A list of the medical expenses that are covered by group health insurance

A group mediclaim policy offers multiple benefits to the employer and the employee. It not only provides the workforce and their families with adequate financial stability but also makes them feel valued. The basic plan and sum insured offered are the same for all the employees irrespective of their designation, age, and health conditions. However, employees may have options to add extra dependents, or benefits in exchange for a higher premium payment. An employee must go through the list of medical expenses covered by group health insurance provided by his employer.

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List of Medical Expenses Covered under Group Health Insurance:

Let us have a look at the list of medical expenses typically covered under group health insurance:

  1. Admission Room Rent and Nursing expenses:

    A group Mediclaim policy covers nursing costs and room rent expenditures paid as part of a hospital stay. The cost of the room rent is typically covered by the insurer up to a percentage of the insured amount.

  2. Inpatient care cost:

    An inpatient hospitalisation occurs when a patient is admitted and receives care for a period longer than 24 hours. To claim group health insurance, the employee must be hospitalised and received treatment for more than 24 hours.

  3. Pre-hospitalisation costs and post-hospitalisation costs:

    The pre-hospitalisation costs include those expenses incurred prior to getting admitted to a hospital, whereas the post-hospitalisation costs include those expenses incurred after one gets discharged from the hospitalization. The costs associated with this category are covered for up to a period of 30 and 60 days, respectively.

  4. Surgical costs:

    The group mediclaim policy coverage will cover any costs associated with having surgery performed as a result of an illness or disease. The amount of coverage covered under this category depends on various factors like your pre-hospitalisation and post-hospitalisation expenses, deductibles, etc.

  5. ICU Fees:

    ICU rents just like room rents are covered but capped at a certain percentage of the sum insured. It is important to know about these limits before an employee raises a claim.

  6. Ambulance costs:

    The group mediclaim policy covers the costs associated with using emergency ambulance services. Up to a specific amount, the group health insurance policy will cover the cost of the ambulance service.

  7. Ayush treatment costs:

    Many group health insurance plans cover the costs of alternative therapies including Ayurveda (Ayurvedic treatment), Yogas, Unani, Siddha, and homoepathy (Homeopathic), which are together referred to as "Ayush." For the costs to be reimbursed, the Ayush therapy must be received in a hospital that is recognized by the government.

  8. Medical-Checkup expenses:

    Group health mediclaim policy covers the medical check-up costs associated with doctor visits.

Case:

Vikas an employee of XYZ company covered under the group mediclaim policy provided by his employer. He suffered a cardiac stroke due to which he was hospitalized for 10 days. As he was covered under his employer’s group health plan, hospitalization expenses, nursing charges, and other medical costs were covered by the plan. Since he suffered a stroke at his home, ambulance charges were also covered. Thanks to the employer-funded group health plan, Vikas and his family did not bear the financial cost due to this medical emergency.

Conclusion:

The above article emphasizes on the list of medical expenses covered in the group mediclaim policy, so that employees are more aware of their group medical policy. Additionally, every employee must go through the terms and conditions, inclusions and exclusions of the plan. Employers should also make sure they offer a comprehensive and need-based insurance plan that proves beneficial for the employees.

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Written By: PolicyBazaar - Updated: 12 January 2023

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