Understanding the Graded Cover in Group Health Insurance

The insurance premium is generally linked to the cost-to-company (CTC) of an employee. It is paid by the employer on the basis of the salaries of the employee. The graded cover in group health insurance offers several sums assured to different employees. The benefits of such insurance are based on the group grades.

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Graded Cover in Group Health Insurance

Many employees do not pay any heed to the graded cover in group health insurance. Insurance companies offer different benefits to employees based on their criteria. Therefore, the employees must understand the eligibility criteria for high coverage. Further, they must verify or check if the eligibility criteria are correctly applied.

Let us discuss the graded cover in group health insurance on the following basis.

  1. Designation

    The insurance benefits are generally differentiated based on the designation of the employee. The criteria of designation are applied for health, accident and life insurance policies. Therefore, the sum is assured based on the designation level. Further, the designation is categorised into three or four groups. The sum assured is determined for each group.

    Example

    • The employees working on the field level or low level can be offered health insurance or the sum assured of INR 3 lakh. Therefore, during the medical expenses, INR 3 lakh shall be reimbursed to such employees.
    • The graded cover in group health insurance for the middle or supervisory level of employees can be determined as INR 5 lakh. Therefore, an amount of up to INR 5 lakh shall be reimbursed to the employees in case of a medical emergency.
    • The employees placed on the top level of management are entitled to higher sum assured. So, they may obtain a sum assured of INR 10 lakh. Therefore, such employees shall be paid up to INR 10 lakh during a medical emergency.
  2. Salary

    The insurance benefits can also be based on the salaries of employees. The CTC of the employees has a crucial role to play in order to determine the group insurance benefits.

    It is common to link the salaries of employees to insurance coverage. The insurer may make it obligatory to offer coverage that should not exceed 10 times the salary or CTC of employees.

    Example

    • An employee earning INR 2 lakhs per annum can be assured of coverage of up to INR 5 lakh in case of a medical emergency.
    • In addition, an employee with a CTC of INR 10 lakh can be guaranteed medical coverage of up to INR 15 lakh for medical expenses.

    The employees must contact HR to verify if the sum assured is updated upon an increment in the salary. The nominee may find difficulties while claiming the appropriate coverage if the salary is not updated to the coverage.

  3. Family Size

    The family size is another option to differentiate the benefits of a group health insurance policy. It is generally applicable in healthcare insurance when the family has also been added to the group health insurance scheme.

    Example

    • A company may provide INR 2 lakh health coverage to an unmarried employee.
    • Further, the company may offer INR 5 lakh healthcare coverage to a married employee but no child.
    • Furthermore, the company may offer coverage of INR 10 lakh to a married employee with two children.

Conclusion

The employee must keep his current designation, CTC and family status updated to the group insurance coverage. In addition, the employee must understand the basic of the sum assured to comprehend the coverage.

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Written By: PolicyBazaar - Updated: 19 April 2023

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Policybazaar for Business - Group Health Insurance - Customer Reviews
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4.4/5
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Based on 189 reviews
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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