The questions you'd rather not have to ask.Answered plainly.

Ethika is a group health & employee benefits broker. We're an IRDAI Direct Broker, which means we're licensed to advise on cover, place it with insurers, and stand with you when a claim is tested — on your side, not the insurer's. We design two halves of the same system: the everyday benefits people actually use (Rise) and the safety net for the day something goes wrong (Protect).

A broker represents you, the client — not any single insurer. We're insurer-agnostic: we recommend cover on its merits for your people, and when a claim is disputed we argue your case.

The precise scope of a broker's duties is governed by the IRDAI (Insurance Brokers) Regulations, 2018; the exact wording on this page is to be confirmed with counsel before launch.

A broker's remuneration is built into the premium structure and regulated by IRDAI — you don't pay extra to have a broker in your corner.

Remuneration rules sit within the IRDAI (Insurance Brokers) Regulations, 2018; this explanation is to be confirmed with counsel before launch. We don't show pricing on this site — cover and cost are shaped to your organisation in conversation.

An agent represents one insurer and sells that insurer's products. A bank tied to an insurer is similar. Buying direct means you deal with one insurer's own team. A broker is different: we're licensed to work across insurers and act for you — comparing the market, designing the plan, and being the point of contact when a claim is disputed. The honest version: a broker earns its keep in plan design and in the claim, not just at purchase.

Employer-paid group health premiums are commonly treated as a business expense, and employee-paid voluntary premiums may have their own tax treatment.

Tax outcomes depend on current law, your structure and the regime employees choose — we're not tax advisors, so the specifics should be confirmed with your finance team or a qualified advisor.

That's a fair description of how a lot of broking works — visible at sign-up, then quiet until something breaks. We're built the other way round. The everyday half (Rise) is meant to be used all year, and the safety net (Protect) is staffed by a real team your people reach directly when a claim goes wrong — not a portal that wakes up once a year.

When something goes wrong, your employee reaches Red Carpet — a real Ethika team — not a portal and not the insurer's call centre. They pick up, they stay on it, and they reach the claim before the insurer does. The advisors you'll meet stand for the whole team; we don't assign one named person to one claim, so support never depends on who's at their desk that day.

Every claim comes to Ethika first. Our team audits it before it's ever submitted, so problems get caught on your side of the table — early and quietly, instead of after a rejection. If a denial or deduction comes anyway, a specialist takes it: the policy read line by line, the medical record matched against the exclusion being claimed, the escalation built in writing.

Most disputes trace back to a handful of patterns: a treatment still inside a waiting period, a permanent policy exclusion, a documentation or filing gap, a non-disclosed pre-existing condition, or a sub-limit being triggered.

The specific reason always rests on your policy's own wording, and what can be reversed depends on which pattern applies; this is general information, not advice on a particular claim. Our job is to read the clause against the medical record and argue the case where the policy allows.

A room-rent sub-limit caps the daily room cost the policy will cover; a disease sub-limit caps payout for a specific procedure regardless of the overall sum insured. If a member takes a room above the cap, some policies apply a proportionate deduction across linked charges.

How these clauses apply — and what protections exist — depends on the policy wording and current IRDAI rules; we'll walk your team through your specific plan rather than generalise. Plan design is where most of this pain is prevented.

Cashless means the insurer settles directly with a network hospital, so the member doesn't pay upfront — usually after a pre-authorisation step. Reimbursement means the member pays and claims it back with documents, more common at non-network hospitals. The same Ethika team fronts both; we don't hand your people to a portal depending on which route they're on.

No — and no one honestly can. We fight a claim as far as the policy's own words allow. What we can promise is the fight, and that your people won't face it alone.

We make no representation as to claim outcomes; settlement rests with the insurer under the policy terms. Final wording to be confirmed with counsel.

Group cover has historically come with minimum-headcount thresholds, and they vary by insurer.

The current minimums and the smallest team we can place cover for are to be confirmed before launch. The honest route is a conversation — tell us your headcount and we'll tell you plainly what's possible.

In many plans, yes — employees can enhance their sum insured, add dependents including parents, or opt into a voluntary top-up, usually at enrolment or renewal and often at their own cost.

Exactly which options apply, and on what terms, depends on the plan we design with you and the insurer; specifics to be confirmed for your policy.

A high claims ratio at renewal is one of the most common pressures HR brings us. There's no magic number we can promise, but there are honest levers: plan-design changes, structuring cover so everyday needs don't all land on the hospitalisation policy, negotiating across insurers rather than accepting one renewal quote, and helping employees use benefits earlier so problems are smaller. We'll give you a straight read on what's realistic for your group.

Surprises usually come from terms quietly changing at renewal and not being communicated. Our answer is the boring-but-effective one: surface every material change to you before it's signed, and communicate it to employees in plain language through the Hub, so a co-pay or sub-limit isn't discovered for the first time at a hospital counter.

Adding joiners and removing leavers mid-term — endorsements — is routine, and on the Hub it's meant to be a few clicks rather than a paperwork chase, with a real team behind it if something needs sorting.

The exact endorsement turnaround and any insurer cut-off dates are confirmed for your policy.

It's one useful signal, but a single headline ratio can hide how an insurer behaves on the hard, disputed claims that actually matter to your people. We weigh it alongside how a claim is serviced on the ground, the network, and the policy wording — and we'll give you a straight read rather than picking an insurer on one number.

In plain terms: a Group Mediclaim (GMC) policy covers hospitalisation; a Group Personal Accident (GPA) policy covers accidental injury, disability or death; and statutory schemes like ESI are mandated for eligible employees under their own rules. They do different jobs and often sit together.

Which are required versus optional for your organisation depends on your workforce and the law; we'll map it with you, and statutory specifics are confirmed with counsel.

Maternity and parenting support sit within the everyday half of what we run, and group cover often handles maternity more generously than a retail policy would.

Whether maternity and newborn cover is part of your base plan or added on — and on what limits and terms — depends on the plan we design with you and the insurer; we confirm the specifics for your policy rather than quote a figure here.

Yes — the everyday half (Rise) is built for exactly this. Alongside hospitalisation, the things people use day to day can include outpatient consultations, pharmacy, dental and vision check-ups, preventive health checks, and onsite wellness.

Which of these apply to your plan, and their annual limits, are confirmed for your policy — we don't list numbers on the site.

About Rise →

Yes. Mental health is part of the everyday support we run, alongside themes like cancer, maternity, parenting and daily meditation.

The exact form this takes for your people — and any newer programs — is confirmed before it appears in your plan. Where mental health sits inside the insured policy versus the wellness layer follows IRDAI rules and the policy wording, confirmed with counsel.

Every policy carries exclusions — areas it simply doesn't pay for — and they're where a lot of claim surprises come from.

The exact exclusions are set by your policy wording and current IRDAI rules, so we won't generalise them here. What we do is walk your team through your plan's exclusions in plain language up front, so they're known before a claim, not discovered during one.

We offer PoSH training.

Full PoSH compliance — constituting the Internal Committee, the external member, case handling and statutory filings — is a partner-managed add-on, not something we deliver ourselves; the precise boundary is confirmed with counsel. We'll point you to the right support rather than overstate what we do.

Group cover is tied to employment, so it generally ends around the last working day.

Under IRDAI rules, an employee can usually migrate or port group cover to an individual policy with the same insurer, subject to conditions and timelines — the exact window and eligibility depend on the policy and current regulation, so we confirm the specifics rather than quote a number here. We help your leavers understand their options so no one falls through the gap.

Generally, cover holds while the group policy is active for that member — which usually includes the notice period up to the last working day — and ends when membership ends.

The precise cut-off and any grace provisions are set by the policy and IRDAI rules; we'll confirm against your specific plan rather than generalise.

A lapse between policy periods is exactly the gap that hurts — an emergency in an uncovered window can leave a claim impossible to file.

Whether an employer carries any obligation in that gap is a legal question that turns on your own policies and contracts, not something we can answer generically. What we can do is manage renewal timing so the gap doesn't open in the first place, and flag it early if one is approaching.

A company has two jobs for its people: help them rise, and protect them when they fall. Protect is the safety net — cover and claims, fought for you — for the day something goes wrong. Rise is the everyday half — personalised benefits that fit each person and actually get used. One worldview, organised into two halves.

About Protect →  ·  About Rise →

Ethika Hub is your whole benefits world in one place — one view for HR, one app for your people — with a real team behind every screen. It's the connective layer that runs both Protect and Rise; it doesn't replace the people, it gives them somewhere to work from.

About Ethika Hub →

Often, yes. Where a global broker owns the programme, we can co-lead on how benefits are delivered and how claims are fought on the ground in India — the day-to-day service layer your people actually touch. We'll be straight in the call about where we add to what you already have and where we don't.

We treat employee and health data as sensitive by default and collect only what a benefit or a claim genuinely needs.

Our handling of personal data is governed by our Privacy Policy and India's Digital Personal Data Protection framework; the full statement of purposes, retention and your rights lives on the Privacy Policy page, to be confirmed with counsel before launch.

Privacy Policy →

Yes. Non-essential cookies are off until you opt in, and any consent box is unticked by default. We never put personal details into web links or query strings.

See our Cookie Policy for the categories and how to change your choice; final wording to be confirmed with counsel.

Cookie Policy →

The honest read comes first: in the call we'll tell you plainly whether a change would help your people, or whether you're already well served. If it does make sense, the move is something we manage around your renewal so cover stays continuous — we'll walk you through what changes for HR and what changes for employees before anything is decided.

Group benefits used to be framed as a large-company perk, and a lot of founders were told to come back when they were bigger. That's changed.

The team sizes and stages we serve best are to be confirmed before launch — the simplest path is a conversation, where we'll be straight about whether we're the right fit for where you are now.