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.
The following features will help you understand more about Group Medical Insurance:
Comprehensive Coverage
Comprehensive coverage ensures that you don't have to go through any inconvenience during a medical treatment. Cost of hospitalization, consultation expenses, pharmacy, diagnostics etc. are covered by your group health insurance.
Cashless Claims
In a cashless claim, the insured does not have to pay for medical expenses in case of hospitalization and the hospital directly settles the bill with the insurer. Cashless service of medical treatments is provided in the network of healthcare providers associated with the insurer.
Flexible Terms & Conditions
Group Health Insurance policies are flexible while covering health emergencies. Employers have an option to make their policy’s terms and conditions flexible as per the needs of their employees.
Coverage for Dependents
Group Health Insurance offers extended coverage and policy benefits to the employee's dependents such as spouse, children and parents.
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
Benefits for Employers
Benefits for 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?
STEP 1
Emergency
Intimate us within 24 hours of your hospitalization
Planned Hospitalization
Intimate us 48 hours prior to your hospitalization
STEP 2
Cashless
Request for pre-authorization
Reimbursement
Claim from submission
Complete the pre-authorization form available at the hospitals insurance/TPA Desk and send us through fax.
Approval
Approval letter sent by the claim management team
Query
Hospital/Insured to respond to the query raised by the claim management team
Rejected
You may initiate the treatment and file for reimbursement claim
Submission of claim form along with required documents, as per the policy terms & conditions
Approval
Approval letter sent by the claim management team
Query
Insured to respond to the query raised by the claim management team
Rejected
We will communicate the reason(s) in case of rejection
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
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.
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The premium calculated above is based on the data provided by you in the application form.
The above information must be read in conjunction with the sales brochure and policy document.
Tax Benefits would be available as per the prevailing Income Tax laws.
GST has been levied as per applicable Tax laws.
The general terms and conditions of the usage of this website also apply.
For any clarification, please feel free to contact us on 1800-102-4488.
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Terms & Conditions of Premium Quote Generation
"Care Health Insurance Ltd & associate partners may contact you to assist you with website navigation of www.careinsurance.com and assist in proposal filling."
The premium calculated above is based on the data provided by you in the application form.
The above information must be read in conjunction with the sales brochure and policy document.
Tax Benefits would be available as per the prevailing Income Tax laws.
GST has been levied as per applicable Tax laws.
The general terms and conditions of the usage of this website also apply.
For any clarification, please feel free to chat with our customer service on WhatsApp at 8860402452.
I authorize Care Health Insurance and associate partners to contact me via email or phone or SMS and record the conversation for training & Quality purpose.