What is Group Health Insurance Policy? Explained for Better Employee Healthcare

  • postauthorRaj
  • postdateAugust 5, 2021
  • postreadtime11 min read
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As an owner/founder of a startup or SME, you are required by law to provide employee healthcare benefits to your team. Most medium and large companies take advantage of group health policy. But what is group health insurance policy?

Here’s a look at this thorough what is group health insurance policy guide for better employee healthcare.   

As a small business, startups and MSMEs, you too can take advantage of group health insurance policy for your employee’s health. Alternatively, you can go beyond these plans, and offer other employee health benefits like teleconsultations, discounted medicines health check-ups, etc. Getting such a plan, with all these value-added benefits, gives your employees more ways to take care of their health. In this blog, we have broken down what these plans are, and the benefits they can provide both to employers and their teams. That way, you will know what to look out for when selecting your ideal plan. Moreover, you will also find out how Onsurity’s plans help you provide comprehensive employee healthcare with group health insurance policy to your team. 

What is Group Health Insurance Policy? 

These plans are, as the name suggests, health insurance plans for a ‘group’ of people. Usually, that group is an organization. Like any other insurance plan, group health insurance policy provide coverage for basic health and medical expenses, as well as surgeries and hospitalization. Many large companies prefer corporate health insurance, which most likely includes group health insurance plans for their employees as well. This is because: 

  • Group health insurance policy is cheaper per employee than individual health insurance plans 
  • Individual medicals and underwriting might be waved off, therefore all employees mostly get covered 
  • Plans can be customized based on the organization’s needs and finances 
  • Some plans offer a wider range of employee healthcare benefits like discounted medicines, teleconsultations etc

Advantages of Group Health Insurance Policy

Attract and Retain Employees

Good quality employee health benefits are vital to attracting new employees, as well as retain old ones. The Society for Human Resource Management found that 46 per cent of employees said: “health insurance was either the deciding factor or a positive influence in choosing their current job.” So, if you want to hire and retain the best talent, you need to invest in quality group health insurance policy. 

Tax Benefit

The money put towards healthcare benefits for employees can also be claimed under tax benefits of group health policy. That means you aren’t just saving on expenses, but taxes. It is a good reason to invest in group health insurance plan as soon as possible. There is, however, one thing you need to know. To be eligible for such a group plan, your organization has to have a minimum of seven, full-time employees. Usually, group health insurance policies do not extend to part-time, contract or freelance staff. It’s all part of the changes to India’s labor laws. 

Motivate Employees

Rising medical, dental, and vision costs are still a top concern for employees, despite the growing popularity of a range of employee benefits. Employer sponsored healthcare plans assist employees in avoiding the exorbitant expenses of medical care, as well as, to a lesser extent, dental and eye care. As a result, having a corporate group health insurance policy motivates employees and enhances productivity.

Features of Group Health Insurance Policy

Hope the question, what is group health insurance policy, has been answered. Now it is time to take a look at the features of group health insurance.  If one is unfamiliar with the features of a Group Health insurance policy offered by insurers, making a decision may be difficult. As a result, it is beneficial to gain a sufficient understanding of the services provided by any service provider.

Some important features of group mediclaim policy are:

No Waiting Period

The leading providers will not include a waiting period clause in any group health insurance policy. There is no waiting period, which implies that the coverage is available from the first day of employment. Even expenses for chronic diseases such as diabetes and urgent operations for hernias, such as knee replacement, can be cover. Employees who are planning to start a family are also automatically eligible for maternity and postnatal benefits, without having to wait.

Cashless Hospitalization

The cashless claims during hospitalization service cuts down on paperwork and saves time for both management and employees. This feature is frequently included by some very few providers to make it a natural choice for a variety of businesses. After all, who doesn’t want to cut down on paperwork?

Some employers incorporate the ‘hospital network’ in a group health policy in addition to the cashless option. There are reputable health care centers in the network offering discounts.

No Co-Pay

Under Co-Payment in insurance, employees are not required to pay a percentage of medical or hospitalization expenditures out of pocket under some top group health insurance policies. The best plans will cover the entire cost, and the company will not be accountable for a single cent of the medical bill payment.

Is Group Health Insurance Mandatory?

Yes, after the nation-wide COVID-19 lockdown in 2020, medical insurance for employees has been mandatory. There was no clear rule requiring such a cover prior to 2020. However, following a pandemic-plagued year, the authorities have enacted additional laws in this area. Medical insurance for employees will be made mandatory as of April 1, 2020, according to a circular released by the Insurance Regulatory and Development Authority of India (IRDAI).

Moreover, most small businesses were not aware of such group insurance policies. It was only after the pandemic that they started asking this question of, what is group health insurance policy. Following the shutdown, businesses were required to follow a Standard Operating Procedure for resuming operations, which included providing workers with insurance. In addition, the IRDAI recommended non-life insurers to develop policies that are comprehensive, inexpensive, and easy to understand.

Common Inclusions in Group Health Insurance

Most commonly available group health insurance covers the following things:

  • A group of people are usually covered by a group health insurance policy
  • It pays for medical expenses incurred as a result of illnesses, diseases, or accidents
  • It also covers charges incurred prior to and after admission to the hospital
  • A member’s spouse and children or other dependents can be added to a group health insurance coverage for an additional fee
  • The policy allows for cashless transactions and direct billing to the hospital
  • It is also possible to claim reimbursable domiciliary expenses
  • As each firm has a distinct workforce strength, the pricing of employee health insurance or corporate health insurance programs varies

Common Exclusions in Group Health Insurance

Here are some common exclusions in group health insurance:

  • Most group health insurance programs do not cover pre-existing conditions
  • Medical procedures or tests that are required are not usually covered
  • War-related injury or disease is also not taken into account
  • Corporate group health insurance coverage do not cover external durable goods like a wheelchair or lenses
  • Treatments related to cosmetics and dental unless necessitated by accident are excluded as well

Group Health Insurance vs Individual Health Insurance

What is Group Health Insurance Policy?

  • In this case, the firm serves as the primary point of contact for the group health insurance provider
  • Only the employer has the authority to terminate a group health insurance policy in most cases
  • Usually a group health plan is in effect for the duration of the employee’s employment with the company
  • A group health policy is essentially based on the strength of the organisation, both financially and employee strength
  • The insurer does not undertake pre-medical check-ups in a group health insurance plan, which decreases the possibility of policies being refused

What is Individual Health Insurance Policy?

  • Each individual is the direct point of contact with their particular insurer in this scenario
  • Every person has the right to cancel their insurance policy at any moment
  • An individual policy is valid for as long as the premium is paid on a year-to-year basis
  • Typically, any individual health insurance policy will have pre-medical examinations performed on the basis on which policies are provided
  • Individual group health insurance policies are generally based on an individual’s age, medical history, health issues, and other factors

How to raise a claim for Group Health Insurance?

To avail cashless claim follow these common steps:

  • You can get cashless treatment at any of the partner network hospitals across the country
  • In the case of an emergency hospitalisation, notify the insurer within 48 hours, and three days before admission in the case of a planned hospitalization
  • At the hospital’s insurance desk, provide your health insurance cashless card and a valid photo ID
  • After receiving your request, the insurer may take up to 2 hours to respond, and you will be notified of their decision via e-mail and SMS
  • You can also monitor the status of your application online
  • After all of the formalities are fulfilled, the claim will be processed according to the policy’s terms and conditions

Common practises for a Reimbursement claim:

  • Unless a pre-authorization has been provided, you must notify the insurer within 48 hours of an emergency admission and pay the charges directly to the hospital
  • Claim paperwork must be collected and submitted within 15 days of hospital discharge
  • The insurer will approve or reject the documents based on the terms and policies after reviewing them
Group health insurance explained

Group Health Insurance Explained by Onsurity’s Partner 

Here are just some of the reasons 200+ SMEs and start-ups in India have opted for Onsurity: 

  • Essential CoverageYour plan covers both pre-and post-hospitalization expenses, AYUSH treatments, day-care treatments, in-patient hospitalization and up to 2% of the room rent.  That’s more than most other plans on the market.  
  • Waiting Period: Accidental hospitalization is covered from day 1, COVID-19 after 15 days and specific illnesses after 30 days. Pre-existing diseases come with a waiting period of 4 years.  
  • Plan Flexibility: As an organization, your pay for your team, and they have the option of adding their family to the subscription. It’s a healthcare plan that puts your employees needs first.  
  • Claims and Reimbursements: Through the Onsurity app, you can quickly apply for claims and reimbursements for hospitalization. Our specialized in-house Good Doctor Team is always available to help in case you have any issues.  

What’s covered in Group Health Insurance policy by Onsurity

  • In-patient hospitalization [24 hours or more] with Covid-19 coverage
  • Day Care treatment for illness which require less than 24 hours of hospitalization, 30 days pre-hospitalization and 60 days post hospitalization
  • Ambulance Charges up to INR 2500 per claim
  • Hospital Normal Room Rent – 2% of Sum Insured
  • Hospital ICU Room Rent – 5% of Sum Insured
  • Ayurveda, Unani, Siddha and Homeopathy are covered too

What’s not covered in Insurance policy by Onsurity

  • Maternity
  • OPD Expenses
  • Treatment which does not require hospitalization for more than 24 hours
  • Treatments related to cosmetics and dental unless necessitated by accident
  • Standard exclusions

Onsurity Plus Membership

We at Onsurity, believe in the power of preventive healthcare, so we built a platform that gives you and your team added benefits. These services are all available with your plan you choose. The Onsurity app comes with access to doctor teleconsultations, so no health scare is too small to ignore. From the comfort of their home, your employees can consult the best doctors in the country, when they need to. 

With Onsurity Plus, you can facilitate the healthcare and provide employees with the necessary healthcare benefits. Onsurity Plus Membership has been built for SMEs and start-ups. Our wellness membership plans include different healthcare benefits like teleconsultations, online medicine ordering and complimentary group health insurance policy to members provided by our insurance partner. All that, at an affordable subscription that doesn’t eat into your working capital.  

Our other partners also give you access to digital lab test booking and medical stores. So, your employees can easily have all their medical needs tended to in just a few taps. We at Onsurity believe that everyone should have access to quality healthcare that isn’t expensive. That’s why we built a product that gives employers like you a more affordable and practical employee healthcare plan. Our plans are more comprehensive while being economical without compromising on quality. 

We hope that we answered your question, what is group health insurance policy? To join the digital healthcare revolution, simply head to the Onsurity website and share your company details for our personalized plan variants.

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