Group Health Insurance: Advantages, Features, and More

Group Health Insurance - BimaBandhu

Health insurance is the need of the hour for every individual across the globe. Given the rising uncertainties related to our health and the occurrence of a pandemic, we all need financial protection for medical emergencies. While health insurance policies are readily available online, selecting the right one requires you to gain in-depth knowledge of different types of health insurance plans. Here, we will cover the details of group health insurance to help you understand if it is meant for you.

What is Group Health Insurance?

A group health insurance policy provides insurance coverage to a group of people, such as the members or employees of an organization. It is also known as corporate health insurance and provides coverage in the form of critical illness cover, accidental hospitalization, Covid insurance, etc. 

Mostly, companies or organizations buy group health insurance plans to provide medical health benefits to their employees as an employment perk. Here, the employer pays the premium for the group health insurance policy.

What are the Advantages of Group Medical Insurance Policies?

Corporate health insurance is considered a way for companies to attract and retain talented professionals. It mostly forms a part of the employee-centric benefits and helps their employees feel like being a part of the company. It also increases productivity at work by ensuring the employees that their health is the employer’s responsibility. 

Several group health insurance schemes also cover the employees’ families as an additional advantage. Hence, you, as an employer, can become eligible for tax benefits under the Income Tax Act by covering your employees under a group health insurance policy.

Benefits for Employers

  • Helps in managing employee retention
  • Motivates employees to work with high productivity
  • Ensure mental well-being of employees
  • Tax benefits for providing health insurance for the group of employees

Benefits for Employees

  • Coverage for pre-existing diseases from Day 1
  • Coverage for a wide range of diseases as specified in the chosen plan
  • Wider maternity cover for younger employees

What are the Key Features of Group Health Insurance?

While there are so many group health insurance policies available in the market, all of them have some common features, including:

    • Medical insurance benefits for the insured (employee), spouse, parents, and children
    • Pre-existing disease and maternity coverage*
    • Cashless hospitalization at network hospitals
    • Ancillary benefits such as ambulance cover etc.
    • Accidental or illness-related hospitalization
    • Critical illness insurance cover

Why Do You Need Group Health Insurance?

As an employer, you want to provide maximum employee-centric benefits for their well-being. With insurance benefits covered under group health insurance, both you and your employees can avail of advantages in the long run.

  • With group health insurance plans, you can get wider coverage and extended benefits for your employees.
  • You can customize the policy as per your preference.
  • Group health insurance is more affordable than buying individual health insurance for each of your employees.

Also Read: All About Individual Health Insurance

How does Group Health Insurance Work?

  • An employer buys a group medical insurance plan to cover his/her employees under one policy and pays the premium for it.
  • Since all the employees will be covered under one plan, the sum insured stays the same for all the covered members.
  • Employees get the option to include their spouse, children, and parents, as allowed by the chosen insurer.

What is Covered under Group Health Plans?

Given below are the common inclusions of group health insurance plans:

  • Pre-existing disease coverage
  • Maternity coverage with an associated waiting period
  • Infant insurance cover
  • Ancillary benefits
  • Domiciliary and daycare expenses
  • Pre- and post hospitalization expenses
  • Room rent
  • Nursing charges, etc.

What is not Covered under a Group Health Insurance Plan?

  • Some plans do not cover the employee’s parents.
  • Most of the non-allopathic treatments are generally not covered.
  • Coverage is given to the employee till the time he is working for the organization.
  • Congenital diseases are not covered.
  • Health issues arising from alcohol or drug abuse are also not covered.
  • Prenatal and postnatal expenses are not covered.
  • Claims filed before the waiting period will not be processed.

How to File a Claim?

The claim-filing steps related to group health insurance plans may vary from one insurer to another. However, the most common steps involved are:

  • Contact your insurance provider as soon as possible.
  • Ask about the claim process and documents required.
  • Get the claim form and submit the duly filled form with all the required documents to the insurer.

It is important that you keep a copy of all the required documents and claim form with yourself.

Documents Required for Claim Filing

  • Duly filled claim form attested by the hospital or concerned doctor
  • Health report
  • Prescription given by the doctor
  • Investigation report
  • Police report for accidental cases
  • Final bills
  • Discharge summary
  • Any other document as asked by the chosen insurer

Who Should Buy Group Insurance Plans?

In general, organizations having 10 or more employees offer these types of insurance plans. However, you can buy them if yours is a:

  • Small company or startup
  • Mid-sized company
  • An established organization with more than 1000 members

For the exact minimum member requirement, ask different health insurance providers in India.

What to Look for While Buying Group Medical Insurance?

  • Premium as compared to its benefits
  • Insurer’s reputation
  • Service quality
  • Geographical coverage
  • Network hospitals

Differences Between Individual Health Insurance and Group Health Insurance

Individual Health Insurance Group Health Insurance
Purchased by each individual  Purchased by the employers or group heads
Individuals can cancel the policy whenever they want. Only the employer has the right to cancel the purchased policy.
It is valid for as long as the premium is paid every year. It is valid as long as the employee is a part of the organization.
Policy premium primarily depends on the insured’s age and health condition. Policy premium depends on the sum insured and other benefits chosen by the employer.
Pre-medical checkups are required. Pre-medical checkups are generally not required.

Why Check BimaBandhu?

Most health insurers offer group medical insurance plans at affordable premiums which depend on various parameters. These include group size, member profile, sum insured selection, etc. At BimaBandhu, we are dedicated to providing detailed information about various aspects related to group health insurance. 

 

Understand how these insurance policies work and their benefits before you buy any of them. That’s why, we say – ‘Insurance Hai Zaruri, Par Sahi Chuno’.

FAQs

What is the purpose of buying group health insurance?

With group health insurance, you (as an employer) can ensure the physical and mental well-being of your employees. You will also benefit in the form of employee retention and tax savings.

Is Coronavirus covered under group insurance plans?

Not every such insurance policy covers Coronavirus. For more details, ask your employer or insurer about the same.

Who is eligible to be covered under group medical insurance?

Individuals who fall under the age bracket of 18-70 years and are employed with an organization are eligible for group health insurance coverage.

Standard health insurance plans have multiple waiting periods for different diseases and reasons. Read more about waiting periods in detail.

Is room rent customizable under group insurance?

It is generally possible to customize the room rent type under a group health insurance policy in terms of a certain percentage of the sum insured or no room rent capping at all.

How to calculate group health insurance premium?

It is calculated based on the number of employees to be covered, their respective age, and the number of dependents.

What are the limitations of group health insurance?

The only limitation is that the coverage provided under a group policy may not be enough for the employees covered in it. 

 

0 Shares:
You May Also Like