group mediclaim insurance benefits

Benefits of a Group Mediclaim Insurance

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

Health issues and healthcare are an indispensable part of our life. In the present-day context, a rise in the number of diseases is followed by an increase in healthcare costs. The only way to protect our savings from steep healthcare costs is Health Insurance. A health insurance plan either can be individual health insurance or group health insurance. In both cases, it safeguards your savings from being frittered away in medical expenses. It also provides tax benefits to both an individual (holder of individual health insurance) and companies (providers of group health insurance).

In recent years, we can see several key developments. There are so many new start-ups and businesses established in recent years. The success of any business is only achieved by the welfare of its employees. But these employees face a lot of financial, physical, and health struggles in their life. So if a company provides group health insurance coverage to their employees, then it assures them that they are living a secure life. As a result, they focus more on their work rather than worry about healthcare costs. 

Now the question arises; what is Group Health Insurance Plan? Is it beneficial for both employees and employers? How is it different from individual health insurance? Let us answer all these questions through this article.

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. This plan provides health insurance coverage to employees of an organization or a company; that is why it is often known as Corporate Health Insurance. Some organizations offer this 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. Since all employees are grouped under a single policy, the premium cost is relatively low compared to regular health policies.

The benefits of Group Health Insurance:-

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 companies provide them with health insurance, then it helps them relax and not worry about healthcare challenges. In return, they feel their importance to the organization enhanced and work harder to deliver results.
  1. Uplift Company’s Goodwill and help in Employee retentionWhen 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 longer term commitment to the company.
  1. Tax BenefitsAccording 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. 

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 health insurance, 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 membersIn most group health insurance plans, the dependents of the employees are also considered as a part of the policy. So here not only you but your family members also get insured life within a single plan. 
  1. Easy to claimIn 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.

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

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 group health insurance 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. 

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. 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.

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.

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