Your complete resource for policy benefits, claim processes, and building a proactive wellness culture for your team.
What is Group Health Insurance (GHI)?
Group health insurance is a type of insurance which covers members of a group (which has not been formed solely for the purpose of buying a group health insurance) under one master health insurance policy. The most common and popular form of group health insurance is the one taken by an Employer for their Employees, as a part of the Employee Benefits program. A Group health insurance for employees covers the hospitalization expenses due to any illness, disease or accident during the policy period; an employee can make a claim up to the sum insured, she/he is eligible for, under the policy.
The Core Benefits of Group Health Insurance
Group mediclaim insurance policy for employees comes with lower premiums when compared to a retail or individual health insurance plan. This discount in premium is due to the large number of members and a bulk premium paid in advance by the policyholder.
Group health insurance policy is a real complementor to individual health insurance. Individuals who may not be able to take higher cover in their individual health insurance would benefit from group medical coverage.
Coverage for pre-existing diseases is one of the major group health benefits that is available under group insurance for employees. There is no waiting period of any kind such as pre-existing, specific diseases, 30-day in a corporate group health insurance policy.
Group health insurance for startups is highly customizable as insurance companies can provide tailor made group medical insurance policy for employees.
Group medical insurance plans have an option to include family members on payment of additional premium. This would benefit the senior citizens and individuals with extreme conditions who might not be eligible for health insurance.
The Dual Advantage: A Win-Win for Employees and Employers
Key Benefits for Your Employees
- Economical: Group mediclaim insurance policy for employees is highly economical as the premium is paid by the employer in most cases. Even in cases where the employees pay their share, the premium is far lower compared to an individual health insurance plan.
- No pre-policy checkup: Corporate group health insurance plans come with an advantage of no pre-policy checkup at the time of taking the policy. This means that the chance of rejection is nil and employees with any kind of adverse health conditions may avail the cover under a group health policy.
- Day 1 cover: Group coverage insurance comes with zero waiting period which means that employees can claim from day 1 without having to wait for a certain period unlike in an individual health insurance plan.
Strategic Advantages for You as an Employer
- Tax benefits: The premium contributed by the employers towards a group mediclaim policy for employees would be eligible for tax benefits under Section 37 (1) of Income tax act, considered as a business expense.
- Reduces absenteeism: Group medical insurance also helps in employee productivity by reducing employee absenteeism. Employee happiness is directly related to their productivity as per the latest research and group mediclaim insurance policy for employees may increase employee happiness.
- Retains talent: Talent retention is one of the major challenges faced by employers. A corporate group health insurance could help in retaining the talent of a firm. Firms offering group medical insurance for employees have a competitive advantage over their rival firms.
Who Can Be Covered Under a GHI Policy?
Government companies
Employees working in a government organization are usually covered by the group medical insurance... in such cases a group health insurance for employees could be useful.
Private Companies
Employees working in private companies would not have any government insurance cover... Private companies offer group health insurance for employees as a part of their employee benefits.
Start-ups
Start-ups do not enjoy the resources that are available with the established companies... improve employee wellness and happiness at the workplace.
Unions
Many of us might not have an idea but group health insurance plans for individuals can be given when they are a part of a union... take the group coverage insurance based on their requirements.
Associations
Associations such as home associations, societies, trade associations, and other social organizations such as NGOs may also take the group health insurance plans... should not be formed for the sole purpose of availing group mediclaim policy.
Beyond the Policy: The Ethika Advantage
A standard policy is just the starting point. We enhance the value of your GHI with programs designed to build a holistic wellness culture.
The GHI Claim Process Explained
At a Network Hospital
Visit & Register
In case of emergency, visit your nearby hospital and register with the insurance section at the hospital for a cashless facility. If the hospital is a network hospital, then the claim would be processed from the hospital’s end.
Inform HR
After the claim is registered, send a mail to your HR team who would then loop in your group health insurance broker or group health insurance agents.
Broker Assistance
If the claim is assigned to Ethika insurance, we would provide Red carpet claims assistance and the complete responsibility of the end to end claim settlement process would be with us.
Direct Settlement
The claim amount would be settled directly to the hospital before the discharge and any remaining amount that is not covered under the policy should be borne by the employee before discharge.
At a Non-Network Hospital
Inform Insurer
The first step in the reimbursement process is to inform the insurance company or agent within 24 hours of hospitalization. This intimation should be followed up with a claim registration number that would be given by the insurance company.
Pay & Collect Docs
Once the employee is discharged from the hospital, you are required to submit all the relevant and required documents in original form to either your HR or to your agent who in turn would share them with the insurance company for processing the claim.
Receive Payment
Once all the documents are received the claim would be settled based on its merits within 15 days of receiving all the required documents.
Difference between GHI & Retail health insurance
| Differentiator | Group Health Insurance | Individual health insurance |
|---|---|---|
| Given to | Group of people | Individuals |
| Who pays the premium | Mostly Employer, sometimes employees | Individual taking the policy |
| Waiting Period | No | Yes |
| Who can control the policy? | Employer | Individuals |
| Claims can be made from | Day 1 | After waiting period |
| No claim bonus | Not available | Yes |
| Insured is | Employees | Individuals |
| Eligibility | Group member | Individual above 18 years age |
| Customization of plan | Available | Not available |
| Pre-policy medical checkup | Not required | Required |
| Minimum number | 7-15 | 1 |
How to Get Started with Ethika
Visit Website
Visit the Ethika Insurance website and navigate to "Offerings > Group health insurance".
Enter Details
Enter your contact details, name & email and click on “Get Started”.
Expert Call
You will receive a call from our health insurance expert who will ask for the required details for quote generation.
Receive Quotes
Once the details are shared, our expert will share group health insurance quotes from multiple companies that suit your requirements.
Confirm & Issue
Once you confirm, we can proceed to payment and policy issuance.
Documents Required for Purchase
- Complete list of the employees with their date of birth, sum insured required, designation, employee number etc.
- If family members are to be included in the group mediclaim policy, then their complete details are to be shared.
- Know Your Customer (KYC) documents such as Aadhar Card, PAN card, Passport Voter card etc.
- Business registration certificate
- Canceled cheque leaf and bank details
For more details please contact on our toll free number 7559755957 for complete information on the documents required for purchasing a group medical insurance policy for employees.
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Book My Free Strategy SessionFrequently Asked Questions for HRs
What is Group Health Insurance?
Group health insurance is a floater health insurance policy which is offered to a group of individuals. In general, group floater health insurance is offered by employers to their employees.
Which Group health insurance is best in India?
The best group health insurance in India can be decided on the basis of few factors such as: Claim settlement ratio, Premium amount, Customization options, Inclusion of family members, Time taken for mid-term additions or deletions.
Who can take a group health insurance policy?
Any business that has at least 7-10 employees working with them can take a group floater health insurance policy.
What is the maximum age to take a group health insurance policy?
The maximum entry age in group floater health insurance plans varies among the companies. But, most of the companies keep the entry age in the range of 65-80 years.
Is Covid-19 covered under group health insurance policy?
Yes. Group health insurance plans cover the hospitalization expenses incurred by the policyholder due to Covid-19.
When is the best time to get group health insurance for my employees?
The first best time to get group health insurance for your employees was yesterday and the second best time is today. You can simply get in touch with Ethika insurance here for your group health insurance requirements.
Can I buy group health insurance if my workplace has only 10-15 members? Who else can be covered in group health insurance?
Yes. You can buy group health insurance if your workplace has 10-15 members. In case of employer-employee health insurance, employees along with their spouses, children and parents/ parents-in-law could be covered, whereas in case of a nonemployer-employee relationship, all the enrolled individuals can be covered.
How to get Group health insurance for my small business?
You can get group health insurance for your small business by getting in touch with us here. We can cover any number of lives and our premium depends on various factors such as coverage, demography, age of members, and previous claim experience.
Can I take corporate group health insurance and individual health insurance at the same time?
Yes. You can take a corporate health insurance plan as well as an individual health insurance plan at the same time and we strongly advise you to take both of them at the same time.
What are the limitations of group health insurance?
A group health insurance policy is a customized policy as per the needs of the policyholder and does not usually have any restrictions.
How is group health insurance different from individual health insurance?
A group health insurance is taken by the employer for employees and is customized as per the needs of the employer. On the other hand, individual health insurance plans cannot be customized and are purchased by individuals to include their family members.
As an employer what should I look for before purchasing a group health insurance plan?
As an employer, before buying a group health insurance policy, you should look at the claim settlement ratio, coverage offered, after sales service of an insurance company.
Why should I take group health insurance for my employees?
Group health insurance is a part of the employee benefits offered to your employees and in a way it could help reduce employee retention, increase employee happiness and thereby have a positive influence on employee productivity.
Is it mandatory to provide health insurance to my employees?
No. It is not mandatory to provide health insurance to employees. But as a part of the employee benefits, employers provide group health insurance to their employees.
Can a group health insurance policy be transferred from one insurance company to another without losing the benefits?
Yes. It is possible to transfer your group health insurance plan from one insurer to another without losing out on the benefits. You need to submit the details of your employees, coverage required, and customize the terms and conditions so that your new insurance company can provide you with a quotation.
What is the initial waiting period in a group health insurance policy?
There is no initial waiting period in a group health insurance policy as it is a customized policy.
What is a waiting period?
A waiting period is the time during which the policyholder would not be able to avail the benefits under their insurance policy. For example, if there is an initial waiting period of 30 days, any hospitalization that happens during this period would not be covered except for accident related hospitalization.
What are the exclusions in a group health insurance policy?
There are few exclusions in a group health insurance policy:
- Any treatment that is done on an experimental or trial basis.
- Cosmetic surgery unless it is required due to an accident
- Hospitalization expenses due to self-harm or self-injuries inflicted by the insured in normal circumstances or under the influence of alcohol or any other intoxicating substances.
- Gender change treatment
- Expenses incurred for investigation and evaluation
- Hospitalization due to involvement in sports and other adventurous activities.
What is covered in a group health insurance policy?
A group health insurance covers the following:-
- In patient hospitalization
- Our patient hospitalization
- Day care treatment
- Pre and post hospitalization
- Organ donor expenses
- Maternity expenses
- Newborn baby cover
- Critical illness expenses
- Ambulance cover
- Health checkup
- Domiciliary hospitalization etc.
Is there room rent capping in group health insurance?
Room rent capping could be selected as an option in group health insurance. Room rent capping would usually be a certain percentage (for example 1%) of the overall sum insured of the policy or the actuals.
What is a pre-existing condition? Is there any waiting period for pre-existing conditions in group health insurance?
A pre-existing condition refers to any disease/illness/ ailment or injury that is diagnosed by a physician within 48 months prior to the effective date of the policy or its reinstatement. There is no waiting period for any pre-existing condition in a group health insurance policy.
What is a health check-up facility in group health insurance?
A health checkup facility is the medical checkup facility provided by the insurance company across the network hospitals and diagnostic centers.
What is the maternity benefit in group health insurance?
Maternity benefit refers to the coverage provided by the group health insurance policy during the pregnancy and delivery period. It covers both pre and post natal expenses.
Is abortion, miscarriage, legal termination covered in group health insurance?
Yes. Abortion,miscarriage and legal termination are covered in a group health insurance policy subject to the condition that these should be done on the advice of the treating doctor. Voluntary abortion is not covered under the policy.
Does group health insurance policy provide health insurance cover to new born babies?
Yes. A group health insurance policy provides health insurance cover to newborn babies under the maternity section of the policy. Newborn babies are covered from day 1 up to 90 days for all their hospitalization expenses under the maternity cover of the policy.
Are congenital diseases covered in group health insurance?
External congenital conditions are not covered under a group health insurance policy unless they are life threatening. However, internal congenital conditions are concerned under the policy.
Does a group health insurance cover AYUSH related hospitalization?
Yes. A group health insurance policy covers AYUSH related hospitalization and also the expenses incurred for alternative treatments.
Is pre-policy health checkup mandatory under group health insurance?
No. There is no need to undergo pre-policy checkup in a group health insurance policy. No medical tests are required to take a group health insurance policy.
What is the maximum age covered in group health insurance?
The maximum age that is permitted in a group health insurance is as follows:
- Employees & their Spouse- Up to 80 years
- Children - Up to 25 years
- Parents/ Parents-in-law- 80 years
What happens to the policy after the expiry date?
After the expiry date, there would be no coverage under the group health insurance policy.
What is the maximum number of claims allowed under a group health insurance policy?
There is no limit on the maximum number of claims that can be made in a group health insurance policy.
How to avail cashless treatment?
Get admitted in a hospital > Submit relevant documents and duly filled claim form to the hospital insurance team > They’ll send it to the insurance company for cashless approval > Insurance company will check the documents and give approval for cashless treatment > Hospital carries out the treatment > Policyholder to pay any extra amount other than that was approved under group health insurance cashless claim > Discharge from hospital.
Whom to call in case of emergency hospitalization?
In case of an emergency you can always call us at 7559755957 (Available 24*7).
What is the process if I want to avail treatment from a non-network hospital?
If you want to avail treatment in a non-network hospital, then you should follow the below process:
If planned admission, then inform the insurance company before 48 hours. If unplanned admission > Get admitted and treated in non network hospital > Make payment to the hospital > Collect discharge copy, original bills and other required information > Submit all the original documents to the insurance company including duly filled and signed claim form > Insurance company would check the documents and process the claim > Claim settled on reimbursement basis.
What documents are required for making a group health insurance claim?
Here is a list of documents that are required for making a claim under a group health insurance policy:
- Duly filled and signed claim settlement form
- Payment details such as NEFT or Canceled chèque leaf
- Discharge summary
- Final hospital bill with a detailed breakup and payment receipts
- All investigation reports such as original blood reports, X-ray reports, CT scan, MRI etc
- Medico legal certificate and FIR in case of accident related cases.
How is the premium for group health insurance policy calculated?
The premium for a group health insurance policy is calculated on the basis of the total number of members, age of the members, sum insured required, coverage required, and the past claim experience history are required under the policy.
What are the advantages of group health insurance?
The major advantages of a group health insurance policy are:-
- No waiting period for preexisting conditions and other waiting periods
- Maternity cover without waiting period (for new joiners)
- Inclusion of family members
- No pre policy medical checkup
- Customization of policy
Can I cover dependents in a group health insurance?
Yes. Dependents such as children could be covered up to the age of 25. Once they reach 25 years they would not be allowed to be covered under the policy. Parents and parents-in-law could be covered up to 80 years of age.
Is my group health insurance valid PAN India?
Yes. Your group health insurance policy is valid across India and you could avail hospitalization in any of the hospitals (except the blacklisted hospitals) across India.