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

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

Noting is right or wrong it is always relative. The same is the case with Group Health Insurance and Individual 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.

We all keep hearing from most of the agents that Group Health Insurance is best as it covers the pre-existing diseases. IRDAI (Insurance Regulatory and Development Authority of India) defines Pre-Existing disease as “Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and/or were diagnosed, and/or for which medical advice/treatment was received within 48 months prior to the first policy issued by the insurer and renewed continuously thereafter”.

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In a group health insurance policy, as the insurance is taken for the whole group no scanning is done for the pre-existing disease at an individual level. Therefore, the pre-existing disease is covered for all individuals in a group. However, once the individual goes out of the group the cover ceases and he will not have any coverage. The damage is more when he gets diagnosed with any ailment while in the group and now he wants to quit the group.

Imagine a healthy employee joined group insurance of an organization at age of 25years and diagnosed with a heart ailment at age 40years, now he wishes to voluntarily quit the group to start up a business of his own. Whether he will get the benefit of insurance with respect to heart ailment under the individual policy?

Unfortunately, no. For individuals, health insurance is only for Healthy people. So, he may not get any coverage in individual policy since now he is already suffering from the disease.

Under an individual health insurance policy, individuals are required to declare any existing ailments and insurer may choose to decline or load the premium for covering them depending on the severity of the ailment. Even if they are given the policy, the pre-existing benefit still takes 24 to 48 months to cover them into the policy.

Hence it is better to get once covered under individual policy when he is healthy and is of less age. If he is already suffering from any disease, then the group coverage with pre-existing cover is the best solution.

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

Susheel Agarwal

Susheel Agarwal

Susheel is a certified Happiness Coach, which enables him to help organizations develop healthy and happy workplaces. Years of extensive in-depth research by interacting with various leaders of happy & not so happy organizations, attending several Happiness and Leadership programs along with his own authentic experiences, Susheel has been successful in establishing a happy workplace. He currently works as a Thought Leader and a Passionate Coach, educating corporate leaders to do the same.

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