Group Health Insurance
Group Health Insurance provides medical coverage to a group of people, usually employees or members of an organization, under one plan with following unique features.
- Customized plansAffordable prices
- 24*7 SupportDedicated claims manager
- Total CareAll round wellness benefits
- Tax Benefits (Business expense for the Employer/Deduction under Sec. 80 D for employees)
- 24*7 Customer Support by TPA/Company’s network/Toll free no.
- Maternity Extension including cesarean delivery, cover to Child from Day one up to 90 days.
- Option to include /exclude family members
- Waiver of First 30 days, specified diseases and existing disease exclusions is possible
- Employee is covered from date of joining
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What is Group Health Insurance?
Group health insurance provides coverage for a group of people, usually employees of a company or members of an organization. It helps protect them from high medical costs by covering their healthcare expenses.
One big advantage of group health insurance is that it is usually cheaper than individual health insurance and you can get instant coverage for pre-existing diseases without any waiting period. This makes it a good choice for both employers and employees.
Group health insurance plans typically cover a wide range of medical costs, including hospital stays, surgeries, medicines, and follow-up care after hospital treatment. Some plans may also cover doctor visits and other outpatient treatments.
Top Reasons to Buy Group Health Insurance
- Important for Jobs: A study by the Society for Human Resource Management (SHRM) shows that 60% of employees think health insurance is very important when picking a job.
- Increase in Work Productivity: The World Health Organisation (WHO) says that bad health can reduce work productivity by 20-25%.
- Tax Savings: If the employer pays for health insurance, they can save taxes as it can be treated as expenses. Not offering this means missing out on tax benefits.
Who Should Buy Group Health Insurance
Group health insurance is a good option for businesses that want to offer health coverage to their employees. Here’s who should consider buying it:
1Businesses with Employees
If you own a business and have employees, offering group health insurance can be a great way to take care of their health needs. It can help attract and keep good workers.
2Businesses Wanting to Improve Employee Satisfaction
Offering health insurance shows your employees that you care about their well-being. It can increase loyalty and make your business a better place to work.
3Small to Medium-Sized Businesses
If you run a small or medium-sized business, group health insurance can help you compete with larger companies in attracting top talent.
4Companies That Want to Stay Competitive
Group health insurance can help your business stand out when recruiting employees, making you more competitive in the job market.
Benefits of Group Health Insurance for Employers
- Keep & Attract Employees: Offering group health insurance is a great benefit for workers. It helps keep current employees happy and attract new ones.
- Saves Money: Insurance companies can cover many people under one policy, making it cheaper for the employer to buy the insurance.
- Extra Protection: If an employee faces a serious illness, the employer can add extra coverage (called a corporate buffer) if the original insurance amount is used up.
- Builds a Good Reputation: Giving employees group health insurance shows that the company cares about their well-being, which helps create a good reputation in the workplace.
Benefits of Group Health Insurance for Employees
- No Medical Checkup: Employees don’t need to undergo any medical tests before getting group health insurance.
- Cashless Claims: Employees can get treatment at a network hospital and complete the cashless claim process in 45-60 minutes.
- Coverage Before & After Hospital Stay: The insurance covers medical costs before and after the employee's hospital stay.
- No Waiting Period: Unlike individual health plans, there is no waiting time for certain health issues under a group health insurance plan.
- Infant Coverage from Day 1: The employee’s newborn baby is covered from the moment of birth.
- Reimbursement Claims: If the employee goes to a non-network hospital, they can submit a reimbursement claim within 15 working days.
- Room Rent Coverage: 1% of the insured amount is provided for a normal room and 2% for an ICU. Some insurers offer no limits on room rent.
- ESKP (Employee, Spouse, Kids, and Parents): The insurance also covers the employee’s family, including their spouse, children, and parents.
Key Features of Group Health Insurance
Here are some important features of group health insurance for employees:
1Extra Expenses
Corporate health insurance covers costs like ambulance services.
2No Medical Tests
Employees can join the insurance without needing to take any medical tests.
3Affordable Protection
Group health insurance is cheaper than individual health insurance plans.
4Cashless Treatment
Employees can get treatment at network hospitals without paying upfront, making it easier financially.
5Additional Health Benefits
Employers can offer extra benefits like regular health check-ups, mental health support, and doctor consultations to improve employee well-being.
6Pre and Post-Hospitalization Coverage
The insurance covers medical expenses before and after hospitalization, including 30 days before and 60 days after being discharged.
7Day Care Procedure
It covers treatments that don’t need an overnight stay in the hospital, making it easier and cheaper for employees.
8Pre and Post-Services
This policy covers care before and after treatment, like doctor visits and follow-ups, to ensure complete recovery.
9Pre-existing Conditions
It also covers existing health issues without any waiting period, so employees don’t need to worry about previous health problems.
10Maternity Benefits
Group health insurance also provides coverage for pregnancy, childbirth, and aftercare for both the mother and baby.
Difference between Group Health Insurance and Personal Health Insurance
| Features | Group Health Insurance | Personal Health Insurance |
|---|---|---|
| Definition | Insurance provided by employers or organizations to a group of people (employees, members). | Insurance purchased by an individual or family for personal coverage. |
| Policy Holder | Employer or organization is the policyholder. | The individual or family is the policyholder |
| Eligibility | Coverage is typically extended to employees, members, or their families. | Available to any individual or family, regardless of employment. |
| Coverage Scope | Includes a group of people with similar coverage terms. | Coverage terms are tailored to the individual’s needs. |
| Cost Sharing | Often subsidized by the employer or organization. | The individual is responsible for paying the full premium. |
| Customization | Generally not customizable; same plan for all members. | Fully customizable based on the individual’s healthcare needs. |
| Renewability | Typically renewable as long as the individual remains with the employer or organization. | Renewable as long as premiums are paid, with no employment link. |
| Portability | Coverage often terminates when leaving the employer or organization. | Coverage remains with the individual regardless of job status. |
| Waiting Periods | Typically shorter or waived for existing employees. | May have longer waiting periods for pre-existing conditions. |
| No Claim Bonus | Cannot be accessible | Can be accessible |
| Coverage Type | Limited or basic coverage options depending on the employer’s plan. | Extensive coverage options including add-ons like dental, vision, etc. |
Inclusions and Exclusions of Group Health Insurance
1Inclusions
Corporate health insurance covers costs like ambulance services.
- Hospitalization Coverage: Your hospital stay costs are covered! This includes charges for nursing, medicines, doctor’s fees, room rent, and more.
- Day Care Treatments: There are over 150 treatments that need less than 24 hours of hospitalization, and those are also covered!
- Pre and Post Hospitalization Expenses: If you have expenses 30 days before or 60 days after your hospital stay, those are covered too.
- Healthcare at Home: If there aren’t enough beds at the hospital, you can get treatment at home, covered up to a certain amount.
- Maternity Coverage: Whether it’s a normal delivery or a C-section, your delivery-related expenses are covered.
- AYUSH Treatments: Treatments like Ayurveda, Unani, Siddha, and Homeopathy are covered up to your plan’s limit.
2Exclusions
- Self-Harm: Injuries you cause to yourself on purpose are not covered.
- Unproven Treatments: Treatments or medicines that are still being tested or not commonly accepted are not covered.
- Dental and Eye Care: Regular dental check-ups or eye care are not covered, though some policies may include a small part of these.
- Drug or Alcohol Problems: Health issues caused by drug or alcohol use are not covered.
- Non-Medical Costs: Things like travel, stay, or personal items during hospital visits are not paid for.
- Risky Activities: If you get hurt while doing dangerous things like adventure sports or risky jobs, it’s not covered.
- HIV/AIDS: Costs for treating HIV or AIDS are not included.
- War or Radiation: Any sickness or injury caused by war or nuclear radiation is not covered.
- Cosmetic Surgery: Beauty treatments or surgeries are not covered unless needed after an accident or for medical reasons.
Group Health Insurance Add-Ons
Here are some add-ons that you can add to your group health insurance for better coverage:
- OPD Cover: You can get money back for doctor visits and tests that don’t need a hospital stay.
- Newborn Baby Cover: Newborn babies are also covered under the maternity limit.
- Extra Coverage (Corporate Buffer): If your total cover amount gets used up, you can get more coverage by paying a bit extra.
- No Waiting Time for Maternity: Normally, you have to wait 9 months for maternity cover, but this waiting time can be removed.
- Maternity Cover: Costs during childbirth are covered, but only up to a certain limit.
Eligibility Criteria of Group Health Insurance
- A company can buy group health insurance if it has at least 7 employees.
- If the company has less than 7 employees, it can still get the insurance by including the family members (dependents) of employees so that the total number of people covered becomes 7 or more.
Documents Needed to Make a Group Health Insurance Claim
You need to submit the right documents to get your claim approved. Here's what you need:
- The original discharge summary from the hospital.
- Receipt showing the payment made for the hospital bill.
- Test reports and medicine bills with the doctor’s advice.
- A valid photo ID of both the patient and the employee.
- The final hospital bill with a clear list of all charges.
- Hospital certificate showing a number of beds and facilities signed and stamped on hospital letterhead.
- If any implant (like a stent or joint) was used, the original bill and sticker for it.
- A canceled cheque with the name of the insured person printed on it, or a self-attested bank statement/passbook copy showing account details and IFSC code.
Extra Documents for Accident-Related Claims
- Copy of MLC (Medico-Legal Case) or FIR, if available.
- If not available, the doctor must give a written explanation.
- The doctor should also confirm that no harmful substance (like drugs or alcohol) caused the accident.
How to Claim Group Health Insurance?
1Cashless Claim (For Planned Hospital Stay)
Use this method if you are getting treated at a network hospital (a hospital tied up with the insurance company).
Steps to Follow:
- Fill out a pre-approval form at the network hospital at least 48 hours before your hospital stay.
- The TPA (Third Party Administrator) will approve your request and confirm the cashless claim within 2 hours.
- On the day of admission, carry your health card number and photo ID.
- At discharge, the insurance company will pay the hospital directly - you don't have to pay.
2Reimbursement Claim (For Non-Network Hospital or Emergency)
Use this method if you are treated in a hospital not in the network or in an emergency.
Steps to Follow:
- Tell your relationship manager within 24 hours of getting admitted.
- After discharge, submit the claim form and all required documents within 30 days.
- Keep all original bills, reports, and discharge papers safe.
- The insurance company will check your documents and bills.
- Share a canceled cheque to receive the money in your bank account.
- If everything is fine, the claim will be processed in 15–21 days (as per policy rules).
Why Buy Group Health Insurance from Square Insurance?
Here’s why choosing Square Insurance is a good idea:
- Help in Buying: We give you quotes from different insurance companies so you can pick the one that fits your needs best.
- Quick Quotes: You get instant quotes to compare and decide fast.
- Claim Support: Our team helps you through the claim process and makes sure it’s done smoothly.
- Personal Help: You get a dedicated manager who supports you with questions, claims, and renewals - step by step.