What is Group Health Insurance: The Ultimate Guide

  • postauthorEditorial Staff
  • postdateMay 27, 2024
  • postreadtime16 min read
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Group Health Insurance

In today’s complex healthcare landscape, providing your employees with the right group health insurance or employee health insurance is essential. A group health insurance policy is a type of coverage you, as an employer, offer to your employees and in many cases, their family members.

Unlike individual health insurance, group health insurance is purchased by an employer and extended to a group of employees, resulting in a beneficial spread of risk across a larger pool which makes such plans affordable.

Group health insurance plans are typically more cost-effective and provide broader coverage compared to individual policies. Many group health plans also include pre- and post-hospitalisation benefits, regular health check-ups, and coverage for pre-existing diseases. Key features of a good plan should include reasonable waiting periods and an extensive network hospitals.

Investing in corporate health insurance for employees protects them and enhances job satisfaction, productivity, and corporate reputation.

Remember, a healthy workforce is the backbone of any successful business.

Also, Read: Cashless Health Insurance

What is Group Health Insurance?

Group health insurance is a group insurance product offered by insurance companies, specially designed to cater to the healthcare needs of an organised group, typically employees of a company.

The essence of group health insurance is its inclusiveness, providing coverage without imposing stringent medical checks, as the risk is spread over multiple individuals. Tailored to fit an organisation’s budget and needs, these policies often include additional benefits such as discounted medicine orders, annual health check-ups, or free doctor tele-consultations.

Why is Group Health Insurance Important?

Group health insurance in India provides both employees and employers with significant protection against diverse healthcare expenses. This comprehensive coverage extends beyond hospitalisation, covering pre- and post-hospitalisation expenses, maternity benefits and more.

Moreover, for employers, group health insurance boosts retention rates and offers tax incentives in most cases. For small businesses in particular, it’s a cost-effective method to offer their employees access to healthcare coverage, giving employees the necessary peace of mind and in turn, boosting their productivity.

Here are some key features:   

  • Cost-effective  
  • Potentially boosts retention rate 
  • Family cover
  • Convenient claims process 
  • Tax incentives  

Furthermore, it provides a safety net for those impacted by the high cost of healthcare in India. From this perspective, group health insurance isn’t just a financial product – it’s a lifeline. 

Also, Read: Employer Employee Insurance

How Does a Group Health Insurance Policy Work?  

A group health insurance policy is a bouquet of health insurance benefits that cater to employees and in many cases, their families. It serves as a strong shield during medical emergencies, alleviating financial stress.

A group mediclaim policy covers aspects like doctor visits, hospital stays and prescription drugs. It’s usually funded by the organisation, making it an attractive employee benefit. With flexibility at its core, the policy can be tailored to meet specific needs including sum insured, coverage options, and addition of dependents.

Key features may include:

  • Coverage for hospitalisation expenses
  • Benefits for day-care procedures
  • Maternity benefits

It extends beyond just being beneficial for employees. For you as an employer, it facilitates talent attraction and retention, promoting a productive and healthy workforce. Moreover, since the policy is spread across a group of individuals, the risk factor lowers significantly, making group health insurance policies more affordable than individual plans.

Who Should Purchase Group Health Insurance? 

If you are a business owner and have a team that works with you, you should consider investing in group health insurance. From startups to established businesses, any company wishing to boost employee morale and productivity should consider offering insurance and healthcare benefits.

It’s important to remember that the benefits of group health insurance extend beyond mere corporate health cover; it’s a safety net for your team and their family’s welfare, ensuring they can focus on their work without worrying about healthcare-related costs. 

who should purchase group health insurance

1. Startups 

For startups, purchasing group health insurance isn’t merely a strategic move. It’s a foundational step to building trust. By procuring a group health insurance policy, you signal to your employees that their well-being is a priority in your company, which enhances the attractiveness of your startup for prospective talent and significantly boosts employee retention rates.

In addition, it’s a savvy financial decision as it paves the way for substantial tax savings in the long run.

Some key benefits of group health insurance for startups include: 

  • Attracting top talent 
  • Enhancing employee retention rates 
  • Boosts morale and overall work productivity  
  • Tax benefits in many cases

2. SMEs (Small and Medium Enterprises) 

As your startup evolves into an SME, group health insurance becomes an essential tool in maintaining high morale and productivity among your employees. The financial stress triggered by medical or healthcare expenses can be significantly alleviated through a group mediclaim policy which covers not just the employees but often, their families as well.

Here is why SMEs should consider group health insurance:   

  • It reduces stress related to unforeseen medical or healthcare expenses. 
  • It enhances productivity by ensuring employees’ focus remains on work, not on potential healthcare costs. 
  • It instils a sense of security among employees, fostering a positive work environment. 

3. Large Enterprises 

For large corporates and established organisations, offering group medical insurance plans is expected and somewhat mandatory to uphold the company’s reputation. Having comprehensive coverage profoundly affects how potential hires perceive your organisation while reinforcing relationships with current employees by providing them with a feeling of security.

Here is why corporate health insurance is crucial for large enterprises:  

  • It upholds the company’s reputation as an employer who cares about employee welfare. 
  • It attracts quality talent that values these benefits. 
  • It fosters stronger relationships with current employees, creating a more supportive and empathetic work environment. 

Regardless of the size or niche of your company, offering group health insurance benefits is a testament to your commitment towards employee welfare and well-being. Your organisation becomes not just a workspace, but a nurturing environment where employees feel valued and secure.  

Remember, a great group health insurance plan will adequately cover your employees’ healthcare needs while aligning with the financial constraints of the company. So, it’s essential to choose the right plan from the wide array of group health insurance policies available today. 

Also, Read: Group Term Life Insurance for Employees

Key Features of Group Health Insurance 

Group health insurance is essential for business owners looking to provide comprehensive medical coverage to their employees. This type of policy is designed to offer peace of mind in the event of unexpected hospitalisation, whether for routine procedures or medical emergencies.

One of the most appreciated features of group health insurance is the cashless claim process that allows your team to receive the necessary treatment without bearing the costs out of their own pocket.

Furthermore, this insurance policy not only covers costs incurred during hospitalisation but also accommodates pre- and post-hospitalisation expenses such as diagnostic tests, follow-up check-ups, and medications, making it a comprehensive solution that safeguards your employees’ financial well-being.

Other key features include proactive health benefits like: 

  • Outpatient consultations 
  • Regular health check-ups 
  • Support for mental wellness 
  • Fitness and nutrition plans  
  • Dental treatment  

It is important to keep in mind that policy features may vary depending on your chosen provider, so it’s best to discuss your specific requirements in detail with your insurance partner. Group medical insurance is an invaluable tool for fostering an environment that prioritises wellness and recognises the essential role your team plays in the success of your enterprise. 

Related Read: Top 8 Key Features of Group Health Insurance

What is Covered under Group Health Insurance for Employees? 

The essence of group health insurance is the provision of comprehensive health cover to a team in an organisation. Simply put, it’s an umbrella policy provided by the insurance company to safeguard your employees’ healthcare expenses.  

As an employer, getting the best group medical insurance is integral to your workforce’s well-being. Ideally, the following should be covered under a good group health insurance policy in India for employees:

group health insurance inclusions
  • Pre-existing disease coverage: Unlike individual health insurance, employees are redeemed from the standard waiting period for pre-existing illnesses. 
  • Pre- and post-hospitalisation coverage: Expenses incurred before admission (up to 60 days) and after discharge (up to 90 days) from the hospital should be covered. 
  • Corporate health benefits: Benefits like regular health check-ups and wellness programmes should ideally fall under the policy’s ambit. 
  • Network hospitals and cashless hospitalisation: Access to network hospitals across India as well as seamless cashless hospitalisation should be offered under the policy. 
  • Family inclusion: Employees should be able to add their family members under the coverage. 

A group mediclaim policy can be one of the most critical employee benefits, providing coverage for minor ailments or significant health interventions. It will not only mitigate your employees’ financial burdens but also demonstrate your empathetic approach, making it one of the best tools for employee retention. 

Quick Read: Difference Between Network and Non-network Hospitals

What is Not Covered in Group Health Insurance for Employees? 

Group health insurance is a necessity. However, it’s important to understand that not all health conditions are covered under a group health insurance policy. According to the terms and conditions of a group health plan, certain exclusions apply.

group health insurance guide - exclusions

Primarily, the following are generally not included in a group health insurance policy: 

  • Specific treatments: Certain procedures like cosmetic surgeries or sex change operation is usually not covered by the insurance company. 
  • Rehabilitative care: Post-hospitalisation care is a key feature of a good group health insurance plan. However, long-term rehabilitative care may not fall under the coverage. 
  • Certain types of hospitalisation: A group mediclaim policy provides coverage for pre- and post-hospitalisation expenses. Yet, hospital stays that don’t relate to an illness or surgical procedure may not be covered. 
  • Pre-existing diseases: While policies do offer coverage for pre-existing diseases, a waiting period is observed before coverage for pre-existing diseases kicks in. The insured must understand the particulars of their policy thoroughly.   

It is also important to note that features of group health insurance plans can vary significantly from one policy to another. Group health insurance cost is also influenced by inclusions and exclusions. As an employer, it is a key task to consider these factors and choose a corporate health insurance plan that best meets the needs of your employees. 

Quick Read: Exclusions in Group Health Insurance

Advantages of Group Health Insurance Policy in India 

Group health insurance policies are a boon to employers and employees alike in India. As an employer, you’ll find that these insurance plans are cost-effective, primarily due to the lower premiums. Not to mention, they double up as an excellent employee retention tool. After all, a comprehensive group health insurance policy underlines your concern for your employees’ health, making them feel valued. 

The policy coverage isn’t restricted to just them; their family members, including spouses, children, and parents can also be covered under a group medical insurance. The policy typically covers hospitalisation expenses, day-care procedures, maternity benefits, and more. Additionally, tax benefits, easy claim settlements, and value additions are other advantages of a group health insurance policy.   

Group Health Insurance Benefits for Employees 

Group health insurance for employees is indeed a boon. As an employer, one of your key decisions should be to offer your workforce an optimum group health insurance policy available, with standout features like:  

1. Smooth claims processing

This ensures a hassle-free experience, minimising challenges associated with complex settlements. It makes the procedure more accessible for your employees and simplifies the routing of bills.

2. Extensive family coverage at no extra cost

Depending upon the terms and conditions of the group health plan, it should permit the insurance policyholder to include family members or dependents without additional costs.

Group health insurance in India is one of the most supportive undertakings for employee well-being.

Group Health Insurance Benefits for Employers 

As an employer, corporate health insurance can be one of the best tools to attract and retain top talent. Here’s why it’s beneficial for you: 

1. Employee welfare

A group health insurance policy shows potential hires and current workers that you are invested in their wellbeing. This enhances loyalty and can be a deciding factor during job recruitment. 

2. Cost-effective

Compared to individual health insurance, group health insurance policies provide value for money. The risk is spread across all insured, reducing the cost for each.

3.Tax benefits

In many cases, premiums paid towards the group health insurance plan offer tax advantages, making it beneficial from a financial perspective. 

Also, Read: What is Group Term Life Insurance?

Group Health Insurance Claim Process 

Understanding ‘what is group health insurance’ can be overwhelming, but the claim process is simple. There are two types of claims: cashless claims and reimbursement claims. In the cashless claim, the insured doesn’t need to pay the hospital.

The insurance company directly settles the bills with the network hospital. For reimbursement claims, your employees pay and then submit bills to the insurance company for repayment. The following two sections explain in detail how the two types of claims can be filed.   

Suggested Read: Health Insurance Claim Process

1. Steps for cashless claim 

If you’re an employer seeking to provide the best group health insurance plan to your team, understanding the claim process is essential. Through cashless claims, your employees can enjoy a stress-free experience during hospitalisation. 

At the very start, inform your insurance company of a potential claim that could come up from your end.  

  • Ensure your employees carry their health ID card provided under the group health insurance plan. This card acts as proof of insurance, streamlining the admission process.   
  • Once at the hospital, your employee needs to fill out a pre-authorisation form. This is a crucial step as it allows the hospital to ascertain that your group mediclaim policy covers the treatment required.  
  • Post verification, if all terms and conditions are met, and no waiting period applies (especially for pre-existing diseases), the insurer directly settles bills with the hospital. 

2. Steps for reimbursement claim

  • In case of a reimbursement claim under corporate health insurance, first, ensure that your employee preserves all original medical bills and documents. Inform your insurance company about the hospitalisation within a specified period mentioned in the policy.  
  • Once discharged, collect all necessary documents from the hospital, including detailed bills, discharge summary, medicine prescriptions and pathology reports, if any.  
  • Submit these along with a duly filled and signed claim form to the insurance company. The insurer will then assess these documents before releasing the reimbursement amount. 

Quick Read: Domiciliary Hospitalisation

Documents Required for Group Health Insurance Claims 

A crucial part of the process of a group health insurance claim is the timely submission of all required documents. Here’s what you need to prepare: 

  • A filled-out claim intimation form. 
  • Evidence of your policy, like the health card. 
  • Pre-authorisation letter from your third-party administrator. 
  • All original medical bills and reports. 
  • Discharge summary from the hospital. 
  • A copy of the FIR or death certificate if applicable. 
  • Prescribed medicines and follow-up consultation memos. 
  • Invoices of all medical tests and diagnosis reports. 
  • KYC documents 

Don’t forget, it’s important to have these ready to ensure a smooth process. No one wants to scramble for documentation during challenging times.  

Related Read: Health Insurance with OPD Cover

Health Card in Group Health Insurance Plans 

A health card is a key feature of group health insurance plans in India. Issued to each policy member, it serves as proof of coverage and a gateway to cashless treatment at network hospitals. The card carries vital details including the policyholder’s name, policy number, sum insured and expiration date.

In case of hospitalisation, it enables the insurance company to pay directly to the hospital, covering pre- and post-hospitalisation expenses. 

Differences Between Group Health Insurance and Individual Health Insurance 

When it comes to securing the health of your employees, understanding the nuances between different types of health insurance is essential. Group health insurance and individual health insurance policies have their distinctive features and benefits. The crux lies in appreciating these differences to select the best plan for your workforce.

Here is a list of benefits of group health insurance:

  • It covers a group of individuals under a single policy, easing administrative negotiations with the insurance company.
  • The cost, or premium, is often lower due to shared risk across the group.
  • Continuity of coverage, however, might be an issue in case an employee leaves your organisation.

On the flip side, the following are the benefits of individual health insurance:

  • Provides personalised coverage tailored to the policyholder’s needs.
  • Ensures continuity, that is, the policy can accompany the insured beyond his/her employment with your firm.
  • May command higher premiums, especially if the individual has pre-existing diseases or health risks.

In a nutshell, understanding these key features of both alternatives will help navigate the complexities of corporate health insurance effectively.

Related Read: Difference Between Individual and Group Health Insurance

Things to Consider Before Availing a Group Health Insurance Plan 

Choosing a group health insurance policy for your organisation isn’t as daunting as it might seem. You simply need to consider certain key factors that align with your organisation’s specific needs and that of your employees.  

Here are several aspects to be considered when selecting your group health insurance policy: 

1. Size of the employee base

The cost of a group health insurance policy can be affected by the size of your workforce. Larger groups often qualify for better premium rates due to the principle that risk is spread across a larger group, reducing individual liability. 

2. Age of employees

Younger employees often attract lower premiums. This is because they are generally healthier and less likely to get hospitalised and therefore, file claims. Hence, the average age of a group becomes a crucial factor.

3. Nature of work

Some occupations carry higher health risks than others. If your employees are involved in potentially dangerous tasks, such as construction or heavy machinery operations, you may be faced with higher premium costs.

4. Extra features

Add-on benefits like coverage for maternity, dependents, or other add-ons increase the cost but can significantly enhance the value of your healthcare benefits.

5. Co-pay

This refers to an arrangement where the insured chooses to pay a portion of medical costs out-of-pocket, reducing the overall premium amount.

6. Claim settlement history

A positive track record is vital in gauging the reliability of an insurance company. A smooth claim settlement process ensures that employees are adequately supported during their hour of need.

7. Wellness initiatives

Programmes promoting healthier lifestyles often result in lower healthcare costs overall, making them a valuable addition to any corporate health insurance plan.

8. Geographical coverage

The policy should cover medical facilities in areas where your employees live and work.

Understanding the ins and outs of group health insurance, including its advantages and disadvantages, will help you provide comprehensive coverage without leaving any gaps that could lead to financial distress for your employees.

Choosing a group health insurance policy is one of the most critical decisions you need to make. Keep these factors in mind when considering the benefits of a group health plan.

Also, Read: How is Group Health Insurance Premium Calculated?

How to Choose the Best Group Health Insurance Plan in India? 

Choosing the best group health insurance plan to safeguard your workforce’s health is no small task. Your employees are your most crucial asset, and their well-being directly affects your company’s productivity and morale. But how do you navigate the labyrinth of insurance plans?

Here’s a simplified process:

  • Conduct research and comparisons of different providers online.
  • Identify the insurance company that offers plans aligning with your employees’ demographics and your financial capacity.
  • Visit their website or set up an offline meeting
  • Select your preferred plan and sum insured based on eligibility.
  • Provide essential company and workforce details.
  • Customise the plan to ensure it fits your team’s unique needs.
  • Review the terms and conditions of the policy meticulously before confirming your purchase.

Remember, apart from monetary assistance in case of medical emergencies, key features of group health insurance plans also include wellness programs, pre-existing disease cover and annual health check-ups.

Also, Read: Employee Benefit Expenses

Why Onsurity is the Best Choice for Group Health Insurance? 

In the arena of group health insurance, Onsurity is emerging as a beacon of hope for many companies across India. Onsurity is carving out a niche by offering comprehensive and tailor-made healthcare benefits, catering to the unique needs of your team. 

The inclusive coverage offered by Onsurity’s healthcare plans cover in-patient hospitalisation, daycare treatment as well as pre-and post-hospitalisation expenses. Importantly, it accounts for unprecedented situations, such as COVID-19-related expenses.  

Onsurity’s proactive understanding of the diversity among employees in organisations helps them offer customised wellness benefits as well. These consist of life insurance and personal accident coverage under one membership, in addition to a wide array of other wellness benefits like big discounts on lab tests, medicine orders, free doctor consultations, mental well-being solutions etc.  

What sets Onsurity apart from other corporate health insurance providers is their commitment to customer service. Onsurity offers dedicated end-to-end claims assistance which ensures a hassle-free experience for your team. 

Another unique feature of the policy offered by Onsurity is the absence of a waiting period. In most cases, the benefits kickstart from day one. They also extend coverage to all types of employment contracts, creating an inclusive environment which is key in today’s diverse world. 

Additionally, Onsurity also offers employees the option to purchase healthcare benefits for their loved ones directly through their Super App. This can extend to covering in-laws, siblings, and LGBTQIA+ partners, offering a truly comprehensive approach to healthcare coverage.

Conclusion

In conclusion, group health insurance is a win-win for both you, the employer and your employees. Providing health coverage not only protects your workforce from unexpected medical expenses but also enhances their loyalty towards the company.

In the event of illness or accidents, the policy serves as a safety net, covering hospitalisation costs, health check-ups and even pre-existing diseases after a waiting period. Remember, in a group health insurance plan, risk is spread across multiple individuals, often making it more affordable than individual health insurance. So consider investing in a comprehensive group mediclaim policy – it’s one of the best ways to ensure your team’s well-being.

FAQs:

1. What is a group health insurance policy?

A group health insurance policy is a single policy that provides coverage for a group of employees, offering benefits like coverage for pre- and post-hospitalisation expenses, pre-existing diseases, and other hospitalisation expenses. 

2. Which group health insurance is best?

The best group health insurance is subject to the specific needs and requirements of your employees. Consider key features like coverage, network hospitals, and policy terms and conditions.

3. What is the difference between individual and group health insurance?

Individual health insurance covers one person while a group health insurance covers a collective of people, often employees in a company. Group policies often have less waiting period.

4.What is group insurance for employees?

Group insurance for employees, or corporate health insurance, is an insurance product that provides comprehensive medical coverage to employees, often inclusive of their families.

5. Who can be covered in a group health insurance policy?

Employees and often times their dependents can be covered under the policy. 

6. What are the tax benefits of providing group health insurance for employees?

Providing group health insurance for employees can offer tax advantages to companies, as premiums paid are generally deductible since they fall under business expenses.

7. What are the different types of group insurance?

Group insurance can encompass health, life, disability, critical illness and wellness coverages depending on the provisions made by the employer or organisation.

8. What is the minimum number of employees for corporate health insurance?

Generally, insurers require a minimum number of participating employees to qualify for corporate health insurance, but this number varies by insurer. Typically, a minimum of 20 employees are required. However, Onsurity covers companies that has as few as 3 employees as well. 

9. How do I add a new employee to our existing group health insurance plan?

To add a new employee to your existing group health insurance plan, contact your insurance company and provide them with the necessary employee data.

10. How does group health insurance work for small businesses?

Group health insurance works for small businesses as it provides comprehensive health coverage for employees, potentially incentivising employee retention and improving workplace morale and productivity. 

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