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Group Insurance October 8, 2020
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.
Table of Contents
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.
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.
|Room, Boarding and Nursing Expenses as provided by the Hospital or Nursing Home where the insured is admitted. This should not exceed 1 % of the Sum Insured or INR. 5,000 per day whichever is less.||Pre-existing health conditions, disease, ailment or injuries. The following are the exclusions if you are suffering from hypertension, diabetes, or both hypertension and diabetes at the time of taking the policy:-
Cerebro Vascular accident
Diabetic Foot or wound
Internal Bleeds or Haemorrhages
Coronary Artery Disease
Hyper or Hypoglycaemic shocks
The exclusion shall apply to any complications arising from pre-existing ailments, diseases, or injuries. Post the policy inception, the exclusion for pre-existing conditions will be upto 4 years if the policy is in force continuously.
|ICU expenses not exceeding 2% of your policy Sum Insured or a maximum INR 10,000 per day, whichever is less||Injury or disease caused by War, nuclear weapons/materials Invasion, Act of Foreign Enemy, War like operations (whether the war is declared or not)|
|Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists fees as mentioned in the report or receipt||Circumcision (unless needed for the treatment of a covered disease or accident), vaccination, inoculation, change of life, cosmetic, or aesthetic treatment of any description, plastic surgery unless it is necessitated due to an accident or as a part of any illness.|
|Anaesthesia, Blood, Oxygen, Operation Theatre (OT), Surgical Appliances, Medicines/Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices that are implanted during surgical procedures like a pacemaker, Relevant Laboratory or Diagnostic test, X-Ray||Surgery for the correction of eyesight, cost of spectacles, contact lenses, hearing aids, etc.|
|Ambulance services for which the company will pay 1% of the sum insured or INR 2,000, whichever is less (If the patient has to be shifted from residence to hospital in case of Emergency Ward, I.C.U., or from one Hospital or Nursing home to another||Dental treatment or surgery which is corrective, cosmetic, or aesthetic in procedures such as filling of cavity, root canal, wear and tear unless caused due to a disease or injury and that requires hospitalization and comes under the covered treatment|
|Hospitalization expenses for donating an organ by the donor (except the cost of the organ if any) during the policy term organ transplant is also covered in this best group health insurance policy in India. However, in any case, the liability of the company will be limited to the policy Sum Insured.||Convalescence, general debility, “run-down” condition, rest cure, congenital external diseases, defects, anomalies, sterility, any fertility, subfertility, or assisted conception procedure, venereal diseases, intentional self-injury or suicide, all psychiatric and psychosomatic disorders and diseases or accident due to use, misuse, or abuse of drugs and alcohol, or any intoxicating substances of addiction, etc.|
|An optional cover for maternity expenses and newborn child which can be obtained on the payment of 10% of the total basic premium for all the insured persons under the policy. This benefit has to be exercised at the time of inception of the policy period as there is no refund available in case of cancellation of this option during the currency of the policy.|
If the insured persons already have two or more children they are not eligible for this benefit
The maximum benefit under this policy clause is upto INR. 50,000. These expenses are admissible only if incurred in a hospital or a nursing home as an in-patient in India.
A waiting period of 9-months is applicable for the payment of any claim relating to normal delivery, caesarean section, or abdominal operation for extra uterine pregnancy. The waiting period is relaxed in the case of delivery, miscarriage, or abortion induced by an accident or other medical emergency.
Pre and Post-natal expenses are not covered unless you are admitted to a hospital or nursing home and treatment is taken there. The newly born is covered from day one upto the age of 3 months and expenses incurred for the treatment taken in hospital as in-patient will be payable within the specified sum insured of INR 50,000 under policy maternity benefit extension.
|Expenses due to any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD - III), Lymphadenopathy Associated Virus (LAV), the Mutants Derivative, Variations Deficiency Syndrome, or any Syndrome/condition of a similar kind commonly known as AIDS. including HIV and its complications.|
|Voluntary medical termination of pregnancy during the first 12-weeks from the date of the policy inception is not covered. Congenital diseases of newly born children are also excluded from this policy.|
|Hospital or Nursing Home expenses for evaluation or diagnostic purposes.|
|Vitamins and tonics if not a forming part of your treatment|
|Pregnancy, childbirth, miscarriage, caesarean section, abortion, or complications of any of these.
|Naturopathy treatment, unproven procedure, treatment, experimental, alternative medicine, and related treatment like acupressure, acupuncture, magnetic and such other therapies, etc.|
|Irrelevant treatment to diseases diagnosed during the hospitalization
Private nursing, family doctors referral, out-station consultants, surgeon fees, etc.
|Genetic disorders and stem cell implantation/surgery|
|External and durable Medical/Non-medical equipment used for the treatment of CPAP, CAPD, Infusion pump, etc.
Ambulatory devices like walkers, Crutches, Belts, Collars, Caps, splints, slings, braces, Stockings, etc, of any kind, Diabetic footwear, Glucometer/Thermometer and similar related items and any medical equipment which is subsequently used at home
|Expenses for telephone, television, Aya/barber, beauty services, diet charges, baby food, cosmetics, napkins, toiletry items, guest services and similar incidental expenses/services, etc.|
|Change of treatment from one path to another unless it is allowed or recommended by the consultant under whom the treatment is taken|
|Obesity or condition arising from (including morbid obesity) and other weight
control programme, services, supplies, etc.
|Treatment required due to participation in any hazardous activities such as scuba diving, motor racing, parachuting, hang gliding, rock/mountain climbing, etc.|
|Treatment received in a convalescent home, convalescent hospital, health hydro, nature care clinic, or any similar establishments|
|Stay in the hospital expenses for any domestic reason where there is no active regular treatment|
|Service charges, Surcharges, Admission fees, Registration charges levied by the hospital|
|Outpatient Diagnostic, Medical/Surgical procedures or treatments, including the non-prescribed drugs and medical supplies for Hormone replacement therapy, Sex change, or any treatment related to sex change.|
|Doctor home visit, Attendant, Nursing fees during pre and post-hospitalization period|
|Continued treatment before hospitalization and even after discharge for the ailment, disease, or injury different from the one for which the insured is hospitalized.|
|Massages, Steam bathing, Shirodhara and any such Ayurvedic treatment.|
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.
|The policy covers the payment of medical expenses incurred for treatment taken in hospital for illness/injury contracted or sustained during the policy period. This includes Hospital (Room & Boarding and Operation theatre) charges, Surgeon fee, Anesthetist, Specialists, diagnostic tests, medicines, blood, oxygen, appliances like a pacemaker, artificial limbs and organs||Pre-existing diseases/injuries when post-policy inception for the first time.|
|Domiciliary Hospitalization treatment for a period exceeding 3 days in case of a normal course it would require care and treatment at a hospital/nursing home but is taken whilst confined at home in India under the following circumstances like:-|
Patients cannot be moved to Hospital/Nursing home
Patients cannot be admitted to the Hospital/Nursing Home due to lack of accommodation
Domiciliary hospitalization payable is limited to the Sum Insured as specified in the Schedule, and in no case, will cover the expenses incurred for:
Pre and Post Hospitalization medical expenses
Treatment of Asthma, Bronchitis, Chronic nephritis and nephritic syndrome, Diarrhea & all types of dysenteries including gastroenteritis, Diabetes mellitus and insipidus, Epilepsy, Hypertension, Influenza, cough and cold, all psychiatric or psychosomatic disorders, Tonsillitis and upper respiratory tract infection including laryngitis & pharyngitis, Pyrexia of unknown origin for < 10 days, Arthritis, gout and rheumatism
|Disease contracted by an Insured Person during the first 30 days from the date of policy commencement. The pre-existing exclusion shall not apply:-
If in the opinion of medical practitioners that are constituted by the company, the Insured could not have known of the existence of the disease or any symptoms or complaints at the time of the proposal.
In case you are covered under this scheme or a group insurance scheme with any of the Insurance Companies in India for a continuous period of 12 months without any break.
|Payment of medical expenses incurred for treatment pertaining to daycare treatment||During the first year of operation of the insurance cover,
Expenses incurred on the treatment of diseases such as cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal diseases/anomalies, fistula in anus, piles, sinusitis and related disorders are not payable. If these diseases are pre-existing at the time of proposal, they will not be covered even during the period of subsequent renewals
|Pre-hospitalization medical expenses incurred during a period as specified in the schedule, before hospitalization.||Circumcision (unless it is necessary for the treatment of a covered disease or injury due to an accident), vaccination, inoculation, change of life, cosmetic or aesthetic treatment of any description, plastic surgery unless it is a part of any illness treatment|
|Post-hospitalization medical expenses incurred during a period as specified in the schedule||Cost of spectacles, contact lenses and hearing aids|
|Dental treatment or surgery of any kind (unless hospitalization is necessitated)|
|Convalescence, general debility, 'run-down' condition or rest cure, congenital external disease, defects, anomalies, sterility, venereal disease, intentional self-injury due to intoxicating drugs/alcohol.|
|Expenses for any condition, which is directly or indirectly caused due to or associated with Human T-Cell Lymphotropic Virus Type III (HTLV III), Lymphadenopathy Associated Virus (LAV), Mutants Derivative, Variations Deficiency Syndrome, or any Syndrome or condition of a similar kind like AIDS
|Expenses for diagnostic, X-ray, laboratory examinations, other diagnostic studies not consistent to the diagnosis and treatment of the positive existence or presence of any ailment, sickness, or injury, for which insured confinement is required at a Hospital/Nursing Home or home under domiciliary hospitalization|
|Vitamins and tonic expenses unless it is prescribed by a certified medical practitioner|
|Treatment traceable to pregnancy, childbirth including caesarean section. And the voluntary medical termination of pregnancy during the first 12 weeks from the date of policy conception.|
|Disease or injury directly or indirectly caused due to war, invasion, an act of a foreign enemy, war like operations (whether the war is declared or not)|
|Disease or injury directly or indirectly caused by or contributed to nuclear weapons or materials.|
|Non-medical charges as mentioned in the "List of Medical Expenses Excluded" in the policy document|
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.
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.
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:
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:
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:
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