What is Group Health/Group Medical Insurance?

Group Health Insurance is a type of Health Insurance plan that covers employees of an organization. Through contributory or non-contributory version of these policies, employers offer coverage to their employees during their employment tenure.

It is a valued benefit for employees & their immediate family members like spouse, children and parents since group health insurance premium costs for employees are significantly lower than individual health insurance plans. Companies also get tax reduction on these, making it advantageous for both employer and the employee.

Why Choose Care Health’s Group Health Insurance?

• Pre-existing diseases covered from day 1*
• Specialized Health Insurer dedicatedly working in the industry
• One of the best Claim Settlement ratios for Health Insurance nationwide
• No TPA/third party intermediation required because of in-house claim management
• Flexibility to choose plans based on employer’s need
• No Pre-policy health check-up
• Real-time access to digital portal/mobile app for service-related queries
• 504+ Day-care surgeries covered
• Wide range of sum insured options
• 24/7 support for queries/claim assistance
• Critical illness coverage for hospitalization from day 1
• One of the largest network of cashless healthcare providers

Salient Features of Group Health/ Group Medical Insurance

Health Insurance has become essential due to the ever increasing cost of healthcare services. What was once considered a bonus, has now become a necessity and thus many organisations today provide group health insurance policies to their employees.

Extended Benefits

Employers can also opt for extended benefits while purchasing group health insurance. Under this, a set of comprehensive benefits are available to employees subject to terms and conditions-

• Maternity expenses can be covered
• New born babies can be covered within maternity coverage.
• Option for OPD coverage.
• Employer can choose a corporate buffer under which employees get an extra amount, if their existing Sum Insured gets exhausted and they need further financial assistance.

Additional Highlights of Group Health Insurance

Below mentioned are the additional benefits of Corporate Health insurance that can be offered to policyholders depending upon their requirements -

• International Second opinion
• Doctor on Call
• Health Risk Assessment
• Discount Connect
• Health Camps
• Vaccination Camps
• Mobile App
• Paperless Claim Processing

Who can Buy Group Health Insurance?

Whether you are a growing start-up, an established organization or a group with a common interest, you are eligible to apply for a Group Health Insurance Plan. Organizations or groups with more than 7 employees or 7 lives (including dependents) can opt for a Group Health Cover.

Inclusions under Group Health Insurance

Group Insurance provides comprehensive coverage for hospitalisation expenses incurred during a medical emergency. The coverage provided is subject to policy terms and conditions and includes:

• In-patient Hospitalization: Expenses like room rent, ICU charges, doctor’s fees, etc. during any planned or emergency hospitalization up to the Sum Insured are covered.
• 30 Day Pre & 60 Days Post Hospitalization: Get coverage for expenses arising from doctor’s consultation, diagnostic tests or medication from 30 days before admission up to 60 days immediately after discharge from the hospital.
• No Initial Waiting Period: Unlike standard health insurance plans, you will not have to undergo waiting period with your Group Health Insurance policy.
• Coverage of Pre-existing Diseases: Cost incurred by you for the treatment of pre-existing diseases will be covered.
• Advanced Medical Treatment: Access to advanced medical care and coverage for treatments like robotic surgeries is included.
• Room Rent: Get coverage for Room rent up to 1% of Sum Insured amount per day.
• Maternity Cover: Maternity cover of up to INR 50,000 for Normal & C-section with no waiting period is available.
• New-born Baby Cover: New-born baby coverage from Day 1* is included.
• Ambulance Cover: Ambulance charges are covered.
• Corporate Buffer: Corporate Buffer is available as per requirement of the employee.

Exclusions under Group Health Insurance

• Self-inflicted injuries resulting from suicide or attempted suicide
• Any treatment or hospitalisation for undergoing contraception
• Expenses arising from or attributable to alcohol or drug use/misuse/abuse
• Treatment arising from miscarriage, abortion and its consequences *
• Tests and treatment relating to infertility and in vitro fertilization
• Expenses related to any admission primarily for diagnostic and evaluation purposes
• Committing or attempting breach of law with criminal intent
• Circumcision unless necessary for the treatment of an illness

Benefits of Group Health Insurance for Employers & Employees

How to Choose the Best Group Health Insurance?

Looking for the best Group Health Insurance for employees could be a tedious process as it takes time and detailed understanding of the product, and correct comprehension of its terms and conditions. The most valuable asset of a company are its employees, who help it grow by contributing their time and energy for the organisation. Therefore, employers take ownership of extending care for their employees by getting a comprehensive Group Health Insurance and securing them financially against unforeseen medical exigencies

Following factors should be considered while buying GROUP HEALTH INSURANCE:

• Compare Available Plans: Saving money on insurance premium may sound great, but the lowest premium available might not fetch you a comprehensive coverage. Hence, comparing features & benefits of various policies in the market to find a plan that best suits your needs will lead to an informed decision.
• Read through Policy Documents (Brochures/Policy terms): it is important to get a thorough understanding of policy terms and conditions such as co-payment, deductible or sub-limits while reviewing policy documents, this ensures you do not encounter any variance during claim filing.
• Check for Network Hospitals: Making a note of cashless network hospitals gives you ease during an emergency. Choosing an insurer with a large network of cashless healthcare providers benefits the policyholder immensely.
• Connect with Customer Care: An insurer that can provide you with 24X7 customer service support or an easy-to-use customer mobile app should be preferred.
• Claim Settlement Ratio: The insurer should have a high Claim Settlement ratio as it reassures the policyholder of a proactive, customer-centric approach.

How to Claim for Cashless - Group Medical Insurance?

Documents Required for Claim Reimbursement - Group Health Insurance

To initiate Reimbursement claim process under the group mediclaim insurance policy for employees, you have to make sure that you have all the required documents-

• Claim Intimation Number – Provided to you by the health insurance team while intimating the claim before hospitalization, in case of planned treatment or 24 hours post-hospitalization in case of emergency hospitalization.
• Duly filled and signed claim form, in original
• Identity proof with photo, age proof and address proof
• Referral letter advising Hospitalization from Medical Practitioner's desk
• Doctor’s prescription advising drugs /diagnostic tests/consultation
• Original bills/receipts from pharmacy/chemist
• Original bills, receipts and discharge card from the Hospital /Medical Practitioner
• Original diagnostic test reports and payment receipts
• Indoor case papers (if applicable)
• Accident proof - First Information Report/ final police report, if applicable
• Disability Certificate from Government Medical Board, Fitness Certificate, Medical Prescription, if applicable
• Post mortem report, if applicable
• Any other information/document as required by the insurance company to assess the claim, in case fraud is suspected

FAQs about Group Mediclaim Policy

• Q.Can we buy a group health insurance policy if we have only 10-15 employees at our workplace?

  The minimum requirement for an employer to opt for Group Mediclaim Policy is 7 employees or lives. In case of 7 lives, one could also include dependents. For instance, if there are 3 employees in the company, there could be a total of 4 dependents on these employees and they can make 7 lives in total.

• Q.What is the difference between group health insurance and individual health insurance?

  An individual health insurance is where a person buys a health insurance policy for himself and his dependents, whereas group health insurance is where an employer/company buys health insurance for all its employees and their dependents, respectively.

• Q.Does Group Insurance also cover families of its employees

  Yes, the product offers provision to cover immediate family members of its employees under the policy’s beneficiary scheme. However, provisions can be different depending on the type of policy, whether it is health, travel or personal accidents cover.

• Q.Who can be covered under corporate health insurance?

  Employees in the age group of 18 - 65 years who are employed with an organization are eligible to be covered under the organization’s Group Health Insurance Policy. Dependents will be covered from day 1 to 80 years of age.

• Q. Can I port my group health insurance to individual health insurance if I leave my company?

  Yes, you can port your Group Health Insurance policy to a retail health insurance if you leave the organization mid-policy year. However, you have to formally apply for the retail policy, stating the reason for your movement from Group Health Insurance to a retail policy. Basis the underwriter’s guidelines, individuals can be transferred to retail policy, post conclusion of assignment with the organization.

• Q.Can I buy both corporate health insurance and individual health insurance at the same time?

  Yes, you can buy both plans at the same time

• Q.How can I calculate group health insurance premium?

  GROUP HEALTH INSURANCE premium is calculated by the insurer basis the data submitted by the policyholder. It is calculated basis age, claim history (in case of renewal), location and nature of work etc.