Group Insurance 2561 views October 29, 2020

What are the GMC and GPA Insurance Policy?

If we were to name one factor that contributes most towards the growth of an organization, it would be its employees. When you see top organizations around, you will notice that they understand this thing, and that’s why they offer different things to keep their employees happy. Taking care of employees’ health is one of the topmost priorities of an organization. Group Medical Coverage (GMC) Policy and Group Personal Accident (GPA) Policy are two of those things that organizations offer to their employees. GMC and GPA Insurance Policy ensures that employees do not face financial losses due to untimely and unfortunate medical events.

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You must be thinking about what these policies offer. Well, GMC and GPA insurance policy take care of all the healthcare benefits at an affordable cost. As you can see both of these insurance policies are Group Health Insurance Plans which means it is provided by an employer to their employees which is a common group of people working in the same organization. The best thing about it is its low cost.

So what exactly is the GMC and GPA Insurance Policy and what are its benefits? We will discuss the same in this article and also what these policies don’t cover so that you can understand better.

What Exactly is the Group Medical Coverage Policy?

As we said earlier, GMC and GPA Insurance Policy are two of the most popular health insurance plans for employees given by employers. First, we are talking about the GMC Insurance Policy. As you can see from the name, this policy is kind of a Group Health Insurance Plan that covers medical expenses and other additional expenses (as opted by the organization) for a group of common people. The aim behind this insurance policy is quite simple – The times we are living in, the biggest worry that anyone can have is about the medical bills he or she has to pay in case of any health situation. That’s why employers offer GMC insurance policies to their employees so that they don’t need to pay the expensive bills.

Buying individual policies for each of the employees would be complex and too costly. That’s where a GMC and GPA insurance Policy comes into the picture. A GMC Policy can provide similar insurance benefits to all the individuals in a group at a low cost. Regardless of the health risk factors of the people in a group, every individual gets the same benefits at the same amount in a GMC Policy. Many companies bear the total cost of the premium, whereas some companies deduct a certain amount from the salaries of their employees.

The premium of a GMC Policy changes from one Insurance Company to another based on three different factors. We are showing them below. Please have a look.

  1. Size of the Group (More the number of people in a group, the cost will be lower)
  2. Demographic Factors ( Average Age, Income, Occupation of individuals in a particular company)
  3. Additional Benefits and Riders opted under the Policy (Changes from one company to another)

What are the Benefits of GMC Insurance Policy that Employees can Enjoy

In the introduction, we mentioned that people enjoy several benefits with the GMC and GPA insurance Policy. Here, we will talk about the benefits offered under the GMC Insurance Policy while we will discuss the same about GPA later. Have a look!

  1. Hospitalization Expenses (Room Rent, Nursing, Medical Practitioner, Anesthesia, Blood, Oxygen, Surgical Appliances, etc.)
  2. Pre and Post Hospitalization Expenses ( Pre-medical Screening Tests, Diagnostic Tests, Consultation Fees, etc.)
  3. Day Care Procedures ( Under this, the employee is discharged on the same day)
  4. Domiciliary Hospitalization Expenses (Medical Treatments taken at Home)
  5. Reimbursement of out-patient expenses
  6. Family Floater Cover (Employees’ coverage to family members)
  7. Cashless Hospitalization (Cashless treatment in any Network Hospital of the Insurance Company)

What are the Exclusions under the GMC Insurance Policy?

You should know the things that are not covered under the GMC Insurance Policy. It will only help you later. We are showing them below. Do check.

  1. Injuries caused due to War, Mutiny, Military Action, etc.
  2. Cosmetic Treatments not specified in the Insurance Policy
  3. Diseases caused due to Drug or Alcohol Abuse
  4. Self-inflicted Injuries
  5. Alternative Treatments not specified under the Insurance Policy
  6. Mental Illnesses
  7. Experimental Treatments
  8. Engaging in Criminal or Unlawful activities

Documents need to submit for Raising a Claims under GMC Insurance Policy

To get the claims under the GMC Insurance Policy, employees will need to submit a few documents that you can see below.

  1. Duly filled Application Form
  2. A prescription from a Medical Practitioner
  3. Investigative Reports
  4. Medical Bills associated with Hospitalization
  5. Pre and Post-hospitalization Bills
  6. Cash Memos
  7. Discharge Certificate issued by the Hospital
  8. A Police Report if hospitalization is due to an accident

Let’s Discuss GPA Insurance Policy

As you can see from its name, this insurance policy helps individuals cover the expenses in case of an accident injury, accidental disability, or accidental death. Employees are considered to be the greatest asset for any organization, and a GPA insurance policy is the method by which the company shows the value to the company. The Insured sum on a GPA Policy can vary from the insurance company and can also be customized according to the Employees’ Salary or category or as per the company’s requirements.

Similar to the GMC Insurance Policy, the benefits will be similar to all individuals in a group, that too at an affordable premium cost. The best thing about this policy is that it is not necessary to be on duty to enjoy the benefits. The policy will cover individuals whether they are on duty or not.

What are the Benefits of GPA Insurance Policy that Employees can Enjoy?

Let’s understand the benefits that employees can enjoy with the GPA Insurance Policy. We are showing them below. Do check.

  1. Accidental Death ( Death of an Employee due to sudden death. All the medical expenses will be covered during treatment.)
  2. Dismemberment ( Loss of Limbs, Loss of Hearing, Loss of Eyesight, etc.)
  3. Permanent Total Disability
  4. Permanent Partial Disability (if the injury leads to a partial disability)
  5. Weekly Benefit ( Loss of pay temporarily due to an accident)
  6. Accident Medical Expenses Reimbursement ( Both OPD and in-patient expenses)
  7. Additional Benefits ( Education Allowance, Family Transportation, Modification Allowance, Repatriation of Remains, Ambulance Charges, etc.)

What are the Exclusions under the GPA Insurance Policy?

A GPA Insurance Policy does not cover everything. You can look below to know the things that are not covered under this policy. Please check!

  1. Death due to any pre-existing condition
  2. Payments made after making the Claim
  3. Death due to a Natural Cause
  4. Fraudulent Claims
  5. Death due to Pregnancy or anything related to childbirth
  6. Death or Injury due to Suicide Attempt, Intentional Self-injury, Influence of Drugs, Participation in any Criminal or Illegal Act, War/Revolution/Mutiny Action, Adventure Sports, as well as Sexually Transmitted Diseases, etc.

Documents to Submit for Raising a Claim under the GPA Insurance Policy

To raise the claims under the GPA Insurance Policy, you will need to submit a few documents. These documents differ according to the type of GPA Claim you want to raise. This means the required documents will be different for a Death Claim than for a Permanent Total Disablement. We are showing them below. Check them out!

For Death Claim

  1. Properly Filled-up Claim Form
  2. Original First Information Report (FIR)
  3. Original Death Certificate
  4. Panchnama
  5. Post Mortem Report

For Permanent Total Disablement/ Permanent Partial Disablement

  1. Properly Filled-up Claims Form
  2. Original First Information Report (FIR)
  3. Hospitalization Report
  4. Discharge Certificate from the Hospital
  5. Panchnama
  6. Original Certificate from the Doctor of Government Hospital stating the Degree of Disability
  7. Termination letter for Claims under ‘Loss of Employment’

For Temporary Total Disablement

  1. Duly filled Claim Form
  2. Original First Information Report (FIR)
  3. Discharge Certificate from Hospital
  4. Hospitalization Report
  5. Certificate from the Doctor of Government Hospital stating the Degree of Disability

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