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Group Health Insurance
Group health insurance is one of the staff welfare measures of organisations/companies. It is an economical way to provide employee health coverage. This employee benefit secures them financially for medical emergencies and promotes their well-being. With shared premium costs and inclusive benefits, it is an avenue to ensure accessible healthcare while nurturing a productive and loyal workforce. Browse through for more information about group health policy.
Explore the range Health Plans by HDFC Life to cover your medical expenses
With Health plans from HDFC Life you can opt for medical insurance at affordable rates
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10,000+ network hospital in India
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Covers 18 types of heart diseases
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Cover of Rs.10 lakh for ₹ 5/Day1
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No Medicals Required
What is the Group Health Insurance?
Table of Content
Group health insurance is for a group of people, especially organisations. It is an employee benefit. Employees can include health insurance for parents, spouses, and children under the same plan. How lucrative the health benefits for groups are and the coverage available depends on the plan type. Group medical insurance covers day-care treatment, maternity care, etc., and is a valuable privilege for employees.
Key Features of Group Health Insurance
The features of group medical insurance are:
- A group consisting of a minimum of 20 to 25 members is eligible for group health insurance for small business. Annual renewal of the plan is mandatory for uninterrupted coverage.
- The coverage limit depends on the group health insurance plans.
- Employer-sponsored health plans are an affordable alternative to individual health insurance plans.
- Members are covered as long they are a part of the group.
- The group medical insurance covers ambulance service, organ donor costs, domiciliary treatment, day care procedures, and pre and post-hospitalisation expenses.
- Group health insurance plans do not require a medical examination.
- The insurer collects the premium in a lump sum irrespective of whether the employee, the organisation, or both pay the premium.
- Individual claims do not impact the coverage of other group members.
Benefits of Group Health Insurance
The benefits of group health insurance for small business are:
- You can get the coverage without a medical screening.
- The plan provides extensive coverage including hospitalisation expenses, ambulance services, day-care treatment, doctor consultation charges, diagnostics, and pre and post-hospitalisation expenses. You do not experience any inconvenience during your medical treatment with most of the expenses covered.
- Some plans provide coverage for preventive health check-ups as well.
- Employees can include their parents, spouses, and children under the same plan.
- They can avail of cashless treatment at network hospitals.
- Group insurance plans cover pre-existing illnesses without a waiting period.
- The employer can choose a hedge under the corporate health coverage wherein employees get an additional amount if their sum insured is exhausted enabling financial assistance for future medical emergencies.
- Health insurance premiums for groups are affordable.
- Workplace health benefits promote employee loyalty.
Inclusions under Group Health Insurance
The following are the inclusions under health insurance for businesses:
Pre and Post-Hospitalization Coverage
Family Coverage Options
Maternity and Newborn Benefits
Domiciliary Treatment
Health Check-ups and Screenings
Non-Allopathic Treatments
Group health insurance providers cover expenses incurred for doctor consultation, lab tests, and medication 30 days before the hospitalisation and 60-90 days from the discharge date.
The benefits of health insurance are extended to parents, spouses, and dependent children wherever the employees have opted for coverage of family members under the same plan.
The group health insurance plans generally provide coverage up to Rs. 50000/- under maternity care i.e., for normal and C-Section delivery without a waiting period. Insurance coverage for newborn babies is available from day 1.
Wherever the patient cannot be shifted to the hospital for treatment or needs continuous medical attention that does not require hospitalisation, cover is available for domiciliary treatment, i.e., treatment at home.
Coverage is available under preventive measures for health check-ups and screenings to encourage the early detection of medical issues.
Non-allopathic treatments or alternative treatments, i.e., ayurveda, Unani, Sidda, homeopathy, naturopathy, etc.
Exclusions under Group Health Insurance
The exclusions under group health insurance are:
Self-Inflicted Injuries
Cosmetic Treatments
War and Terrorism Injuries
Substance Abuse Treatment
Deliberating hurting oneself through suicide or attempted suicide is not covered.
Treatments or surgeries undergone to alter the facial or body contour, i.e., cosmetic treatments, are not included under the employee healthcare plans.
Treatment expenses for Injuries resulting from war and terrorism are not reimbursed.
The treatment expenses incurred for substance abuse such as the use of drugs, alcohol, etc.
Eligibility for Group Health Insurance
To be eligible for group health insurance, individuals have to be on the organisation’s payroll. Freelancers, temporary employees, and retirees are not eligible for cover under health coverage for employees.
Employees can include their parents, spouses, and dependent children up to a specific age in the same plan.
The groups eligible for group medical insurance are:
- Organisations where the employer is providing the coverage as an employee benefit.
- Trade Unions
- Clubs
- Banks
- Associations
How to Choose the Best Group Health Insurance?
Employers provide medical benefits to their employees under group medical insurance to ensure their overall well-being. It is a small perk offered to them for working hard towards the company’s growth. Comprehending the benefits, features, terms, and conditions of the various group health plan options can be overwhelming. Organisations should consider the following to choose the best group health insurance:
Compare Plan Benefits
Understand the Terms & Conditions
Look for In-Network Hospitals
Compare Available Plans
Claim Settlement Ratio
Looking for attractive group health insurance rates is in the interest of the organisation. However, lower premiums may not provide extensive coverage. Instead, compare plan benefits for a plan that suits the company’s needs.
Review the terms and conditions in the policy document for exclusions, deductibles, limitations, copays, waiting period, add-on riders like critical illness insurance, terminal illness insurance, accidental death benefit, etc., to get the best for the premium allocated.
Cashless hospitalisation is allowed only at network hospitals. Check the list of network hospitals to ensure that a large number of hospitals with state-of-art technology and leading doctors are collaborating with the insurance provider for the facility.
Compare the different plans available in the market. Settle for affordable group health insurance that provides maximum coverage with limited conditions and exhaustive medical benefits.
The claim settlement ratio is the percentage of claims settled among the claims received for a financial year. It shows how customer-centric the insurance providers are and indicates their credibility in settling claims. The higher the claim ratio, the easier the claim settlement.
Conclusion
Group health insurance is critical for employee medical protection, but employers should also consider life insurance to complete comprehensive benefits. This combination method ensures comprehensive financial stability by covering both health demands and dependant protection in the event of death. Both forms of insurance provide comparable benefits. By providing this dual coverage, you get a safety net that fosters loyalty and peace of mind.
FAQs on Group Health Insurance
Q. What is group health insurance?
Group health insurance provides coverage to a group of 20 to 25 members, generally, employees of an organisation and their dependants under a single plan. This is a benefit to the employees offered by the employer.
Q. Who can be the dependents in a group health insurance policy?
Parents, spouses, and children can be the dependents in a group health insurance policy.
Q. Is there any disadvantage of a group health insurance plan?
The disadvantages of a group health insurance plan are:
- The coverage ceases if the employee quits or loses the job.
- The employer has control over the plan. The employees cannot choose a plan according to their specific needs.
- The employer chooses the insurance provider and the coverage for the employees
Q. Can I have both corporate and individual health insurance?
Employees who need additional coverage can have individual health insurance along with a Corporate insurance plan.
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Francis Rodrigues
Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.
Written By:
Vishal Subharwal
Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.
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HDFC LIFE IS A TRUSTED LIFE INSURANCE PARTNER
We at HDFC Life are committed to offer innovative products and services that enable individuals live a ‘Life of Pride’. For over two decades we have been providing life insurance plans - protection, pension, savings, investment, annuity and health.
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1. Annual Premium amount ₹ 1869 for Male aged 35 years, Base Benefit, 10 years term, Regular Pay option, Sum Assured=10 lakhs, excluding Taxes & levies as applicable.
ARN - ED/04/25/22890