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group mediclaim insurance benefits
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Benefits of a Group Mediclaim Insurance

“Good Health is Good Business” – Paul Drescher, CEO of Wates Group.

Companies offer group health insurance as a means to retain employees and protect them from financial stress in case of medical emergencies. Employees, on the other hand, remain secure about their medical needs as well as their family’s health, thereby delivering increased productivity at work. 

But that’s not all a group mediclaim insurance does. Here’s looking at the many benefits of an employer-sponsored insurance policy: 

  • Comprehensive coverage
  • Coverage for family members
  • Low cost
  • No medical screening required 
  • No waiting period and faster claim settlement
  • Coverage of pre-existing illnesses
  • Employee retention
  • Motivated employees
  • Tax benefits

What is a Group Health Insurance Plan? 

Group health insurance is a kind of health insurance plan that covers all the members of a group under a single policy. These policies offer several benefits and wide coverage to the members of the group at highly economical costs. This plan provides health insurance coverage to the employees of an organization or a company; that is why it is sometimes also referred to as Corporate Health Insurance. 

Some organizations offer the group mediclaim policy to their employees free of cost. On the other hand, some companies charge a nominal cost to the employee to defray premium costs and deduct them from their monthly salary. This deducted amount is known as the premium cost of the employer-provided health plan. Since all employees are grouped under a single policy, the premium cost is relatively low compared to regular health policies.

A Group Mediclaim Insurance Policy for employees has many lucrative benefits to offer for both the employer as well as the employee. Group health insurance plans provide medical coverage for the policyholder (employee) as well as his/her family members. This extended and comprehensive support for professionals is one of the primary reasons that has compelled most organizations to buy these policies for their employees.

How Does Group Health Insurance Work

Group mediclaim insurance is purchased by companies and organizations and provided to their members or employees. These policies are specifically designed to be purchased by groups, which means individuals cannot purchase coverage through these policies. Group health insurance plans generally require at least 70% participation in the plan to be valid. Because of the many differences and factors—insurers, plan types, costs, and terms and conditions—between plans, no two group plans are ever the same.

Group members or employees are given the option to accept or decline coverage once the organization purchases a plan. In some cases, plans may come in tiers. This means that the insured parties have the option of taking basic coverage or better coverage with various add-ons. The premiums are split between the company and its employees based on the plan. In most cases, health insurance coverage is also extended to the immediate family and/or other dependents of the employees.

Key Features of a Group Health Insurance Plan

Take a look at some of the most attractive features of a group health insurance policy:

  • The best group mediclaim insurance policies provide coverage for boarding costs other than anesthetist, surgeon, and consultation charges. Expenses incurred due to oxygen, anesthesia, and diagnostic materials are generally covered. Some group health insurance policies also cover dialysis expenses and X-rays.
  • The policyholders get a cashless claim benefit with group health insurance plans, wherein the insurance provider directly settles off the bills and expenses with the hospital.
  • Coverage for domiciliary hospitalization is also provided by some group health insurance policies.
  • Pre-hospitalization and post-hospitalization expenses for a fixed period of time are covered under a group mediclaim insurance too.
  • The best group health insurance plans also provide coverage for maternity and pregnancy-related expenses.
  • Policyholders of certain group health insurance plans also get the benefits of coverage extension for specific critical illnesses above the hospitalization cover.
  • Procedures that take less than 24 hours of hospitalization are generally not covered under most health insurance policies. But, group health insurance offers coverage for specific treatment procedures that take less than 24 hours of hospitalization like eye surgery, chemotherapy, tonsillectomy, etc.
  • Group health insurance plans also offer other lucrative benefits like waiver of the waiting period, the exclusion for first-year other than reimbursement for ambulance expenses, etc.

The benefits of Group Health Insurance:-

The primary benefit of a group health insurance policy is that it spreads risk across a pool of insured individuals. This unlocks several benefits for group members by keeping premiums highly economical. On the other hand, insurers can better manage risk when they have a clearer idea of who they are covering.

The group mediclaim policy for employees has double-edged benefits for both the employer as well as the employee.

I) From the Employer’s Perspective:-

  1. Improvement in Motivation level of Employees- Employees are always valuable to any organization; they can make or break a workplace. In most cases, employees are not able to afford healthcare expenses. If a company provides a group mediclaim insurance policy for employees, then it helps them relax and not worry about healthcare challenges. They also feel happy and motivated about the fact that their organization values them. In return, they feel their importance to the organization enhanced and work harder to deliver results. Hence, getting group health insurance for your employees is a great way to motivate your employees and make them more driven towards their work.
  1. Uplift Company’s Goodwill and help in Employee retention: When a company takes care of its employees by providing them health insurance policies, it creates a good image of the company in minds of the employees. It also reflects on the company’s goodwill valuation. When employees get free of cost or minimum cost health insurance for themselves and their family members from the company, there are high chances that employees will make a long-term commitment to the company.
  1. Tax Benefits: According to the Indian Tax Regulations, the company that provides group health insurance to its employees is eligible to claim tax exemption. It acts as a dual benefit for the Company. On one side, they save their earnings from taxation. On another side, they project themselves as a good employer which improves their Goodwill valuation. 
  1. Higher Plan Advantages for Lower Cost: The group health insurance plans are always more economical than individual or family floater health insurance plans. This is because of the shared premium amount among the employees. Furthermore, it also provides a much higher value with added benefits like cover for pre-existing diseases, hospitalization expenses, etc. This is primarily because group health insurance covers a higher number of people which results in increased advantages for the policyholders.
  1. Customized Cover: Many insurance providers offer the option of customized coverage. Hence, the employer is in control of the coverage and inclusions of the policy. For instance, an employer can select a plan that provides OPD or maternity coverage to their employees. This allows them to design a group health insurance policy for their employees that is aligned with the employees’ insurance needs and expectations. This also allows them to choose a tailor-made policy for their employees that goes hand-in-hand with the budget for the employees’ insurance.

II) From the Employee Perspective:- 

  1. Covering most of the diseases with no waiting period required for pre-existing disease: In the case of group mediclaim policy, as an employee, you get coverage for your pre-existing diseases from the first day onwards. It means you don’t need to worry about any waiting period. Additionally, under this policy, you get benefits of coverage with no limit on diseases. It means whether you are suffering from any disease, you as an employee will get insurance cover for sure. 
  1. Insurance protection for family members: In most group health insurance plans, the dependents of the employees are also considered as a part of the policy. They provide financial protection to the dependents of the employees by offering them extensive coverage. But the coverage that extends to the family members differs from policy to policy and company to company. So here not only you but your family members also get insured life within a single plan. This also eliminates the need for the employee to buy another family floater health insurance plan and pay the premium out of their own pocket.
  1. Easy to claim: In the case of individual health insurance, if you need to claim the insurance amount, you have to take care of the entire process yourself. But when an employer buys a group insurance policy for his employees, then you have to approach your employer. Also, there are several employees insured under this policy, so the employer also ensures that you will get quick approval of your claim.
  1. No-Medical Check Up: Employees will not have to undergo a medical check-up or pre-medical screening and submit medical reports to be covered under most group health insurance policies. This allows them to be easily a part of a group health plan with no complications of medical check-up at all. This is a huge upside over individual health insurance policies where medical check-ups are generally required to be covered under the policy.

So these are some benefits of group health insurance for both the employer and the employee.

Common Exclusions from Group Health Insurance Plans

There are some of the conditions that most of the group health insurance plans aren’t liable to pay for. Here are some of the most common exclusions for group health insurance policies:

  • Many policies do not cover the parents of the employee.
  • Treatments under non-allopathic systems of medicines like Homeopathy, Ayurveda, etc., are not covered under most of the group health insurance policies.
  • Congenital diseases and expenses incurred in the treatment of sexually transmitted diseases are generally excluded from the group health insurance policies.
  • Treatment of ailments, complications, or addiction arising out of alcohol or substance abuse is not covered under group mediclaim insurance plans.
  • The validity of group health insurance for employees is always limited. It is only valid until the employee works in the organization.

Group Health Insurance versus Individual Health Insurance

In individual health insurance, you have to buy a health insurance plan for yourself and your family members. It covers all the medical expenses and pre and post hospitalization expenses caused due to an accident, illness, or surgery, during the policy term. It also provides transportation expenses, free medical check-ups, daycare facility, and diagnostic tests up to predefined limits. So that in some cases both policies provide almost similar coverage, but they differ in cost and customization.

Cost: – In comparison to individual health insurance, the cost of having a group mediclaim policy is comparatively low. You can also avail of it either at zero cost or a minimum premium amount (if you want some add-on benefits), which is deducted from your salary. This is because group health insurance covers a large pool of employees which ultimately means a higher risk pool. On the other hand, individual health insurance offers the same amount of benefits at a significantly higher cost because of lower risk.

Control and Convenience: – In the case of individual health insurance, it is your personal choice whether you want to be a part of a particular policy or not. In other words, you can get the best health insurance plans for yourself if you go with individual health insurance. Does it satisfy your needs or not? But in the case of the group health insurance policy, if you are an employee of the Company, then you will be a member of the policy by default.

What should you choose – individual or group health insurance?

Whether you choose individual health insurance or be a part of group health insurance, you should be well aware of the pros and cons of each of them. On one side, group health insurance plan generates tax benefits only for employers. The employees do not get a share of that tax benefit. More important, if you leave your job, then your group health insurance cover expires. You will not get any healthcare benefits in the future from the company group plan. On the other hand, the group mediclaim policy for employees offers seamless claims, family coverage, wide health coverage without a waiting period for pre-existing conditions, and various other benefits.

Group Medical Insurance Benefits

How does Health Insurance work?

In case you or any of your family members fall sick or meet with an accident. Either you may visit one of the network hospitals of designated healthcare providers, or you can seek care outside the network. The settlement of the claim, whether cashless or reimbursement shall depend on the choice of the hospital. When you seek medical care at the network hospital, the insurance provider and the hospital settle the medical bills between themselves. If you seek care outside the network, then you have to submit the claim form along with all the necessary bills in original and then claim reimbursement.

Is there a way to compare health insurance plans?

There are some important parameters to compare different Health Insurance Plans:

1. Sub-limits on Room Rent: - Under this sub-limit, the insurance provider sets a per day sub-limit on room rent up to a certain percent of the sum assured. So if you compare two policies, then make sure your policy will provide a higher room rent limit so that you don't need to pay an extra amount from your pocket.

2. Check the waiting period clause: In most insurance plans, pre-existing diseases, maternity expenses, and certain specific treatments like hernia and others are considered only after a cooling period of 2-3 years. So before buying any plan, you should make sure to check the time duration and choose a plan that comes with a minimal waiting period.

3. Co-payment clause: It is a percentage of the sum assured that you have to pay from your pocket. So while you opt for a plan then choose a plan that has the least or no co-payment clause at all.

4. Sub-limits on specific treatment: These sub-limits are fixed in some common ailments like piles, gall bladder stones, kidney stones, cataracts, sinus, etc. So if you are planning to buy health insurance and it consists of sub-limits, then you must check the list of diseases that come under sub-limit and their associated cost to you. The monetary cap on the treatment of these varies from insurer to insurer.

Which health insurance plans cover maternity?

There are some examples of health insurance plans that come with maternity cover benefits are:-

1. Star Health Wedding Gift Pregnancy Cover
2. Religare Joy Maternity Health Insurance Plan
3. Max Bupa Heartbeat Family First Plan
4. Apollo Munich Easy Health Insurance Plan
5. Royal Sundaram Total Health Plus Plan
6. HDFC Ergo Health Suraksha Gold
7. Royal Sundaram Lifeline Elite
8. National Parivar Mediclaim Plan

It would help if you kept in mind that almost all maternity covers bought as part of individual/ family floater/ group plans come with mandatory waiting periods ranging from 24 months to 48 months.