Group Health Insurance
Customised Group Health Plans with
comprehensive wellness benefits for your
employees and their families.
comprehensive wellness benefits for your
employees and their families.
*T&Cs apply
Empowering teams through comprehensive and affordable group coverage
Group Health Insurance generally known as Group Medical Cover or Group Mediclaim Policy, which has become a safety measure for millions of Indians. As India gears up to become one of the most rapidly expanding insurance markets in the next decade, the significance of Group Health Insurance is expected to grow even further.
With the government mandating health insurance for all employees across companies post-COVID, the demand for Group Health Insurance is on the rise. These plans often offer coverage not only for employees but also extend to their spouses and dependent children, ensuring comprehensive protection for families.
What is Group Health Insurance?
Group Health Insurance (GHI) is a type of health insurance policy that offers coverage to a group of people, typically employees of a company or members of an organisation. It is a cost-effective and convenient way for employers to provide health insurance benefits to their employees, as the risk is spread across a group of individuals.
Key features of Group Health Insurance
Here are some key features of Group Health Insurance in India:
Waiting period
Unlike individual plans, group health plans typically don’t have a waiting period, meaning coverage starts immediately, even for pre-existing conditions. However, it is advisable to review your policy document prior to hospitalisation.
Pre-existing conditions
Coverage for pre-existing diseases is often readily available in group plans, offering peace of mind to individuals with prior health concerns. However, it is advisable to review your policy document prior to hospitalisation.
HR friendly dashboard
Our dashboard is designed to streamline your productivity, saving you countless hours of manual work. By seamlessly integrating multiple HRMS platforms, you can increase your output significantly. With features to effortlessly add and remove employees, track active and inactive statuses, handle payments, and manage membership details, our system offers a comprehensive solution for optimizing your HR processes.
Dependents included
Employers have the option to extend insurance coverage to include the spouses and children of their employees, as long as the children fall within a specified age range. This inclusion allows for the entire family to be protected under the same policy. However, it is advisable to review your policy document prior to hospitalisation.
Maternity cover
Many plans offer maternity benefits, covering prenatal, delivery, and postnatal care. However, it is advisable to review your policy document prior to hospitalisation.
Different plan options
Companies offer a variety of plans to accommodate the unique needs and financial situations of their employees. These plans may include options for healthcare coverage, regular health checkup services, wellness programs, and more. By providing a range of choices, companies aim to ensure that employees can select the benefits that best suit their individual circumstances and preferences.
However, it’s important to note that specific features and coverage may vary depending on the plan chosen by the group or employer. Carefully reviewing the policy documents before enrolling is crucial.
Advantages of Group Health Insurance
Healthcare benefits can be highly valuable for both employers and employees. Here are some of the benefits of offering Group Health Insurance:
Overall, offering healthcare benefits can be a win-win for both employers and employees. Employers can attract and retain employees, improve productivity and morale. Employees can access affordable healthcare, and feel valued and supported by their employer.
What’s covered in Group Health Insurance?
- Room charges: Depending on the plan, it may cover various room categories (single, twin, etc.)
- Doctor fees: Consultation charges by specialists and surgeons within network and non-network hospitals.
- Nursing care: Charges for nursing services during hospitalisation.
- Diagnostic tests: Coverage for necessary X-rays, blood tests, and other diagnostic procedures.
- Operation theatre charges: Costs associated with surgical procedures.
- Pre-hospitalisation: Diagnostic tests, consultations, and medications in a certain period before hospitalisation. Typically, this is covered as mentioned in the health insurance policy.
- Post-hospitalisation: Medications, physiotherapy sessions, and follow-up consultations for a specific period after discharge. Typically, this is covered for as mentioned in the health insurance policy.
- Day care procedures: Day care treatment refers to medical treatment, and/or surgical procedure which is undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs.
- Ambulance cover: Transportation costs by ambulance to the hospital in case of emergencies may also be covered based on the policy terms and conditions.
- Pre-existing conditions: Depending on the plan, coverage for pre-existing conditions may be available.
- Psychiatric illnesses: Hospitalisation for treatment of psychiatric illnesses if necessitated is covered.
Additional inclusions (vary by plan):
- Maternity benefit: Covers prenatal, delivery, and postnatal care expenses.
- Newborn baby cover: Offers coverage for specific medical expenses of the newborn child generally up to 90 days.
- Organ donor cover: If you donate an organ, some plans cover your medical expenses.
- AYUSH treatment: Cover for traditional Indian medicine like Ayurveda, Yoga, Unani, Siddha and Homeopathy might be included in some plans.
What’s not covered in Group Health Insurance?
While Group Health Insurance offers valuable protection, it’s essential to understand what is not covered. Here are some common exclusions:
Remember: Exclusions can vary significantly depending on the specific plan and insurance company. Always thoroughly review the policy document to understand what is excluded before enrolling.
How to apply for a claim in Group Health Insurance?
Cashless Claim
Cashless requests can be of two types :
- Planned
- Emergency
Before raising a request for cashless, one needs to confirm the network status of the hospital. The same can be readily seen in the Onsurity Super App. Log on to the Onsurity Super App using the registered mobile number. Under ‘Health Insurance’ please go to ‘Hospitalisation Assistance’. Click on ‘View Hospitals’ which displays a page. One may enter the hospital name, city, or pin code and search for the hospital.
Planned Cashless Request
STEP 1: Log On
Log on to the Onsurity Super App using the registered mobile number. Under “Health Insurance” please go to ‘Hospitalisation Assistance’. Click on ‘Raise a request’. Fill in the necessary details and ‘Submit’. The request reaches the Good Doctors team at Onsurity, who will get back to the you and explain the details of the cashless process.
STEP 2: Pre-Authorisation Approval
The member is expected to submit the mentioned documents at the insurance counter or the TPA desk of the hospital. The hospital then raises a cashless request. The member will wait for the pre-authorisation approval for the suggested treatment.
STEP 3: Scrutiny by TPA/Insurer
Once you submit your documents to the TPA/insurer, they’ll examine them carefully. Depending on their assessment, they’ll communicate one of three possibilities: either there’s a shortfall in the documents, the initial claim is approved, or the claim is rejected. They’ll notify both the hospital and the member accordingly.
STEP 4: Final bill and discharge summary
Once the treatment is done, the hospital will provide you with the final discharge summary and all the bills. On the basis of your initial approval, the further discharge details will be shared with the insurer. Once the insurer finally verifies everything, you can pay the remaining standard non-admissisable items, co-pay, sub-limit excess etc. as per terms and conditions. Once everything is settled you will be discharged.
Emergency Cashless Request
In case of emergency, one is requested to reach the nearest hospital as it is the priority of the moment.
STEP 1: Submission
Kindly submit the Onsurity health card and KYC documents at the insurance counter or the TPA desk of the hospital. The hospital will raise a cashless request.The member will wait for the pre-authorisation approval for the suggested treatment.
STEP 2: Processing
Once you submit your documents to the TPA/insurer, they’ll examine them carefully. Depending on their assessment, they’ll communicate one of three possibilities: either there’s a shortfall in the documents, the initial claim is approved, or the claim is rejected. They’ll notify both the hospital and the member accordingly.
STEP 3: Final bill and discharge summary
Once the treatment is done, the hospital will provide you with the final discharge summary and all the bills. On the basis of your initial approval, the further discharge details will be shared with the insurer. Once the insurer finally verifies everything, you can pay the remaining standard non-admissisable items, co-pay, sub-limit excess etc. as per terms and conditions. Once everything is settled you will be discharged.
Reimbursement Claim
1. Login
Please log in to the Onsurity Super App using your registered mobile number. Navigate to the health insurance section and proceed to the claims tab, where you can submit pre-hospitalization, hospitalization, and post-hospitalization claims. Remember to upload soft copies of the required documents. It is important to retain all original documents, as the insurer may request them if necessary.
2. Scrutiny by Good Doctors
Documents uploaded via the app are received by the Good Doctors team. They go through the documents to check if all documents are in place. Based on the availability of the documents, a shortfall may be raised, or the case is filed to the TPA. In case of possible rejection, the member is informed about the possible outcome.
3. Submission and Processing
Once all the documents are collected by the Good Doctors team, the documents are filed to the TPA. Based on the merit of the documents, the case may be approved, rejected, or queried for additional required documents. If queried, the documents once shared by the member follow Step 1 and Step 2.
4. Settlement or Rejection
Approved cases will be processed for payment. Once the payment is deposited into the member’s account, the case will be considered settled. If a claim request is rejected, the member will be informed accordingly.
Disclaimer: Onsurity acts as a group administrator, offering support during cashless requests and claims reimbursement processes. However, the ultimate authority for the approval, validation, and payment of claims lies with the insurance company. Additionally, the list of hospitals within the network is subject to change and is updated periodically. Therefore, it is advisable to verify the availability of cashless services by inquiring at the hospital’s insurance counter before admission, to prevent any unforeseen complications.
Types of Group Insurance
Companies can offer various types of group insurance plans to their employees. Below are some of the most common types of group insurance plans available in India.
- Group Health Insurance:This covers the medical expenses of all employees in a company. Typically, the employer pays for the insurance, but the cost is often factored into the employee’s overall compensation or CTC (Cost-to-Company).
- Group Term Life Insurance:This policy pays a fixed sum assured to the nominee in case of the employee’s death. Employees can add the nominee at the time of onboarding.
- Group Personal Accident Insurance:This is a type of insurance that provides financial compensation in case of injury or death due to accident of the policyholder.
Why choose Onsurity as your Group Health Insurance partner?
Ensure easy cashflow with monthly subscription-based plans that don’t require you to pay a lump sum upfront, covering teams as small as 3 with monthly subscriptions starting at Rs. 145 per employee.
We don’t just offer insurance, but comprehensive healthcare and wellness plans to ensure your team is fully covered.
More than 8,000 businesses trust Onsurity with their team’s healthcare needs.
Experience a seamless and efficient claims process with Good Doctors, our dedicated claims support team, who assist you in facilitating the claim process at every step.
Ensure easy cashflow with monthly subscription-based plans that don’t require you to pay a lump sum upfront, covering teams as small as 3 with monthly subscriptions starting at Rs. 145 per employee.
We don’t just offer insurance, but comprehensive healthcare and wellness plans to ensure your team is fully covered.
More than 8,000 businesses trust Onsurity with their team’s healthcare needs.
Experience a seamless and efficient claims process with Good Doctors, our dedicated claims support team, who assist you in facilitating the claim process at every step.