Group health insurance, also referred to as corporate health insurance, extends coverage to a designated group of individuals, such as employees within a company or members of an organization. Corporate insurance policy covers pre-hospitalisation expenses (relevant medical expenses incurred within 30 days before hospitalisation) post-hospitalization expenses (relevant medical expenses incurred within 60 days after leaving hospital), pre-existing diseases, etc.
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Group health insurance policies are designed to provide coverage for a specific group of individuals, commonly offered as an employment benefit. Employers typically extend this benefit to their employees, who may also have the option to include their family members, such as spouses, parents, children, or parents-in-law, under the same policy. The comprehensiveness and cost-effectiveness of these insurance plans may vary depending on the specific coverage and plan selected by the employer.
One significant advantage of group medical insurance plans is their immediate coverage of pre-existing medical conditions, without imposing any waiting periods. These group medical insurance plans also encompass a wide range of medical necessities, including treatment for common illnesses, maternity benefits, daycare services, and protection against personal accidents, among other valuable benefits.
In contrast to individual health insurance policies, which often mandate non-negotiable waiting periods and can be associated with high premium costs, corporate health insurance is considered an essential and valuable benefit rather than merely a nice-to-have perk.
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Group Health Insurance Benefits for Employers:
Here are a few group health insurance benefits for employers:
Talent Attraction and Retention: Demonstrating care for employees through health insurance enhances their view of your organization, reducing turnover.
Value and Tax Benefits: Employee health insurance not only boosts satisfaction but also offers cost-effective advantages and potential tax benefits.
Enhanced Focus and Satisfaction: Offering comprehensive benefits motivates employees, resulting in higher job satisfaction and productivity.
Here are a few group health insurance benefits for employees:
Easy Claims: Group mediclaim insurance policy for employees streamlines claims, making it hassle-free process. (Condition: If employee visits a network hospital then the employee can get cashless claim settlement and if the employee does not visit the network hospital then the employee will have to make the payment for the treatment done and get reimbursed for it with the specified days by the insurance company).
Family Coverage: Group mediclaim insurance policy for employees can include family members at no cost, boosting company goodwill. This depends on the company providing group health insurance whether they want to provide coverage to the dependents of the employee such as spouse, kids, parents as well as in laws.
Disclaimer: to learn about the benefits provided under the group health insurance, contact the HR department of your company or refer to the policy documents because the benefits provided by the insurance company varies from one insurer to another.
Disclaimer: *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 group mediclaim insurance policy for employees:
Ancillary Expenses: Group health insurance for employees extends coverage to ancillary costs, including ambulance expenses.
No Medical Screening: Corporate group health insurance plans offer enrollment without the need for medical screenings.
Cost-Effective Protection: Group health insurance for employees offers a more economical alternative compared to individual health policies.
Cashless Treatment: Insured individuals can access treatment at network hospitals without upfront payments, reducing financial stress.
Pre and Post-Hospitalization Coverage: Group health insurance for employees includes medical expenses before and after hospitalization, offering comprehensive support.
Added Health Benefits: Employers can provide extra benefits like OPD consultations, regular check-ups, and mental wellness support to promote proactive employee well-being.
Why is Group Health Insurance Required?
Let us give you a logical explanation of why group health insurance is purchased by the employer for their employees:
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 centered 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.
Group Health Insurance: Inclusions & Exclusions
Here are the common coverage provided under a corporate insurance policy:
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: Reimbursement for medical expenses incurred before and after hospitalization, such as diagnostic tests and follow-up treatments.
Daycare Procedures: Coverage for medical procedures or surgeries that do not require overnight hospital stays is provided under a corporate insurance policy.
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.
Common exclusions under group health insurance policies in India often include:
Waiting Period for Specific Treatments: Some policies have waiting periods for specific treatments or procedures, such as maternity coverage or certain surgeries.
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 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.
Optional Coverage Extensions
Here are some of the extended coverage provided under the company insurance for employees:
Maternity Coverage with Expense Cap: Maternity coverage that includes a cap on expenses during childbirth under a group health insurance policy for employees.
Waiver of Maternity Waiting Period: The option to waive the standard 9-month waiting period for maternity coverage under medical insurance for employees.
Coverage for Newborns within Maternity Limit: Inclusion of newborn babies under the maternity coverage limit under medical insurance for employees.
Outpatient (OPD) Coverage: Comprehensive coverage for outpatient medical expenses under medical insurance for employees.
Corporate Buffer: Additional coverage or protection provided by the corporate policy in case the existing sum insured is exhausted. However, the employee has to pay an additional premium under medical insurance for employees.
Eligibility Criteria to Purchase Group Health Insurance
A company with a minimum number of 7 people that can include the dependents of the employees is eligible to purchase a group health insurance policy. There are group health insurance plans that can be bought if the company does not even have 7 employees working under it.
Case Scenario: XYZ Startup, a small tech company, recently expanded its team to include five full-time employees. Realizing the importance of employee benefits, they wanted to get health insurance. Initially, with only five employees, they didn't qualify for a group health insurance plan.
However, some insurance companies offered group health insurance plans to XYZ Startup if they added just two more people, and they could also include employee dependents. Eventually, the company chose to include the dependents of all five employees, meeting the eligibility criteria to purchase the group health insurance for their employees.
How to Claim for Group Health Insurance?
Follow the steps below to get a cashless claim under group health insurance.
Step 1: First of all, the employee needs to check with the Policybazaar claim handler about the network hospital.
Step 2: Once the employee gets to know about a nearby network hospital, The employee needs to carry the health card provided by the insurance company. Otherwise, he will not be entertained by anyone in the hospital.
Step 3: The employee will have to fill up the claim form provided by the hospital.
Step 4: Then the employee gets the approval within 2-3 hours.
Step 5: After this, the employee can be admitted and get the treatment done.
Step 6: When the doctor allows the patient to get discharged, the final approval for claim settlement is done between the hospital and the group health third-party administrator.
Follow the steps below for a reimbursement claim under the group health insurance plan.
Inform the insurer within 24 hours of hospitalization.
Submit the claim form and all required documents within 7-15 days of the discharge.
Collect all the original hard copies of bills, reports and discharge summaries.
The insurer will process the claim after checking the terms and conditions of the policy.
Provide a cancelled cheque for bank details to transfer the amount.
The insurer will process the claim within 15 days of providing all the details which are subject to the insurer's terms and conditions.
Note: The policyholder is suggested to keep a copy of all the documents and claim form 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:
A fully completed and signed claim form in its original form. There are two parts of the form. Part "A" should be filled out by the employee, and Part "B" by the hospital. Both sections are mandatory.
Original bills and receipts issued by the hospital. (Mandatory)
Original bills from the pharmacy or chemists. (Mandatory)
Original pathological, diagnostic test reports, radiology reports, and corresponding payment receipts. (Mandatory)
The final bill should include a detailed breakup (List of specific expenses such as consultation fees, costs associated with medical procedures, etc.). (Mandatory)
The payment receipt for the final bill. (Mandatory)
A discharge summary from the hospital. (Mandatory)
An ID proof and a photo of the patient. (A photocopy is required)
A scan report, if applicable.
The sticker, if any, in the case of an implant. (Mandatory)
A separate invoice for lenses or a hospital clarification with lens details and patient information if lenses were purchased in bulk quantity. (Mandatory)
Note: The policyholder has to submit the original copies of all the 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: Buyers can receive competitive quotes from various insurance companies, enabling them to select the most suitable option for their 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 a swift resolution.
Renewal: Policybazaar facilitates the renewal process, making it convenient for policyholders to continue their coverage seamlessly.
All employees who are more than 18 years old and below 70 years 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, spouse and sometimes even parents.
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.
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.
Room rent capping in employee health insurance (Group Mediclaim) 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.
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.
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.
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.
It is a standard exclusion for most insurers. Again, this exclusion can be waived and get it covered in the group medical insurance policy. Do note that all companies do exclude external congenital diseases.
Some health insurance plans pay for the expenses of general health check-ups at least once in some years. Generally, this facility is available once every four years and is provided as a value-added service for corporate customers.
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.
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, I can offer you the most suitable and competitive quote.
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.
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 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.
If the policyholder chooses a room with a tariff higher than the limit specified in the policy, there will be a proportional deduction in the claim amount. In other words, the policyholder will need to pay the difference between the opted room's cost and the permissible limit.
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.
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Disclaimers+
+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 "Next" 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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