All About Group Health Insurance

Group health insurance is a health insurance plan that offers cover to a specified group of individuals like members of an organization, employees of a company, etc. It is also referred to as a corporate health insurance plan, the insurance coverage offered under it generally includes COVID insurance, accidental insurance, critical illness cover, daily hospitalisation benefit, maternity cover, etc. A Group Mediclaim Plan is an excellent way to safeguard your employees and their families, especially after seeing the continuous rise in health-related expenses. This is due to the fact that a Group Mediclaim plan provides coverage against the expensive health related treatment cost incurred by the employees in case he/she gets hospitalized because of an accidental injury or illness.

Salient Features of a Group Health Insurance Policy

There are various corporate or group health insurance plans offered by different insurance providers in the market. Highlighted below are some of the common features in all group health insurance plans:

• A group health insurance plan offers coverage against ancillary charges like ambulance expenses.
• There are certain health insurance companies that offer coverage against maternity and pre-existing disease.
• Group health insurance providers generally offer coverage for medical benefits for self, dependent parents, spouse and children.
• Group health insurance plans provides cashless hospitalisation at network hospitals
• There are some Group health insurance plans that offer fee reimbursement of specialists and other medical practitioners for follow check-ups.

Why is a Group Health Insurance Plan Needed?

Nowadays, more and more organizations are trying to be employee-centric and thus, they provide health insurance plans to its employees. Listed below are some important reasons as to why a group health insurance plan is needed and beneficial for both employees and employers:

• Affordable Premiums: The premium paid towards a group health insurance plan in comparison to an individual health insurance plan is much affordable. This is due to the fact that the premium that an individual needs to pay considering the coverage that an individual gets is always higher in group health plans.
• Wider Coverage: There are various group health insurance plans that offer wider coverage and enhanced benefits to the policyholder.
• Option to Customize: The health insurance plans for corporate and groups provide customization of cover options. For instance, one can choose a policy that offers OPD coverage or maternity cover.

Key Inclusions Under Group Health Insurance

The key inclusions offered under a group health insurance plans offered to the insured individuals are as follows:

• There are certain insurance plans that offer coverage for ambulance expenses.
• Pré-hospitalisation and post-hospitalisation expenses.
• Coverage for pre-existing illness from 1st day.
• Cover for maternity is offered under all group health insurance plans, however, some of them have a waiting period of 9 months while others do not.
• The infant is offered coverage from day 1 of his/her delivery.
• Daycare and domiciliary expenses.
• Fees of a specialist and medical practitioner.
• Nursing and room rent expenses.
• Coverage by some insurance plans for chemotherapy, radiotherapy, pacemaker cost, etc.
• Oxygen, anaesthesia, OT charges, blood, drugs, medicines, diagnostic cost like x-ray, etc.

Common Exclusions Under Group Health Insurance Plan

The common exclusions under a group health insurance plans are as follows:

• Coverage is not provided for non-allopathic treatments like Ayurveda, homeopathy, etc.
• There are certain insurance plans that do not offer coverage to employees’ parents.
• Complications arising because of the usage or abuse of drugs or alcohol.
• Congenital illness and other expenses incurred during the treatment of AIDS or any other alignments.
• The validity of a group health insurance plan is always limited for the employees and stays active till the time the employee works with the company.

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Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.