-allopathic treatments like homeopathy, Ayurveda, etc. are not covered.
• The validity of a health insurance policy for employees is always limited and is valid only until the employee works with the organization.
• Congenital diseases and all the expenses incurred in the treatment of AIDS and other related alignments.
• Alignment or complications arising out of the use or abuse of alcohol or drug. 

How to Claim for Group Health Insurance?

The common steps that most of the health insurance providers follow in order to file a claim are:

• Contact the health insurance provider in order to file a claim as soon as possible by calling the toll-free number.
• The customer care representative guides on the claim process and all the documents required.
• An insured can download the claim form from the website of the insurance provider or can ask for the same to the customer care representative of the company.
• Duly fill and sign the claim form.
• Attach all the required documents with the form.
• Send the claim form with all the documents to the specific address of the insurance provider.

Note: The policyholder is suggested to keep the copy of all the documents and claim form with him/her.  

Documents Required for Making a Claim

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:

• Duly filled claim form with the sign of concerned doctor or hospital.
• Final investigation report.
• Doctor’s prescription.
• Medical reports.
• Final bill with the breakup.
• In case of accident, police report.
• Cash memos and itemized bills.
• Discharge summary with a suggested line of treatment.
• Any other document required by the health insurance provider.

Note: The policyholder has to submit the original copies of all the documents.

Buy Group Health Insurance Policy at PolicyBazaar

Group health insurance is a medical insurance that covers a group of people, who are usually the members of societies, employees of a common company, or professionals in a common group. Group health insurance helps companies identify and mitigate the risks faced by their employees. Rising costs of healthcare have made it necessary for every employer to cover their employees and their families from financial instability that may arise in case of hospitalization. Also, group health insurance helps companies in attracting talented staff. Whether you are a small group or a company, you can easily retain best talent in the industry by offering comprehensive health insurance coverage.

Almost all health insurance companies offer flexible covers at affordable premium rates, which depend on conglomeration of factors, like size of the group, profile of members, etc.  It works under certain terms & conditions, which are applicable to all insured members.

At PolicyBazaar, we strive to use highly innovative approach to help you in comparing best health plans. Compare and choose the right health plan, which provides coverage to all members in a single policy.

Want a Healthy Workforce? We can Help!

It is no secret that employees’ value benefits of group health insurance. However, as premium costs escalate and claim procedure being stringent; employee health insurance has become a tight rope walk in India. We at PolicyBazaar introduce a wide gamut of group health insurance policy products to help you in choosing best corporate insurance plans that will suit both parties i.e. employers and employees. Blending the entire service right from expert advisory, purchase assistance and policy renewal in one package, PolicyBazaar works towards making insurance process easy and convenient.