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.

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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 2020

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.

CoverageExclusions
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:-
Diabetic Retinopathy
Cerebro Vascular accident
Diabetic Nephropathy
Diabetic Foot or wound
Hypertensive Nephropathy
Internal Bleeds or Haemorrhages
Diabetic Angiopathy
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 lessInjury 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 receiptCircumcision (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 anotherDental 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.

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.

CoverageExclusions
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 organsPre-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 treatmentDuring 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 scheduleCost 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.
Naturopathy treatment
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.
Unproven/Experimental treatment
Non-medical charges as mentioned in the "List of Medical Expenses Excluded" in the policy document

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)

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