Group Health Insurance

Group health plans are employer- or group-sponsored plans that provide healthcare to members and their families. The most common type of group health plan is group health Insurance, which is health Insurance extended to members, such as employees of a company or members of an organization.

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Group Health Insurance

Group Health Insurance (GHI) offers standardized medical coverage to a group of people. Such plans may often include additional health benefits like vision and dental procedures, as well as pharmacy coverage.

GHI helps ensure that employees have access to essential medical services, promoting their overall well-being and financial security.

Additionally, it often includes benefits such as routine check-ups, preventive care and prescription coverage, making it an attractive option for employees.

What is Group Health Insurance?

Group Health Insurance is a comprehensive health coverage plan provided by an employer or organisation to its employees or members. This type of Insurance pools a group of people together under one policy, offering healthcare benefits at a more affordable rate compared to individual health plans.

Group medical Insurance covers a range of medical services, including doctor visits, hospital stays, surgeries and prescription medications. It may also include preventive care such as vaccinations, routine check-ups and screenings. By providing this coverage, employers help ensure their employees have access to necessary medical care.

One of the main advantages of Group Health Insurance is that it spreads the risk across many people, which typically results in lower premiums for everyone involved. For most group health Insurance plans, employers either pay the entire or a portion of the premium, making it even more affordable for employees.

Group Health Insurance not only offers financial protection to employees against high medical costs but also creates a healthier, more productive workforce for the employer.

Types of Groups Covered

According to IRDAI, a group, under a group health Insurance policy, is defined as members coming together to engage in a common economic activity but not merely formed to obtain health Insurance coverage benefits.

There are majorly two types of group Insurance policy bearers:

1. Non-Employer-Employee Groups

These groups include members of registered welfare associations, credit cardholders of specific companies or banks and customers businesses offering Insurance as an added benefit.

2. Employer-Employee Groups

These groups consist of employees from any registered organisations.

The organisations opting for Group Health Insurance coverage should have a Group Administrator or Proposer who will sign the proposal or the declaration form. They will be named in the Policy Schedule and may or may not be insured under the policy.

Why Buy Group Health Insurance?

Employees are the invaluable assets for any organization. Their welfare and care are of utmost importance for the organization. With changing lifestyle, rising medical cost & the recent pandemic has demonstrated us how important it is to have an Insurance for employees.

The Covid induced lockdowns had a great impact on the work of the Small and Medium Enterprises. To come in terms with the new reality and emerge from this downturn, SMEs have to find new ways to meet these challenges and pave the way for growth.

One of the ways is to invest in the Employees and their well-being by means of Group Health Insurance which goes a long way in making sure that Employees appreciate the health and financial security provided through Insurance coverage, now, more than ever.

As more and more people nowadays look for work-life balance and a fair set of benefits from their organisation, hiring and retaining good employees is no longer an easy task.

As an employer, a Group Health Insurance plan equips you to work towards employee wellness in several ways.

Better employee retention

A group health coverage from the employer gives a sense of security to the employees and their families. Moreover, it creates a feeling of belongingness and employees feel cared for. This inclusiveness goes a long way in gaining loyalty, trust, and sincerity from the employees.

Happier employees

The rising cost of medical treatment is often a cause of worry for many. Securing your employees with group health Insurance frees them from the mental stress of unplanned medical expenses. A Group Health Insurance plan frees your employees from the mental burden of high treatment costs and results in better mental health for them.

Motivated employees

Happy employees are motivated employees. The value and care your employees feel with Group Health Insurance boosts their motivation and contributes to a supportive and healthy workplace culture.

Advantages of Group Health Insurance Policy

Comprehensive Coverage

Employees covered under a group health Insurance plan can enjoy comprehensive health coverage without a pre-medical examination. Depending on policy terms, this coverage can also extend to providing them with maternity coverage, regular doctor consultations, and much more. Moreover, unlike individual plans, where policyholders must undergo medical tests, group plans do not require any pre-purchase medical tests.

Covers Employees And Their Families

Group health Insurance offers maximum employee benefits. Such a policy provides employees and their families with coverage against unforeseen and emergency medical expenses during hospitalisations. Depending on policy terms, the employee can choose to include some or all of their family members as dependents under their group plan.

Pre-Existing Disease Coverage from Day 1

Group health Insurance offers financial security to the employees. These plans often allow coverage for pre-existing conditions from day one. This means that the organisation or employer can choose to include benefits for pre-existing diseases immediately, without waiting periods. This option ensures that employees receive necessary medical care right away, enhancing the overall value of the Insurance plan.

Boosts Employee Morale

Group plans can help boost employee morale and increase a business’s employee retention rate. People value jobs and work environments where they feel appreciated and cared for. As an added benefit, they can also help enhance employees’ mental well-being and increase productivity, as employees are less likely to be burdened with any financial stress relating to their medical expenses.

More Affordable

Group plans are a far more affordable option when compared to other plans. This is because the insurer’s risk is spread across a large number of employees, thereby lowering the overall cost of Insurance on an individual basis.

Customisable

Group health coverage can be tailored by the employer to suit the group’s specific size and needs. This customisation ensures that the coverage is relevant and beneficial for all members. Employers can adjust various aspects of the plan, such as the types of benefits offered and the coverage limits, to best meet their employees’ requirements.

Who should buy Group Health Insurance?

Group Health Insurance is a valuable investment for various types of organisations, including young startups, small businesses, growing startups, medium-sized companies, established startups and large organisations.

Here is why each of these entities should consider purchasing group health Insurance:

Young startups and growing startups

Small Businesses

Offering group health Insurance can be a crucial factor in building a loyal and motivated workforce for a small business. Health Insurance benefits can make your business more appealing to potential hires, helping you attract skilled employees. Additionally, group health Insurance can improve employee satisfaction and reduce turnover, which is essential for a small business’s stability and growth.

Medium Businesses

As your company grows, so do your employees’ needs. Group health Insurance can provide comprehensive employee protection with healthcare benefits that meet these needs. It can also enhance your company’s reputation as a caring and responsible employer, making it easier to recruit and retain top talent.

Established Startups

For startups that have moved beyond the initial stages and are more established, offering corporate health Insurance is a sign of maturity and stability. It demonstrates that the company is well-positioned to provide long-term benefits to its employees, which can boost the business’s brand image in the industry and among prospective employees.

Large Organisations

For large organisations, group health Insurance is almost a necessity and serves as a means of cost control. With a large number of employees, offering comprehensive health coverage is essential to maintaining a healthy and productive workforce. It also helps manage healthcare costs more effectively through negotiated rates and better coverage options.

Benefits of Group Health Insurance for Employers

Group Health Insurance offers numerous benefits for employers, making it an essential consideration for any business looking to support its workforce and reduce costs.

Here are some key advantages:

Tax Benefits

One of the significant employer incentives for providing group health Insurance is the tax advantage it offers. Employers can often deduct the cost of health Insurance premiums as a business expense, lowering their overall tax burden. This makes offering health Insurance a financially sound decision for employers who are looking for a means to promote employee care.

People-First Approach

By offering group health Insurance, employers demonstrate a commitment to the well-being of their employees. This people-first approach can boost employee loyalty by showing that the company values its workforce. It creates a supportive work environment, which can lead to increased productivity and job satisfaction.

Lower Premiums

Group health Insurance typically has lower premiums than individual plans. By pooling together a large number of employees, the risk is spread out, leading to more affordable rates. This cost-effective solution helps businesses manage their expenses while providing comprehensive health coverage.

Employee Value and Satisfaction

Providing health Insurance is a competitive advantage in attracting and retaining talent. Employees value health benefits highly, and offering a robust health Insurance plan can improve employee satisfaction and reduce turnover. A satisfied workforce is more likely to be engaged and committed to the company’s success.

Financial Well-Being

Group health Insurance is a critical product for the financial well-being of the workforce. It protects employees from medical emergencies and provides peace of mind by ensuring they have access to necessary medical care. This financial security can lead to a more focused and less stressed workforce.

Customisable Policies

Employers can customise group health Insurance policies to fit their budget and the specific needs of their employees. This flexibility allows businesses to choose the level of coverage that is most appropriate for their workforce, ensuring that they provide meaningful benefits without overstretching their financial resources.

Benefits of Group Health Insurance for Employees

Here are some of the most lucrative benefits of group health policies that the employees of an organisation can enjoy:

Timely Consultations

Employees can gain access to timely nutritionist and doctor consultations. This helps them manage their health more effectively. This also ensures that they can seek professional advice and support for their dietary and medical needs on time.

Booking Lab Tests

Employees can easily book lab tests, which are usually done at much-discounted rates. This benefit ensures regular monitoring of their health, leading to early detection and treatment of any potential diseases.

Ordering Medicines

Employees can now order discounted medicines hassle-free, as they can easily get prescriptions through the insurer’s network. This convenience saves time and ensures they receive their medications promptly.

Maternity Benefits with Zero Waiting Period

Many such plans offer maternity coverage with no waiting period. This ensures immediate financial support for expecting mothers and employees who are planning a family.

Employees Can Get Dependents Covered

Finally, such plans allow employees to get their dependents covered, providing comprehensive health benefits for their entire family.

Key Features of Group Health Insurance Policies

Since group Insurance is a tailor-made health plan, these features are indicative and can differ based on customisation by the employer when deciding on their desired scope of coverage.

Key Features	Details
Waiting Period	Option to Coverage from Day 1
Policyholder	Employer
Insured Members	Employees only or Employees + Family Members as Dependents (Optional): Legal spouse, children, dependent parents
Mid-Term Addition of Dependents	New borns and spouses in case of marriage for a requisite premium.
In-Patient Treatment	Covered up to the Sum Insured and the Sub-Limit applicable per claim.
Pre-Hospitalisation Coverage and Post-Hospitalisation Coverage	Covered up to the number of days as specified in the policy schedule/ Insurance certificate
Day Care Procedures	Covered up to the number of days as specified in the policy schedule/ Insurance certificate.
Domiciliary Treatment	Covered if opted for as per policy schedule
Maternity Cover	Covered if opted for as per policy schedule
Baby Day One Cover	Covered if opted for as per policy schedule
Pre/Post-Natal Cover	Covered if opted for as per policy schedule
Organ Transplant	Covered if opted for as per policy schedule
Cashless Treatment Claims	Available for Network Hospitals.
Ambulance Cover	Covered if opted for as per policy schedule
Network Hospitals	11000+ hospitals across India.
Family Transportation Benefit	Covered if opted for as per policy schedule

What is Covered in Group Health Insurance?

Employees Can Get Dependents Covered

Indemnification of medical expenses incurred due to disease/ illness/ injury during the policy period that requires the insured person’s admission to a hospital as an in-patient for a minimum period of 24 consecutive hours. A daily hospital cash benefit is also available here.

Pre-Hospitalisation Expenses

Expenses for consultations, investigations, and medicines incurred up to the number of days as specified in the policy schedule prior to admission to the Hospital. The coverage can be claimed under In-patient Treatment/Day Care Procedures/Domiciliary Treatments.

Post-Hospitalisation Expenses

Expenses for consultations, investigations, and medicines incurred up to the number of days, as specified in the policy schedule, after discharge from the Hospital. Like pre-hospitalisation expenses, this benefit can be claimed under In-patient Treatment/Day Care Procedures/Domiciliary treatments.

Day Care Treatment

Coverage for expenses for listed Day Care treatment due to disease/ illness/ injury during the policy period taken at a hospital or a Day Care Centre. For more information, you can check our blog on common daycare procedures covered by health Insurance.

Domiciliary Treatment

Coverage for expenses related to at-home or domiciliary treatments of the insured person if the treatment exceeds three days for management of an illness. It does not include coverage for enteral feedings or end-of-life care.

Note: Domiciliary hospitalisation means medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances:

1.the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or

2.the patient takes treatment at home on account of non-availability of room in a hospital

Organ Transplant

Coverage for medical and surgical expenses of the organ donor for harvesting the organ where an insured person is the recipient. These expenses will be covered if the organ donation is in accordance and compliant with The Transplantation of Human Organs Act (Amended), 1994. The insured person must also have submitted an in-patient hospitalisation claim under the in-patient hospitalisation treatment cover to be eligible for this cover.

Ambulance Cover

Coverage for expenses incurred on transportation of the insured person in a registered ambulance to the hospital in the case of an emergency or transfer from one hospital to another for better treatment. The claim must be admissible under this policy’s in-patient treatment or daycare procedures to be eligible for this cover.

Maternity Coverage

Coverage for maternity expenses for childbirth and/or maternity expenses like the medical and lawful termination of pregnancy and the medical resuscitation of the newborn baby as per the sub-limit specified in the policy schedule. In the case of ectopic pregnancies, while they aren’t included under our maternity cover, they can still be claimed under the in-patient treatment clause of our Group MediCare policy.

Family Transportation Benefit

The transport cost of one immediate family member, like the insured person’s legal spouse, child, parent, etc., is reimbursed if the insured person is admitted to a hospital at least 200 km away from their residence.

What is not Covered in Group Health Insurance?

Waiting Period

Any claim made during the policy waiting period, the waiting period for specific diseases and pre-existing diseases will not be covered. However, there are exclusions available for these.

Investigation and Evaluation

Expenses related only to primary diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.

Rest and Respite Care

Expenses related to enforced bed rest and respite services for terminally ill people.

Obesity/Weight Control

Expenses related to the surgical treatment of obesity that does not fulfill all the below conditions:

Surgery to be conducted is upon the advice of the Doctor.
The surgery/procedure conducted should be supported by clinical protocols.
The member has to be 18 years of age or older.
Body Mass Index (BMI) of the patient is greater than or equal to 40 or greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:

Gender Change Treatment

Expenses related to treatment and surgery for gender change.

Cosmetic or Plastic Surgery

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following accidents, burns, or cancer or as part of medically necessary treatment. Additionally, this does not include dental treatments.

Addiction

Expenses for treatment for alcoholism, drug or substance abuse, or any addictive condition and their consequences.

Unproven Treatments

Expenses related to any unproven treatment, services and supplies for or in connection with any treatment.

Miscellaneous

Expenses for some cases of refractive error treatment, injury due to adventure sports, breach of law, and sterility and infertility treatment.

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Group Health Insurance

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