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Which one is better to opt – Retail Health Insurance or Group Mediclaim


retail health insurance vs group health insurance - vector graphic representing person - thinking of two things

With the given benefits of Health Insurance and growing diseases, it’s a burning question what is the right time for health insurance and which type is right?

Nothing is right or wrong it is always relative. The same is the case with Group Health Insurance and Retail Health Insurance. To answer the question of which among the two is best it would be good to know what it offers and what is not and under what circumstances, then choose what best suits one’s needs.

A health insurance policy can be classified into two types in general as mentioned below:


Retail Health Insurance

Retail health insurance is a type of health insurance policy that is offered to individuals as well as families. It is also known as individual or personal health insurance. This type of health insurance can be taken by an individual and the dependents can be included in the same policy.

Group Health Insurance

Group health insurance is a type of health insurance that is offered to a group of members. A group of people would be covered under a single health insurance policy. Most of the group health insurance policies are employee-employer group health insurance policies.

Group health insurance can also be offered to non-employee-employer relationships such as NGOs or Associations depending on the merits of the case.

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Let’s compare the retail health insurance and group health insurance policy to decide which one to opt for.

This comparison helps us understand the difference between group and retail health insurance:


DescriptionRetail Health InsuranceGroup Health Insurance
What is it?Retail health insurance is a type of health insurance which is offered to an individual or a familyGroup health insurance is also a type of health insurance which is offered to a group of members. Organized or unorganized groups are considered for group health insurance.
What is covered?It covers hospitalization expenses, emergency ambulance expenses, organ donor expenses, ICU and room rent expenses, Nursing expenses etc.It covers hospitalization expenses, emergency ambulance expenses, organ donor expenses, ICU and room rent expenses, Nursing expenses etc.
Who can buy it?Any individual who is a resident of India can buy the policy and has the choice to include the family members.Any organization which has employee-employer relation or non-employer-employee relationship can buy the group health insurance policy.
Who pays the premium?The proposer of the policy or the insured pays the premium in case of retail health insurance policy.The employer would pay the premium to the insurance company on behalf of the employees.
Who is the Proposer & Insured?Proposer is a person who proposes or asks for retail health insurance whereas the insured is the person who is covered under the retail health insurance policy. Insured and proposer can be same or different depending on the circumstances.Proposer is the employer and the insured is the members of the group health insurance policy. The proposer can also be added in the group health insurance policy thereby becoming the insured member.
Eligibility criteriaAny person above 18 years of age is eligible to take a retail health insurance policyShould be a member of the organization to avail group health insurance policy.
Sum InsuredThe sum insured would range from Rs.50k to Rs.1 Crore for pre underwritten insurance policies. If a higher sum insured is required then the same would be examined by the underwriter who would decide on the merits of the case.The sum insured would range from Rs.50k to Rs.10 Lakhs in most of the cases. If a higher sum insured is required then the same would be examined by the underwriter who would decide on the merits of the case.
Pre policy medical checkupPre policy medical checkup would be required depending on the medical condition of the applicant and the information declared in the proposal form.There would be no pre-policy medical checkup in the group health insurance policy.
Policy copyPolicy copy would be shared with the insured and also health cards would be given to all the members of the policy.Policy copy as well as the health cards will be shared with the employer. Employers in turn share the health cards with the employees.
Minimum lives requirementThe minimum requirement to avail a retail health insurance policy is 1 Adult.The minimum requirement to avail group health insurance is 7 members.
Add-onsAdd-ons would be decided by the insurance company and would differ for different types of retail health insurance policies.Customers can select any of the add-ons under the group health insurance policy without any limitations.
ClaimsClaims are settled by the insurance company directly to the insured customer.Claims are settled to the insured members or the company depending on the understanding between the insurance company and the customer.
PortabilityPortability can be availed. The request for portability should be submitted 45 days prior to the expiry of the policy.There is no portability option as the insurer can be changed at the time of renewal and there is no need to obtain or apply for any portability under the group health insurance.
Initial waiting periodThe initial waiting period of 30 days would be applicable under the retail health insurance policy.The initial waiting period can be exempted under the group health insurance.
Pre existing waiting periodPre-existing disease waiting periods range from 1 year to 4 years.Pre-existing disease waiting periods can be waived off.
Specific disease waiting periodSpecific disease waiting periods of 1-2 years would be applicable under the retail health insurance policy.The specific disease waiting period can be waived off under the group health insurance policy.
Maternity waiting periodThe maternity waiting period of 9  months would be applicable under the retail health insurance.The maternity waiting period of 9 months can be waived off and coverage can be availed from day 1 under the group health insurance.
No claim bonusNo claim bonus would be given if there was no claim in the previous years and the maximum no claim bonus would be up to 150% of the basic sum insured.There would be no claim under the retail health insurance policy even if there are no claims reported in the previous year.
Break-inThe insured customer will lose all the accrued benefits such as waiting period waiver, no claim bonus etc. if there is a breakin under the policy. The policy will lapse if the renewal premium is not paid within the grace period after the renewal date.Group health insurance policy can be renewed at any point of time after the expiry of the policy. As there would be no accrued coverage under the policy there is nothing to lose except for the health insurance coverage.

For any further assistance or clarity please feel free to reach us at Ethika

Susheel Agarwal

Susheel is the CEO of Ethika Insurance Broking P Ltd. This company, which has a current value of 10 million dollars, was bootstrapped by him and two of his friends. He attributes his success to his ability to inspire others to seek happiness at work.