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Group Health Insurance Plans are a type of insurance that helps companies or organizations cover the health expenditure of their employees. These plans are generally offered to confirmed employees having served their probation period successfully. Also known as corporate health insurance, it comes with extended coverages and lower premiums for employers to pay. Yes, in a group health insurance plan, employers pay the premium to cover the health of their employees. The number of members in these plans can be very high and thus the overall payment to the insurer becomes much higher than that of individual health insurance plans. As a result, health insurance companies give concessions on the premium to corporations seeking a group plan.
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The premium concession may not be the only thing that would prompt companies to have group health insurance plans for their employees. Such plans must be serving a larger interest of employers…So, what are those interests? Let’s have a look at them.
In a cut-throat competition where employees have a wide range of career options, retaining them becomes a huge challenge for employers. Employees constantly jump from one organization to another to ramp up their professional growth. But with Group Health Insurance, employees contemplate staying in the organization for long, if not forever. With employee retention being looked into, companies can focus on their operations much better than in a scenario of a mass exodus of employees. In such a scenario, the cost of the company will go up as it has to invest massively towards training and skilling new employees.
Once the employees are assured that the company will take care of their as well as their family’s healthcare expenses, their performance only gets better and helps them accomplish organizational goals easily.
People with proven track records are much sought-after in the corporate world – every company wants to have them to increase their profitability. And when these people get a sight of group health insurance on their ‘Job Letter’, their tendency to join a company offering the same remains high. By hiring such talents, companies can move up the growth ladder much faster.
While employees won’t have to worry about paying for the medical treatment, employers receive tax benefits on the premiums they pay to the insurer for such plans. So, both employers and employees stand to benefit from this plan.
As explained in the introduction, the premiums for group health insurance remain lower than that of individual plans.
If you are working somewhere, you may like to know the benefits you’re going to have with group health insurance plans. So, here are the benefits…
A waiting period is defined by the name itself – you need to wait for some time before the coverage begins. There is an initial waiting period of 30 days from the date of policy inception. This rule, however, does not apply to accidental injuries. If you have any pre-existing diseases before the commencement of the plan, a waiting period of 2-4 years will apply. Similarly, critical illness and maternity plans come with a waiting period of 6 and 9 months, respectively. All these are part of regular health insurance plans. In contrast, no waiting period exists in group plans, which means you can get the cover from Day 1.
Like regular health insurance plans, the group plan also covers pre and post-hospitalization expenses up to the days as specified in the policy. So, it could vary from one group health insurance plan to another. While pe-hospitalization expenses mean the costs incurred before admission to the hospital, post-hospitalization expenses are the costs after discharge from the hospital
These come under the maternity cover where the insurer covers the expenses made before and after the delivery. However, some group plans may not cover pre and post-natal hospitalization expenses. So, read the policy document carefully.
In case you can’t get hospitalized due to poor health conditions or no vacant beds are lying in a hospital, you will get treated at home with the domiciliary hospitalization cover. However, this requires approval from a qualified medical practitioner.
Claiming regularly can wipe out the sum insured i.e. coverage amount. Even a single claim can exhaust your entire sum insured if the treatment cost is very high. In case of exhaustion, employees can request the employer to refill their sum insured so that they can get covered in the future. The employer will need to forward the request to the insurer to process it. The insurer might place a condition that the refill request should be for a different illness. Based on certain terms and conditions, the insurer can refill the sum insured for employees.
You won’t need to pay for your medical treatment if it happens at any of the network hospitals of the insurer. In the group health insurance kit, you could see a list of network hospitals of the insurance company. You can even go to the official website of the insurer to find the same. Below is the table where you can see the network hospital count of different health insurers.
|Health Insurance Companies||PAN India Network Hospital Count (Approx.)|
|Max Bupa Health Insurance||4,500+|
|HDFC ERGO Health Insurance||10,000+|
|Star Health Insurance||9,900+|
|Aditya Birla Health Insurance||8,200+|
|ICICI Lombard Health Insurance||6,500+|
|Care Health Insurance||15,500+|
|Bajaj Allianz Health Insurance||6,500+|
|Bharti AXA Health Insurance||4,500+|
|SBI Health Insurance||3,000+|
|Reliance Health Insurance||4,000+|
|Future Generali Health Insurance||6,000+|
|Edelweiss Health Insurance||3,200+|
Different health insurance plans can vary in terms of their offerings. Let’s check what these plans have got in store for you.
|Group Health Insurance Plans||Pre and Post-hospitalization Expenses||Day Care Procedure Coverage||Room Rent Coverage|
|Group Care Plan from Care Insurance||Pre-hospitalization cover - Up to 30 days|
Post-hospitalization Cover - Up to 60 days
|Covered Up to the Sum Insured||1% and 2% of the sum insured per day|
|Aditya Birla Group Activ Health Plan||Pre and post-hospitalization expenses covered up to days as specified in the policy||Covered Up to the Sum Insured||Room rent covered|
|Future Generali Group Health Insurance||Pre-hospitalization cover - Up to 30 days|
Post-hospitalization Cover - Up to 60 days
|Covered Up to the Sum Insured||Room rent covered|
|Max Bupa Group Health Insurance||Pre and post-hospitalization expenses covered up to days as specified in the policy||Covered Up to the Sum Insured||No Limit on Room Rent|
|Royal Sundaram Group Health Insurance||Pre-hospitalization cover - Up to 30 days|
Post-hospitalization Cover - Up to 60 days
|Covered Up to the Sum Insured||1% of the sum insured per day|
Yes, group health insurance plans cover COVID-19 treatment expenses in the same way as regular health plans, courtesy a directive from the Insurance Regulatory Development Authority of India (IRDAI) in 2020 asking insurers to include COVID-19 as part of their coverage. Besides, some insurance companies also offer COVID-specific group health plans.
A group health insurance plan should have a high sum insured, extensive coverages and other benefits. Although you can’t alter or request to alter the plan offerings being an employee, you could still be watchful of a few things mentioned below.
Look at the Sum Insured Options Carefully – Most likely, you may not get the chance to choose from the sum insured options. But if you get the chance, choose a high sum insured to counter the rise in medical expenses efficiently. A sum insured is the limit up to which you get covered against your medical expenses.
Room Rent Limit – While some group health insurance plans come with a room rent limit, others don’t. In case your plan has a limit, you need to have some savings to pay the extra amount if the actual room rent exceeds the coverage limit in real-time. Let’s consider an example to understand it better.
Example – If your health insurance comes with a sum insured of INR 8 lakh and the room rent limit is 2% of the sum insured per day. The limit comes as INR 16,000 (8,00,000 x 2%). If the actual room rent is INR 20,000 per day, you will need to pay INR 4,000 and the insurance company will pay INR 16,000 daily.
Check If There are Sub-limits on Diseases/Conditions – Sub-limits don’t only exist for room rent, they remain for diseases or conditions too. If you know the sub-limits in advance, you could arrange for the uncovered amount by mobilizing your savings efficiently. For example, maternity coverage can have certain limits based on the kind of delivery – Normal and Cesarean. So, knowing such limits only helps.
Pre and Post-Hospitalization Expenses – As mentioned above, group health insurance plans cover pre and post-hospitalization expenses. But you need to pay these first before the insurance company will reimburse you. As these expenses are covered for a specified number of days, planning your savings for the extra days won’t be bad as some treatments can run for a long time. But planning will be successful only when you are aware of the days for which you will get covered.
Check Coverage for Other Treatment – Check the coverage for domiciliary and day care treatment carefully. They may get covered for either a certain percentage of/ up to the sum insured. In case the coverage amount falls short of the actual cost, you need a backup of savings to meet the gap.
Individual or Floater Plan – Group health insurance plans can be offered both on an individual and floater basis. If it is on an individual basis, it’s only you who will get covered and not your family. A family floater plan will, however, cover you as well as your dependents against any unforeseen medical emergencies.
The plan covers the following medical expenses –
These plans don’t cover the following treatment/illnesses –
You can claim using any of the two modes – Cashless and Reimbursement. Both these modes come with certain steps that you can see below. Let’s start with Cashless.
Steps Involved in Cashless Claims
As said above, cashless claims are available only at the network hospital of the insurer. But what do you need to do to get such claims processed successfully? Find them out here.
Step 1 – Get admission to the network hospital of your choice
Step 2 – In case of planned admission, you need to get pre-authorization from the health insurance company at least 72 hours before through the network hospital.
Step 3 – In case of an emergency admission, intimate the insurer within 24 hours of hospitalization
Step 4 – The pre-authorization form is available on the helpdesk of the network hospital. Fill it and submit the same to the helpdesk, which will send it to the insurer. The insurer will go through the form carefully before approving the claim based on the terms and conditions associated with the plan. It will send the authorization letter to you and the network hospital via Fax or email.
Step 5 – At the time of discharge, you need to sign the final bill. In case the total bill exceeds the coverage amount, the hospital will collect the difference from you.
Note – While filling the pre-authorization form, submit the insurance ID along with a valid ID proof to the helpdesk.
Reimbursement Claim Steps
In case the network hospital is far from your home or office, you can get yourself treated at any other hospital by paying the costs upfront and getting the same reimbursed by the insurer. Here are the steps for reimbursement claims.
Step 1 -Take the treatment at the non-network hospital and pay the hospitalization bills
Step 2 – Collect all documents including discharge summary, hospital bills, investigation reports, prescriptions regarding the hospitalization before getting discharged
Step 3 – Download the claim form available on the official website of the insurer
Step 4 – Fill the form and send it along with the required documents to the insurer at its registered address within a few days of getting discharged from the hospital
Step 5 – The insurer will check the form and documents carefully before approving the claim
Step 6 – A few days from approval, you will get the claim amount in your bank account
How to Claim Pre and Post-hospitalization Expenses?
Pre and post-hospitalization expenses are covered only when they are certified by a qualified medical practitioner. For pre-hospitalization expenses, you need to send the bills, treatment documents and prescriptions within a few days after hospitalization. Similarly, when expenses happen post-hospitalization, you need to send credible documents evidencing the same to the insurer within a few days from discharge. For both pre and post-hospitalization expenses, one needs to send the Admission Letter as proof of hospitalization.
You need to submit the following documents when claiming your group health insurance.
Applying for a Group Health Insurance Plan at Wishpolicy, a portal offering unbiased advisory on insurance products, makes sense for employers due to the following reasons.
IRDAI Certification – Wishpolicy’s authenticity is greatly established by the certification it has got from the insurance watchdog i.e. Insurance Regulatory Development Authority of India (IRDAI). The certification establishes Wishpolicy as a reliable insurance facilitator.
Impeccable Services – We, at Wishpolicy, thrive on offering fast and innovative solutions that help customers in each step of their claim. A dedicated team will assist you in picking the best Group Health Insurance Plan for your employees. We will guide your employees through the claim process as and when they contact us by writing an email to firstname.lastname@example.org or by calling at 8527888666.
Partnerships with Top 20+ Insurance Companies – We have joined hands with top 20 plus insurance companies that offer impressive Group Health Insurance Plans.
Growing List of Happy Customers – Our services have helped us cover the life and health of 29 million customers so far in India. You could join that list of Happy Customers too.
As the benefits of applying for Group Health Insurance at Wishpolicy have been explained above, it’s time to hit the Apply button at this insurance portal. Check out the steps to do so.
You can receive the policy document on your email ID and send it to your employees through your means.
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