Choosing cover
How to judge a group health policy (before you sign)
Two policies with the same sum insured can settle a claim completely differently. Here are the five things that decide which — and the room-rent clause that catches most teams out.
The difference between a good policy and a bad one never shows on the quote — it shows on the worst day.
Two policies can carry the same sum insured and the same premium, and still leave one team looked-after and another out of pocket. The difference never shows on the quote — it shows on the worst day. Here is how to read it before you sign.
The short version
- Premium tells you cost; five other things tell you what the policy will actually do.
- Room-rent caps are the clause that quietly shrinks claims — understand the proportionate-deduction trap.
- Confirm day-one cover for pre-existing conditions and the network reach for your locations.
- The real test is who fights a stuck claim — a named contact, or a call centre.
The five things that decide the claim experience
Premium tells you what a policy costs. These five tell you what it will actually do: the sum insured, room-rent caps, waiting periods, the hospital network, and who handles a stuck claim.
| What to check | Strong policy | Weak policy |
|---|---|---|
| Sum insured | Sized to the cities your team lives in; uniform or sensibly graded | Too low for metro hospital costs; arbitrary grading |
| Room-rent cap | No cap, or high enough for a private room | Low cap that triggers a proportionate deduction across the whole bill |
| Waiting periods | Day-one cover for pre-existing conditions | Long or unclear waiting periods |
| Hospital network | Strong cashless reach where employees live and work | Thin network; reimbursement the default |
| Claims support | A single, named point of contact for a stuck claim | The employee is handed to a call centre |
Room-rent caps and the proportionate-deduction trap
A room-rent cap does not simply limit your room charge. If you pick a room above the allowed limit, many insurers apply a proportionate deduction to the entire claim — the surgery, the medicines, the tests — in the same ratio.
So a small overshoot on the room can quietly reduce the whole settlement. The fix is to know the cap before admission, or to choose cover without one. For what's covered in the first place, see what GMC covers.
Sum insured, waiting periods and network
A uniform sum insured gives everyone the same cover; a graded one varies it. Neither is “right” — what matters is that it fits the cities your people live in. Good group policies also cover pre-existing conditions from day one, but confirm it explicitly.
Cashless treatment only helps if the network reaches your employees, so check it for their home and work locations.
What a broker should do for you
A good broker turns these checks into your leverage: negotiating technically on premium, structuring the plan around your people, and giving every employee one dependable contact when a claim is stuck.
You can ask any broker to walk you through all five — including us. For the longer version, read how to choose a group health insurance broker, and whether you're even required to offer cover in is group health insurance mandatory in India?
Claims-turnaround benchmarks vary by insurer and are deliberately not stated here.
Frequently asked questions
What is a proportionate deduction?
If you choose a hospital room above your policy's room-rent limit, many insurers cut their share of the entire bill in the same proportion — not just the room charge. A low room-rent cap can therefore shrink a whole claim.
What is the most overlooked factor when comparing group health policies?
Room-rent caps and sub-limits. Two policies with the same sum insured can settle very differently because of how these clauses interact with a real hospital bill.
Does a cheaper premium mean weaker cover?
Not always — but a low quote often means a low sum insured, a restrictive room-rent cap, or a thin network. Compare what the policy pays and how it handles claims before comparing price.
What happens when you talk to us
A 20-minute video call with a Growth Advisor — no obligation, and no quote pushed. It opens with a five-minute video from our founder on how the benefits stack works and why Ethika exists; the rest is your questions. You'll leave with an honest read on your current cover and claims experience, and a straight answer on whether we can genuinely help — even if you never become a client.
20 minutes with a Growth Advisor. No obligation.
A note on this page. Everything here is general information, not insurance, legal, financial or tax advice, and nothing is an offer. For advice about your situation, talk to us.