Group Health Insurance

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What is group health Insurance?

Health insurance has become a necessity for every individual, especially when the world is fighting against COVID-19 pandemic. Also, Indian government has mandated businesses to provide group health insurance to their employees as a part of Post-COVID operating guidelines

Group health insurance is the health insurance in group form bought by companies and organizations for their employees and can be extended to employees' family members. These plans provide financial stability of employees during unexpected health issues, accidents, or any mishaps. These are yearly renewable customizable plans that work under certain agreed terms & conditions.

Why should employer buy group health Insurance for their employees?

Happy Employees, Happy Company. Studies show a positive employee experience results in a positive financial impact for companies.  A group health insurance will not only give your employees and their families enough financial security, but an overall sense of satisfaction that their employer actually cares about them. A well thought of group health insurance plan can achieve the following

  • Employees' loyalty and retention
  • Better productivity through healthier employees
  • Conducive company culture
  • Better hiring and recruitment

Benefits Of Group Health Insurance

  • Immediate cover without any waiting period. Full coverage starts for all employees from day one
  • Cover for pre-existing diseases from day one
  • No health check-up required
  • No capping on no of diseases covered.
  • Maternity benefit cover from day one
  • Newborn baby expenses from day one
  • Low premium in comparison to individual health insurance

Since this is a group health insurance plan, any employee resigning from the organization will not be able to benefit from this plan post his/her resignation from that organization.


Basic features

In Patient Care
  1. Room, Boarding Expenses provided by the hospital / nursing home
  2. Nursing Expenses
  3. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees
  4. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines and Drugs, Diagnostic materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pacemaker, Artificial Limbs and Cost of Organs and similar expenses

In patient care means admission in a Hospital for a minimum period of 24 in patient Care consecutive hours except for specified procedures/ treatments, where such admission could be for a period of less than 24consecutive hours

Pre hospitalisation Medical Expenses incurred immediately 30 days, before the Insured Person is hospitalized.
Post hospitalisation Medical Expenses incurred immediately 60 days after the insured person is discharged from the hospital.
Day care Day care treatment refers to medical treatment, and/or surgical procedure which is: i. Undertaken under General or Local Anesthesia in a hospital/day care center in less than 24 hours because of technological advancement, and ii. Which would have otherwise required a hospitalization of more than 24 hours. Treatment normally taken on an out-patient basis is not included in the scope of this cover
Maternity Expenses Maternity expense Maternity expenses shall include— (a). medical treatment expenses traceable to childbirth ( including complicated deliveries and caesarean sections incurred during hospitalization). (b). expenses towards lawful medical termination of pregnancy during the policy period
Baby day one cover Cover Medical Expenses towards the medical treatment of the Insured Person’s New Born Baby while the Insured Person is Hospitalized for Inpatient Care for delivery

What is Not Covered Under Group Health Insurance?

Group health insurance plans do not cover you for the following expenses:

  • Injuries arising due to war or warlike situations
  • Expenses related to external durable items
  • Dental treatments
  • Cosmetic surgeries
  • Any treatment required due to self harm including attempt of suicide
  • Treatment taken outside India
  • Outpatient treatment
  • Experimental and unproven treatment.

Difference between a group health insurance and ind health insurance

Parameter Group Health Insurance Individual Health Insurance
Who is insured? A group health insurance plan covers a company's employees and their dependent family members An Individual health insurance policy offers coverage to the individuals and their family members.
Who buys the cover? Group Health Insurance is purchased by an employer Individuals
Exit criteria Resignation of an employee subject to group health policy being renewed yearly Lifelong renewable
Coverage for Pre-existing diseases: Day 1 After the completion of the waiting period ie 2/3/4 years depending on the plan bought
Maternity Benefits: Covered, if opted for Different plans available to cover maternity
Medical Check-ups before purchase: Not required Required above certain age. Good health declaration is required by everyone to be buying a new health insurance policy
30 days Waiting period No Yes
2 years waiting period for specified ailments/diseases No Yes
Premium Lower than the Individual policies Higher than the Group Health Policies

Who should buy a Group Health Insurance plan?

Small Companies & Young Startups

If you are a young startup or small company and have at least 7 employees, then you should have a group health insurance plan for your employees. Employer-provided health coverage is important for recruiting, but even more important for retention.

Don’t worry about the cost of group health insurance plans as the group health plans can be customized as per your requirement.

Moreover, cost of group health insurance is an expense on which you will save taxes.

Medium Sized or growing companies

Whether it is a small or medium company, group health insurance helps in building loyalty with the employees and thus help companies to retain talent. Employee benefits plans keep the employees motivated and charged up as their financial worries arising out of any untoward health crisis is taken care of.

Large Organizations & Established Startups

For companies having 1000+ employees, employee health benefit decisions are among the most relevant for remaining competitive in the job market. Satisfaction among employees is associated with attitudes and behaviors that serve the employer's interests.

Large employers are pushing the envelope by improving access to high-quality health care and driving employee engagement with their health benefits.

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