Best Group Health Insurance Policy in India

Group health insurance is a type of plan where coverage is offered to a group of members. This insurance plan is referred to as corporate health insurance usually. A prime benefit under the group health insurance offered by the employers is that the policy coverage can be extended to the family members of the employees in some exceptional cases. Read this page to choose the top Group Health Insurance Policy in India.

Criteria To Choose the Best Group Health Insurance Policy in India

You should consider the following factors while comparing the Group Health Insurance Policy in India. Have a look at the pointers below and know how to get the best group health insurance policy.

1. Pre & Post Hospitalization Cover – The buyer should know whether his./her policy gives him the cover against pre and post-hospitalization expenses. Because if it doesn’t, it is not an ideal group health insurance policy.
2. Domiciliary Treatment – The policy should have a domiciliary treatment cover so that you can be treated at home without having to bear expenses for the same.
3. Maternity & Newborn Cover – You should read the policy documents carefully. Because if it doesn’t pay expenses for maternity and newborn baby, the policy may not be much of use as the primary goal of having insurance is to give security to the family.
4. Pre-existing Condition Waiting Period – Check the policy documents and find when your pre-existing disease will be covered.
5. Sum Insured – The insurance company provides how much security to the policyholder regarding future health risks. Know every detail of the amount that will be covered for a specific illness, doctor fees, medicines, surgery, etc.
6. Premium Payment – Choose the group health insurance policy that gives you suitable options for policy premium payment. Because if the premium is beyond your budget, you will anyways get deprived of the benefits. The reason is obvious – the lack of premium payment.

Best Group Health Insurance Policy in India 2021

Oriental Mediclaim Insurance Policy (Group)

This insurance policy is issued for a year as you can see it in the policy schedule online. But the  insured can renew the policy as long as he/she wants. Take a look at the table below to know the best group health insurance policy in India coverage and exclusion.

Reliance Group Mediclaim Insurance Policy

With this best group health insurance policy in India, you will get coverage of INR 50,000 and INR 1,00,000. The policy can cover 7 to 1,000 workers and give insured access to 7,300+ cashless network hospitals where they can get treatment. Let’s have a detailed look at the policy coverage and exclusions in the table below.

Kotak Group Health Care

Kotak General Insurance Company Limited provides customers a customized health insurance coverage for the employees or a group of members and their dependents as per the company’s requirements. The increasing health risks of today have made it imperative for companies, irrespective of their size, to safeguard employees in case of hospitalization. The  Kotak Group Health Care policy is one of the best group health insurance policies in India because it is available at a flexible and affordable rate. Check out this policy coverage.

In-patient Treatment:- The company will pay the medical expenses incurred by the Insured during the policy period if he/she is hospitalized due to an Illness or Injury for a minimum and continuous period of 24 hours. The following are the reasons for which you can claim this policy.

1. Hospitalization for a Medically Necessary Treatment which follows the written advice of medical Practitioner
2. Medical Expenses incurred at a Reasonable and Customary for one or more of the following:- Room Rent, boarding charges, ICU Charges, Operation Theatre (OT) expenses, medical practitioner fees including fees of specialists, anaesthetists, Qualified Nurses, Medicines, drugs, and other allowable consumables that are prescribed by the treating medical practitioner, Investigative tests or diagnostic procedures directly related to the Injury/Illness for which you are hospitalized, Anaesthesia, blood, oxygen and blood transfusion charges, Surgical appliances and prosthetic devices that are used intraoperatively during a Surgical Procedure, Inpatient physiotherapy charges, etc.

Pre-hospitalization Medical Expenses – The insurer reimburses the Pre-hospitalization Medical Expenses for a period as specified in the Policy Schedule/Certificate before hospitalization/daycare treatment for Illness or Injury which occurs during the policy period. The company will accept the claim for this as In-patient Treatment or Day Care Treatment under this policy. Insured date of admission to the hospital or nursing home for the same Illness/Injury subject to any 1 Illness as defined in the policy document.

Post-hospitalization Medical Expenses:- For Post-hospitalization medical expenses for a period as specified in the Policy Schedule/Certificate for any Illness or Injury which occurs during the policy period. The insurer accepts a claim for In-patient Treatment or Day Care Treatment under this policy depending on the date of discharge for this benefit concerning the same Illness/Injury.

Day Care Treatment:- The following conditions would apply to the Day Care Treatment of the insured during the policy period.

1. The Day Care Treatment is necessary for Medical Treatment and follows written advice from the attending medical practitioner
2. Medical Expenses incurred are reasonable and customary
3. The policy covers only the Medical Expenses for those Day Care Treatments which are listed in Annexure-II of this policy. For the complete list of Day Care Treatments, visit the www.kotakgeneralinsurance.com website.
4. The insurer doesn’t cover any OPD Treatment under this benefit

Domiciliary Hospitalisation:- The company will compensate the Medical Expenses incurred on Domiciliary Hospitalization following an Illness or Injury that occurs during the Policy Period provided that:

1. Medical expenses of the Insured for treatment of a disease, illness or injury taken at home, or otherwise required hospitalization as his/her condition did not allow a hospital transfer or if a hospital bed was unavailable at the time.
2. You need to have written advice of a medical practitioner for this purpose
3. Medical Expenses incurred should be reasonable and customary charges
4. Insured Domiciliary Hospitalization if extended for at least 3 consecutive days. In that case, the company will pay medical expenses under this extension from the first day of Domiciliary Hospitalization
5. The payment of this benefit is within the Basic Sum Insured, which is subject to the limits as specified in the policy, if any.
6. The insurer will not pay any Pre or Post-Hospitalization Medical Expenses under this Extension
7. It also doesn’t pay any Medical Expenses incurred for the treatment of any of the following Illnesses/conditions: Asthma,  Bronchitis, Chronic Nephritis, Chronic Nephritic Syndrome, Diarrhoea and all types of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insipidus, Epilepsy, Hypertension, Influenza, cough and cold, all psychiatric or psychosomatic disorders, Pyrexia of unknown origin for < 10 days, Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharyngitis,  Arthritis, Gout and Rheumatism.

Emergency Ambulance:-  Reasonable and Customary charges that are incurred up to the limit as specified in the Policy Schedule/Certificate of Insurance towards transportation for treatment of an Illness or Injury, the company will pay its expenses as per the following conditions provided that:

1. An ambulance is certified by the treating medical practitioner
2. Under this benefit, if the Insured is transferred from one hospital to another hospital or diagnostic centre for advanced diagnostic treatment where such facility is not at the existing Hospital or if the Insured needed to be moved to a better Hospital facility due to lack of available/adequate treatment facilities.
3. Ambulance cover is applicable for each claim under the policy. Under this benefit, the claim amount is within the Basic Sum Insured, as subject to the limits specified, if any.

Donor Expenses:- In-patient Hospitalization Medical Expenses towards the donor for an organ transplant is up to the limits of the policy Sum Insured (Subject to the availability of the Basic Sum Insured), provided that:

1. The organ donor is any person following the Transplantation of Human Organs Act 1994 (amended)
2. The organ is used for the Insured who has been asked to undergo an organ transplant on advice from the medical practitioner;
3. The claim would be accepted for an In-patient Treatment under the policy in respect of the Insured Person;
4. In the case of Individual sum insured basis, this payout is available on an individual basis
5. In the case of floater sum insured basis, the payout is available on a floater basis

Additional Cover in Kotak Best Group Health Insurance Policy in India:-

1. Alternative Treatment
2. Home Nursing
3. Critical Illness Recuperation Benefit
4. Convalescence Benefit
5. Hospital Daily Cash Benefit
6. Family Transportation Benefit
7. Accompanying Person’s Expenses
8. ICU Daily Cash Benefit
9. Cost of Prescribed External Medical Aid
10. OPD Vision or Dental Treatment
11. Travel expenses for Treatment
12. Cover for Non-Medical Expenses
13. Mortal Remains/ Funeral Expenses
14. OPD Expenses
15. Second E-Opinion Cover
16. . Maternity Benefit
17. New Born Baby Cover
18. AIDS/ HIV Cover
19. Surgical Contraception(Sterilisation and Vasectomy)
20. External Congenital Disease Cover
21. Pre and Post-Natal Care
22. Hospitalization Cover only for Accidents
23. Hospitalization Cover only for Critical Illness
24. Psychiatric and Psychological Care
25. Medical Advancement Surgery Cover
26. Infertility treatment
27. Sports Activity Cover
28. Vaccination Expenses
29. Wellness Program
30. Floater Cover
31. Corporate Buffer
32. Domiciliary Hospitalization Exclusion Cover
33. Donor Expenses Exclusion Cover
34. Room Rent Capping

Exclusions from Kotak Group Health Care Policy

1. Routine medical, eye or ear examinations, preventive health check-ups, spectacles, laser surgery for correction of refractive errors, contact lenses, hearing aids, dentures or artificial teeth aren’t payable under this policy
2. Expenses incurred on the prosthesis, corrective devices, external durable medical equipment like wheelchairs, crutches, instruments which are used in the treatment of sleep apnoea syndrome, continuous ambulatory peritoneal dialysis (C.A.P.D.) and oxygen concentrator for bronchial asthmatic condition, and the cost of cochlear implant(s) unless it is necessitated by an accident or required intra-operatively.
3. Expenses of all dental treatment unless necessitated due to an accident
4. Any expenses of personal comfort like cosmetics, convenience, and hygiene-related items and services
5. Acupressure, acupuncture, magnetic and such other therapies are excluded in this policy
6. Circumcision unless necessary for covered Illness treatment or injury due to an accident
7. Vaccination or inoculation of any kind, except for the animal bite
8. Sterility, venereal disease, or any kind of sexually transmitted disease
9. Intentional self-injury and Injury or Illness due to use, misuse, or abuse of intoxicating substances like drugs and alcohol.
10. Expenses for the treatment of mental illness, stress, psychiatric or psychological disorders
11. Aesthetic treatment, cosmetic surgery, or plastic surgery including any complications due to them are excluded unless necessitated due to an accident or a part of any Illness treatment.
12. Treatment/surgery for a sex change or the complications arising as a consequence of it
13. Expenses incurred on the treatment arising from pregnancy which includes lawful voluntary termination of pregnancy, childbirth, miscarriage, caesarean section, abortion (unless it is a cause of an accident) and any fertility, infertility, sub-fertility, or assisted conception treatment, sterilization, or procedures for birth control and hormone replacement therapy. However, this exclusion does not apply to ectopic pregnancy proved by diagnostic means and certified to be life-threatening by the medical practitioner.
14. Congenital external anomalies treatment
15. Genetic disorder and stem cell implantation, surgery, harvesting, storage, or any kind of treatment using stem cells
16. All expenses directly or indirectly caused due to or associated with Acquired Immunodeficiency Syndrome (AIDS) arising out of HIV, Human TCell Lymphotropic Virus Type III (HTLV–III or IITB-III) or not, Lymphadenopathy Associated Virus (LAV), Mutants Derivative, Variations Deficiency Syndrome, or any Syndrome or any condition of a similar kind.
17. Evaluative, diagnostic, or observation charges for which no active treatment is given. This includes X-Ray, laboratory examinations or other diagnostic studies, not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury that requires hospitalization or not.
18. Expenses on supplements, vitamins and tonics unless it is a part of treatment for Injury or Illness as certified by the attending medical practitioner
19. Weight management services and treatment
20. Vitamins and tonics related to weight reduction programs including the treatment of obesity (including morbid obesity), or any treatment related to sleep disorder or sleep apnoea syndrome, general debility, convalescence, run-down condition or rest cure.
21. Health check-up costs for the issuance of medical certificates and examinations required for employment or travel or any other such purpose.
22. Experimental, unproven or non-standard treatment consistent with or incidental to the usual diagnosis and treatment of any Illness or Injury.
23. Any claim directly or indirectly related to criminal acts
24. Treatment taken outside India
25. Treatment from anyone who doesn’t fit the definition of the medical practitioner.
26. Any treatment charges or fees charged by the medical practitioner outside the scope of license or registration
27. Illness or Injury arising from the commission of continuing perpetration of a violation of law by the Insured with criminal intent
28. Non- allopathic treatment unless covered under the ‘Alternative treatment’ section of the policy
29. Consequential or indirect loss related to hospitalization
30. Injury or Illness directly or indirectly caused by or arising from war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, commotion, unrest, rebellion, revolution, insurrection, military or usurped power, confiscation, nationalization, requisition of or damage by or under the order of any government or public local authority.
31. Any Illness or Injury directly or indirectly caused by or contributed to by nuclear weapons/materials, ionizing radiation, or contamination by radioactivity by any nuclear fuel or from any nuclear waste or the combustion of nuclear fuel.
32. Injury, disease, illness, due to participation in winter sports, skydiving, parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing, riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), unless it is specifically covered under the Policy.
33. All non-medical expenses listed in Annexure III of the policy document
34. Any OPD treatment
35. Admission for diagnostic purpose
36. Medical supplies like elastic stockings, diabetic test strips, and similar products
37. Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment of the skeletal structure by manipulation or muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
38. Age-related Macular Degeneration (ARMD), External Counterpulsation (ECP), Enhanced External Counterpulsation (EECP), Hyperbaric Oxygen Therapy (unless advised by the medical practitioner)