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What is Group Health Insurance?
Group health insurance is a type of health insurance policy that provides health insurance coverage to a group of members under a single policy. The policy compensates the insured members of the policy up to the sum insured limit mentioned under the policy in return for a premium amount. Group health insurance policy is usually taken for a period of 1 year, after which the policy can be renewed on payment of renewal premium.
Group health insurance policy doesn’t require pre-policy medical checkups, unlike personal health insurance policies, which might require pre-acceptance policy checkups depending on the type of proposal. The sum insured under the group health insurance policy will be decided by the employer, it is the employer who generally pays the premium under the group health insurance policy.
There might be instances where the premium for a group health insurance policy is collected from the employees of the organization.
The coverage under the group health insurance may vary for the employees. There might be the different sum insured options under a single group health insurance policy. A group health insurance policy can be taken on an individual basis as well as a floater basis.
In individual policy only the employees of the organization would be covered and the sum insured availability would be restricted to them only.
In the case of floater policies, the sum insured would be floating among the family members who can utilize the sum insured without any restrictions.
The premium under the group health insurance policy depends on the number of members in the policy, the age of the employees, and the sum insured required. The higher the overall sum insured under the policy, the higher would be the premium to be paid under the policy.
A group health insurance policy requires a minimum of 7 members to be covered under the policy to satisfy the minimum number of lives requirement.
As per the Insurance Regulatory and Development Authority of India, it is mandatory to have at least 7 members under the group health insurance policy to avail of the coverage.
The premium would vary from one insurance company to another and also the minimum number of lives requirements. There are certain companies that have a minimum requirement of 15 members and certain companies which have a minimum requirement of 7.
It is advisable to go through an insurance broker while purchasing the group health insurance policy as the insurance brokers would be well versed with the terms and conditions of the policy and deal with multiple insurance companies.
Insurance brokers can advise the customer on the insurance company depending on their requirements. Insurance brokers also offer value-added services in addition to regular services.
Coverage in Group Health Insurance:
Group health insurance policy covers the following:
- In-patient hospitalization expenses incurred by the insured members up to the sum insured mentioned under the policy.
- Day care hospitalization expenses incurred by the insured members up to the sum insured mentioned under the policy.
- Room rent and ICU expenses as specified under the policy.
- Pre and post hospitalization expenses for a certain number of days as mentioned under the policy. Pre hospitalization expenses cover the expenses incurred prior to the hospitalization whereas the post hospitalization expenses includes the expenses incurred after the hospitalization and discharge from the hospital.
- Emergency ambulance charges on a per event basis or per hospitalization basis.
- Waiver of all the waiting periods under the policy. Pre-existing waiting period is the waiting period for the conditions that exist prior to the inception of the policy. The specific waiting period in which certain illnesses would be covered only after a certain period of time. An initial waiting period of 30 days where no illness or disease related expense would be covered except for accident related hospitalization expenses.
- Group health insurance policy also covers maternity expenses. The expenses incurred by the insured members for maternity and other related would be covered under the policy up to a certain sum insured limit. The maternity sum insured would be over and above the basic sum insured under the policy.
- Group health insurance policy also covers the newborn baby. All the vaccination and other related expenses incurred by the newborn baby would be covered under the policy. The newborn baby cover would include the sum insured either from the basic sum insured or the maternity sum insured.
- Cashless claim settlement service at any of the network provider hospitals. Network provider hospitals are the hospitals that are tied up with the insurance company to offer cashless claim settlement to the insured customers.
- No requirement for pre-policy medical checkup under the group health insurance policy.
- The policy can also be extended to cover the family members of the insured employee on payment of additional premium.
Exclusions:
- Group health insurance policy doesn’t cover the injuries arising out of war or war like situations.
- The policy would not cover the expenses related to dental treatments.
- Group health insurance policy would not cover the cosmetic related treatments.
- The policy also doesn’t cover the medical expenses arising out of intentional self-injury or attempt to suicide.
Top Insurance Companies offering Group Health Insurance:
- ICICI Lombard group health insurance policy can be purchased online from here.
- Bajaj Allianz group health insurance policy can be purchased online.
- IFFCO Tokio general insurance group health insurance policy can be purchased from here.
- New India assurance group health insurance policy can be purchased from here.
- Royal Sundaram group health insurance policy can be purchased online.
- TATA AIG group health insurance policy can be purchased online.
- Oriental insurance group health insurance policy can be purchased online.
- New India group health insurance policy can be purchased from here.
- Go Digit group health insurance policy can be purchased from here.
- HDFC Ergo group health insurance policy can be purchased from here.
- Star group health insurance policy can be purchased from here.
- Care group health insurance policy can be purchased from here.
- Aditya Birla group health insurance policy can be purchased from here.