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Group Health Insurance: Plans, Policy and Benefits

Group health insurance plans give health expense coverage to a group of members. This group is generally the employees of a company. A group health insurance is bought by a company and offered to their employees. It is one of the most sought-after ways of covering health expenses. Group health insurances are much cheaper than personal insurance and cover many expenses as well.

What is Group Health Insurance?

A group health insurance or a group medical cover is a type of health insurance that covers a group of people. This group is usually the members of a professional association or corporate company employees. The group health insurance covers the medical and health expenses of the employees and sometimes their family members too. The employers pay the premium for a group health insurance policy.

How to define a Group?

As per the Insurance Regulatory and Development Authority (IRDAI), a group is defined as the coming together of individuals for a common economic goal and not for the primary purpose of availing the group health insurance policy.

The groups are also categorized into two:

1. Non-employer and non-employee group

This includes members from welfare organizations, credit card holders for a particular company, or even customers of a specific service or product where insurance is an add-on benefit.

2. The employer-employee group

This is the type of group that everyone is familiar with. This is a group of employees working for a registered organization.

Features of Group Health Insurance Policy

1. Thorough Coverage

A group health insurance policy covers medical expenses, the cost of specialists/ surgeons, hospitalization charges, and dialysis and X-ray costs.

2. Offers a cover for the family

A group health insurance covers the medical expenses of the spouse or dependents of the employees in most cases. Some companies even offer specialized plans for family cover that could be opted for an additional cost.

3. Cashless settlement

One of the key features of an insurance policy is that it frees you from the hassle of settling the bill at the counter after hospitalization.

4. Flexible terms

The group insurance plan comes with many options. It allows a lot of flexibility; thus, the employee and the employer can choose a plan that works best for them.

5. Additional benefits

With group health insurance, you can avail of discounts on various services from medical organizations. Apart from discounts and offers, some plans can offer maternity leaves and cover pre-existing ailments.

Advantages of Group Health Insurance Policy

For any business, its people are the most treasured assets. We have seen great people in the industry preach about how important it is to take care of the employees in any organization. Employers are now becoming more and more considerate of their employees. Taking care of them, making them feel safe, and rewarding them have become integral to the overall policies. With the Covid Pandemic, this became more clear than ever that safeguarding health is irreplaceable.

Not just for the employees, a group health insurance policy bears many benefits for the employers.

Benefits of Group Health Insurance Policy for Employers

1. A Happy Employee

In this day and age, the employment arena is booming with talented people. While the employees bring their best to the table, it is equally essential for employers to put their best foot forward to grab promising talents and also retain them for the long run. To do so, providing additional benefits is mandatory. A group health policy is one such thing that can tempt an employee to stay with the company for a longer run.

Since the medical expenses are at an all-time high, it is nice to assure your employees of providing for them and their families in time of need. Moreover, the added benefit keeps them motivated and loyal to the company, which any employer would want.

2. Tax Benefits

As employers buy any group health insurance plans, they can show certain tax rebates for themselves and their employees.

3. Earn more benefits at a low cost

Individual health insurance plans cost a bomb. Group health insurance plans give an upper hand to employers. They can bargain the overall premium costs and the cost to companies they bear for the employees.

Benefits of Group Health Insurance Policy for Employees

1. Lower premiums, greater benefits

With a group health insurance policy that the employers provide, the company pays a large sum of premiums. The amount left to be paid by the employees is much less than an individual health insurance plan. The benefits and covers are also more than an individual plan at such a cost. Hence, it is a win-win situation for both.

2. Coverage from Day 1

A group health insurance policy starts covering up for your ailments from the day you join the company and become a part of this policy. Unlike individual health insurance plans, employees do not have to wait for lengthy procedures and waiting periods to get these covered.

3. Maternity Coverage and extra benefits

One of the significant advantages of a group health policy is its comprehensive coverage of a broader spectrum of diseases. Some policies even cover maternity expenses for female employees.

4. Financial security during tough times

We can never be ready for tough times, but being protected during one is the most helpful thing. When the world saw the pandemic crisis in the past years, a group health policy offered by the companies was a great relief to the employees. Being under the protection of a health protection plan proved to be an essential thing during that period.

Read more: Best Health Insurance Plans in India

Best Group Health Insurance Plans in India

Some of the best health insurance plans are described ahead.

1. Star Health Insurance

This company is one of India’s oldest and most reliable insurance companies.

Some key benefits of its policies are given below:

  • Emergency ambulance coverage
  • Hospitalization expense cover
  • The expense of surgeons, medical tests and diagnosis, consultants, etc., is also covered.

2. Future Generali

The services provided by Future Generali makes it one of the best group health insurance policy. In addition, it has a comprehensive coverage plan, making it an excellent choice.

Some of the key aspects are given below:

  • This group health insurance policy covers all the expenses from entry to the hospital until discharge. It covers the expenses of medicines, room, diagnosis, and more.
  • The expenses for specialists, surgeons, and consultants are also covered in this policy.
  • The check-out is also completely cashless, saving any employee from bill settlement or documentation hassle.

3. HDFC ERGO

The policy covers the following expenses:

  • Pre and post-hospitalization charges.
  • It covers hospitalization caused by sickness and accidents along with the related charges.
  • Charges of diagnosis, dialysis, blood, operation charges, etc.

4. ICICI Lombard

It is also one of the most sought-after and best groups health insurance policies.

The charges it covers are mentioned below:

  • It covers more extended periods of pre and post-hospitalization charges
  • It covers hospitalization charges when admitted for a minimum of 24 hours.
  • You can customize the plan as per the requirements.
  • It also covers some major illnesses.

5. New India Insurance Health Insurance

New India Assurance is an Indian Government-owned company and plays an important role in the country’s insurance sector. It was founded by Dorabji Tata in 1919 and has been a leader in the market since. The New India Assurance Group Mediclaim policy covers the insured of illness, injuries, and accidents for the insurance tenure.

Some key benefits of its policies are given below:

  • It covers all the necessary expenses during the hospitalization of the insured.
  • It covers the expenses of any daycare or surgical procedures.
  • Coverage for pre-existing illnesses can be claimed after four years of using the policy.
  • You can claim the reimbursement as per the policies of the particular location.

6. Care Group Health Insurance

The company has robust distribution channels making it one of the most prominent names in the market.

Some key benefits of its policies are given below:

  • This policy covers more than 540 treatment procedures.
  • The insured can raise the claim for the sum insured in case of hospitalization.
  • 2% of the sum insured can also be used for ICU claims.

7. Aditya Birla Group Health Insurance

This health insurance caters to the retail and corporate group health insurance sector.

Some key benefits of its policies are given below:

  • It covers 586 Daycare procedures.
  • You can avail of additional benefits like coma coverage by modifying the policy.
  • Policyholders can earn a bonus for a claim-free year.
  • Ambulance cover and personal accident cover are also included.

8. Niva Bupa Group Health Insurance

Some key features of this policy are:

  • The policy covers hospitalization expenses for diseases, infections, or accidents.
  • It covers pre and post-hospitalization expenses up to a certain number of days.
  • You can have cashless settlements at the network hospitals.
  • The policy allows the addition of the employee’s spouse and three children under 25. You can also add other dependents under this cover.

9. SBI General Group health Insurance

SBI is backed by top names in the industry and has a good hold in the market.

Some of the key features include:

  • Standard hospitalization charges can be covered, including the room rent, nursing charges, etc.
  • It covers pre-hospitalization charges of up to 60 days and post-hospitalization expenses for up to 90 days.
  • The policy covers daycare treatments also.
  • It includes preventive health check-ups that the insured can avail of once yearly.

10. Bajaj Allianz health insurance

The key features of this policy are:

  • Covers daycare expenses.
  • Maternity benefits are included as per the policy and the defined coverage amount.
  • Covers pre and post-treatment expenses like X-rays, blood tests, etc.

How does a Group Health Insurance Plan Work?

Any registered organization having ten members or more can easily buy a group health insurance policy for its employees. After checking with various insurance providers, they can choose any group health insurance policy most suited for them. The company pays the plan’s premium on behalf of its employees most of the time. Since the premium and the policy are the same, all the employees are protected under the same basic plan.

However, if any employee wants to avail of additional benefits like the inclusion of family members or more coverage, they can do so by paying an additional premium.

How to choose the Best Group Health Insurance Plan?

Employers buy a group health insurance plan, and they must choose the best option available to them.

Here are a few pointers on considering while buying a group health insurance plan.

1. Practical Coverage

The primary purpose of group health insurance plans is to provide healthcare benefits to the employees. It will only be sensible that the plan covers aspects valuable to the employee. Hence, while buying a group health insurance plan, the employers must be careful about the covers and benefits of a particular policy and then choose the one that makes the most sense. For example, it should be mandatory for group health insurance plans to cover Covid-19 in current scenarios.

2. Effective service

During a crisis, dealing with bad service or delayed response is the last thing anyone would want to experience. To avoid such things from happening, the employer must ensure that the service provided by the group health insurance providers is top-notch. Accessible communication and instant response should be the priority.

3. Right Premiums

In the end, the plan you would have will depend on the premium you choose to pay for the group health insurance policy. The employers must be careful that the premium paid correlates with the services provided. But one must also take good care of the quality of insurance chosen to avoid a useless policy for saving some money.

4. Geographical Coverage

An ideal group health insurance policy must have accurate geographical coverage. In other words, it should partner with hospitals in different areas. The requirement for healthcare could come anywhere. Hence it is imperative to check the network of hospitals that any policy will cover.

5. Exclusions

There are many things that group health insurance plans cover, but there are a few things that it doesn’t provide. Being transparent and communicating this to the employees is essential to avoid confusion later.

6. Claim Settlement Ratio

This is crucial to judging a policy provider as reliable. The claim settlement ratio will reflect their ability to settle the claims compared to the claims raised. Therefore opting for a company with a high claim settlement ratio will ensure that you have one of the best group health insurance providers.

Group Health Insurance Plans for Employees with Families

The table below displays the details of different Health Insurance Plans for employees with their families. There are seven different companies from which you can choose your plan.

S. no. Group Health Insurance Name No. of lives covered Sum Insured Premium/ Life
1 Go Digit 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 130 per month
2 Edelweiss Health Insurance 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 199 per month
3 National Insurance 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 155 per month
4 Bajaj Allianz 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 140 per month
5 Raheja QBE General insurance company 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 159 per month
6 Care Health Insurance 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 140 per month
7 Niva Bupa 15 (7 employees, 6 spouses, 2 kids) INR 1 Lakh INR 492 per month

Group Health Insurance Plans for Employees only

The following table shows the different types of health insurance for employees who are single or who are to be given individual coverage.

S.no. Group Health Insurance Name No. of lives covered Sum Insured Premium/ Life
1 Go Digit 25 INR 1 Lakh INR 130 per month
2 National Insurance 25 INR 1 Lakh INR 156 per month
3 Care Health Insurance 25 INR 1 Lakh INR 134 per month

What is Not Covered in Group Health Insurance Plans?

Some common things are not covered in even the best group health insurance plans. They are:

  • The policy is valid only until the employee works for the company.
  • Some policies do not extend their medical benefits to the employees’ families and spouses.
  • Maternity benefits are not included by default in any group health insurance plan.
  • Injury or illness from war is not covered.
  • Complications coming from the abuse of alcohol or drug are not covered.
  • Non-allopathic treatments such as homeopathy and Ayurveda are not considered.
  • Congenital disease and its expenses are not covered.
  • Pre-existing diseases which are not informed about are not covered in group health insurance.
  • Since it is a master policy that covers all employees of an organization, it offers the same benefits and coverage to all employees. Hence a group health insurance policy comes with limitations.

How to Claim for Group Health Insurance Policy?

There are some common ways to raise a claim from most group health insurance plans. The steps are given below:

  • You must search for the network hospitals covered under your group health insurance policy to have a cashless claim or reimbursement claim.
  • Contact and inform the insurer well in advance. In case of an emergency, you can have the bills reimbursed later.
  • Get details on how to follow the procedure from the customer care executive of the insurer company.
  • Ensure to carry all the necessary documents and cards to the hospital to make the process smoother.
  • Duly fill out all the documents and forms.
  • Attach all the required files with the form.
  • The insurer might take some time after receiving the request. The status of confirmation can be checked online.
  • After all the formalities are met, the claim will be settled as per the terms and conditions.

Note: The policyholder should submit all the original documents with their group health insurance provider and keep a copy with themselves.

Group Health Insurance – FAQs

Q.1 Why are group health insurance plans essential?

Ans. Group health insurance plans are essential as they give medical expense protection to the employees and their families. With this assurance, an employee becomes more loyal, and the employer can build a better employer brand.

Choosing the best group health insurance plans for the employees makes them more motivated and dedicated to work. Moreover, knowing that their health and medical benefits will be covered in an emergency is a relief.

Q.2 How to ensure that you have the best group health insurance?

Ans. It is not in the hands of an employee to choose any group health insurance plan for themselves; the employers must do this. Before deciding, an employer must look out for meaningful coverage, network hospitals, good service, and reasonable premiums. All this ensures finalizing the best group health insurance policy for the well-being of the employees.

Apart from the standard plan, which brings all the employees under one umbrella, any employee could choose a plan that he thinks would be the best group health insurance plan for him. This could be done by paying an additional premium.

Q.3 How do group health insurance plans affect the tax payings of any employee?

Ans. The premium paid towards health insurance is eligible for tax exemption under section 80D of the Income Tax Act. However, only employers are eligible for this exemption. The employee can only have the benefits stated in the contract and not other than that.

But suppose an employee also pays their group health insurance policy premium. In that case, they can also ask for a tax rebate.

Q.4 How do group health insurance plans differ from individual ones?

Ans. There are a lot of differences between group health insurance plans and individual plans.

  • The group health insurance policy covers a limited number of expenses and is the same for everyone in the company. In an individual health insurance plan, the plan can be tailor-made as per the requirement of an individual, and the covers are also extensive.
  • Pre-medical tests are not conducted while getting a group health insurance policy, but individual policy cases differ. They conduct a series of medical tests before issuing any health insurance policy.
  • The group health insurance policy is valid till the employee is a part of that organization. The individual health insurance policy is only valid till the individual pays his premium.
  • A group health insurance policy depends on the strength of any organization, finances, and number count. An individual health insurance policy depends on an individual’s age, medical history, etc.

Q.5 Can an individual have both a group health insurance policy and personal health insurance?

Ans. Absolutely. One can choose to have a personal health insurance policy and corporate group health insurance plans.

Q.6. Is maternity cover included in group health insurance plans?

Ans. There is no one answer to this question. Maternity coverage is generally not included in a group health insurance plan. However, some companies that aspire to provide their employees with the best group health insurance plans include pregnancy-related benefits under their health protection plans.

Q.7 Are health check-ups part of group health insurance?

Ans. No, general health check-ups are not covered in the plan. However, specific policies can offer one health check-up yearly or after a certain time interval.

Q.8 What is advance cash benefit?

Ans. Based on the estimated cost of treatment, the insurer might provide 50% of that estimated cost in cash for the treatment. The whole settlement is done after the treatment is completed.

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FinanceGABhttps://www.financegab.com/
Ajeet Sharma, the founder of Financegab and a well-known name in the field of financial blogging. Blogging since 2017, he has the expertise and excellent knowledge about personal finance. Financegab is all about personal finance which aims to create awareness among people about personal finance and help them to make smart, well-informed financial decisions.

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