Group Health InsuranceGroup Health Insurance
What Is Group Health Insurance?
A group health insurance scheme is an arrangement by a company or a group that provides healthcare to its employees or members and their dependents. According to IRDAI (Insurance Regulatory and Development Authority of India), any organisation or group with more than 20 employees can avail themselves of the services of group medical coverage. However, micro-insurance schemes can be availed of by groups of at least five members.
It functions much like an individual health insurance or family health insurance policy depending on whom the scheme covers, the only exception being that it is paid for by the employer and ceases the moment the employee leaves the employment with the organisation. In other words, an employee, once he quits his job, cannot carry the benefits along with him anymore.
From the perspective of coverage cost, since the risk is shared by the members of the group, the coverage cost is usually cheaper than an individual coverage cost. However, one must remember that there are many differences between group medical insurance schemes in terms of cost, terms and conditions, and coverage type.
Why is Group Health Insurance Required?
The Problem
The formation of a good team is a difficult task; however, the main problem occurs with keeping this team in the company. When an employee quits, there are always many questions about what might have been done to prevent such a situation from happening. Employees usually expect some work-life balance, adequate salary and health insurance, and they usually quit in case of their perception of being underestimated.
The Solution
In order to create an ideal workplace, it is necessary to implement human-oriented policies. It is possible to create an environment based on care, creativity, and acceptance, which will help employees feel like a part of something bigger.
The employer may achieve all these goals by doing several things, including adopting the Group Health Insurance policy for their employees. It will not only protect against unexpected cases but also increase their satisfaction and, therefore, retention rate.
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Who Should Buy Group Health Insurance?
Start-ups
Start-ups are able to take advantage of rapid and reliable coverage choices which are straightforward to implement, efficient and complemented with easy-to-use digital experience, so that offering of employee benefits becomes an easy task.
Small and medium enterprises (SMEs)
SMEs are helped by flexible products which can adapt to the needs of growing businesses while helping to streamline HR processes with dashboards, policy management and the ability to manage employee-level information.
Large corporations
Large corporations are served with well-structured and scalable products for handling big numbers of employees with relationship management, systems integration and consistent service delivery standards.
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Types of Groups Covered in Group Health Insurance
According to IRDAI, “a group under a group health insurance policy” means that members come together to participate in an economic activity other than that of obtaining the benefit of the group health insurance coverage. There are two main types of groups, which are described below:
Employer-Employee Groups
It refers to organizations, including small, medium, and large sized firms, providing health insurance to their employees. The employer has to pay the entire premium amount or just a part of it.
Non-Employer-Employee Groups
It refers to registered groups, such as welfare associations or societies, providing health insurance coverage to its members. This group may also consist of customers of organizations, including banks providing health insurance to credit card holders.
Benefits of Group Health Insurance
Immediate coverage
Health insurance for individuals will definitely have a waiting period, especially when it comes to pre-existing illnesses. Once you purchase an insurance cover, you must wait for some time before making a claim. The waiting period will vary from one insurer to another but usually is between 2 to 4 years. However, when it comes to group health insurance, the coverage is immediate.
More inclusive plan
The Group Health Insurance schemes normally have more disease coverage, even for pre-existing diseases. Also, such schemes normally have fewer exclusions or limitations. There is also no requirement for medical tests to enjoy the benefit of the cover.
Includes family members
Another advantage of Group Medical Insurance is that it enables one to cover their family through such insurance. This is based on the fact that you will be able to add your spouse, dependent parents or in-laws, and dependent children to the insurance depending on the scheme of your employer. You could also confirm with your employer whether you will be allowed to pay extra premiums to cover some of the family members.
Maternity facility
Advantages of Group Health Insurance include maternity benefits if you are a woman intending to have children in the future. The insurance plan also offers you coverage for medical care of the newborn baby for 90 days after delivery.
Hospital cashless benefit
There is an association of most large Group Health Insurance companies in India with hospitals so that you can have a smooth transaction process during bill settlement. Therefore, the bills related to your treatment will be paid straight from these network hospitals to the insurance company, and you do not need to pay anything from your pocket.
OPD treatment
Most Group Medical Insurance schemes provide outpatient treatment benefits where treatment is provided in a hospital or day care centre without admission into the hospital. You should take time to read through the terms and conditions of your policy.
Preventive healthcare and benefits
Group Health Insurance firms also provide insurance schemes that involve preventive healthcare programs for living a healthy life. You can enjoy reduced rates on laboratory tests, OPD consultations, online doctor consultations, comprehensive body check-ups at your home, mental illness schemes, personalised meditation, dental costs, and more such benefits.
What does Group Health Insurance Cover
Inpatient Hospitalization
Charges relating to room rent, ICU costs, doctor's fee, etc. for all kinds of hospitalisation up to the Sum Insured are covered.
30 Days Before & 60 Days After Hospitalisation
Cover for expenditure incurred due to consultation, investigations, or medicines from 30 days before entering into hospital until 60 days after leaving the hospital.
No Waiting Period
There is no need for a waiting period, unlike general insurance policies for the Group Health Insurance policy.
Pre Existing Diseases
Charges incurred by you in the treatment of pre-existing diseases will be covered.
Advantage Medical Treatment
Coverage for treatments such as robotic surgery will be provided.
Room Rent
The cost of room rent will be covered up to 1% of the Sum Insured per day.
Maternity Benefit
Maternity benefit of up to INR 50,000 for both normal delivery & C-section with no waiting period.
Baby's Cover
Cover for newborn baby from day one*.
Ambulance Charges
Ambulance charges will be covered.
Corporate Buffer
Corporate buffer is available as per the requirements of the employee.
How does the Claim Process Work
Step 1: Inform the insurance company regarding the medical treatment or hospitalization in the stipulated period of time.
Step 2: Get the claim form from the insurance company either by downloading from the company’s website or taking the same from the customer service of the company.
Step 3: Fill the claim form with all the necessary details of the policyholder, the details of the treatment, and the details of the medical provider.
Step 4: Collect all the documents which are required as per the instructions of the insurance company, like medical bills, invoices, medical reports, prescriptions, and diagnostic reports.
Step 5: Submit the claim form along with the supporting documents to the insurance company either offline or online through email/claim portal.
What Are The Eligibility Norms For Purchasing
Group Health Insurance?
- Multinational corporation or large business organisation
- Small and medium businesses (SME)
- Non-profit organisation or charitable institution
- Government organisations or PSUs
- Institutions like school, college, or universities
- Professional bodies or trade unions
- Co-operative societies or community groups
- Start-ups or entrepreneurial ventures
- Religious institutions or hospitals
What Documents Will An Employee Need To Make A Claim?
As an employee, you need to remember certain documents which are necessary to produce while claiming the benefit under the Group Health Insurance Policy. You need to produce original documents. It is important for you to keep at least three copies of all the documents, since you need to produce the original documents to the insurance company. You need to keep your spare copies of the documents if you want to claim again using your individual policy as well.
Claim form
You have to fill and sign the claim form issued by the insurance company.
Health Insurance ID Card
Your health insurance ID card or policy document issued by the insurance company.
Medical bills and Invoices
You have to save your original bills and invoices from the hospital. You will need these documents when you submit the claim form.
Medical reports and prescriptions
You need to save your medical reports, discharge summary and prescriptions from the treating doctor.
Diagnosis reports
You need to save your original reports of the tests conducted during your treatment.
Medicines and Pharmacy bills
You need to save your original medicines and pharmacy bill receipts.
FAQ's
Who pays the premium in a group health plan?
The premium for a group health plan is either paid entirely by the company or split between the employer and the employee.
Which is better, individual or group health insurance?
None of them can be called better in any case, since group health insurance is more effective in terms of affordability and covering pre-existing conditions immediately, whereas individual health insurance provides more freedom and personalisation.
What are the benefits of group insurance?
Group insurance offers cheaper premiums and simpler enrolment than individual plans by providing health, life, or accident coverage to numerous individuals under a single master policy.
Who is covered in a group health insurance policy?
Group health insurance coverage generally covers the active employees or members of a given organisation, firm, or association.
What is the difference between group and individual insurance?
The fundamental distinction is that group insurance is supplied through an employer or organisation, whereas individual insurance is purchased directly by you from a private insurer or government marketplace.