Group health insurance

Since health insurance policies have become a necessity in today’s age, they are offered as group cover too. Rather than covering a single individual or a family, group health insurance plans cover a large number of individuals belonging to a particular group. Each member of the group has an insurance cover to his or her name.

If any member faces any health issue for which a claim is made, the group policy pays the claim for the member but the cover for other group members continue without a break till the policy period. Group health insurance plans have affordable premiums and thus are a good way to secure the health of a group of members.

Features of Group Health Insurance Policy

A group health insurance plan has some common features which differentiate it from other health insurance plans. Here are the applicable features of group health insurance plans –

  • A single policy is issued covering all the members of the group. This policy is called the master policy
  • The group should be a registered group which should not be formed only with the intention of availing a group health plan
  • Premiums of the policy are paid in one lump sum by the members or by the head of the group or jointly by the members and the group head.
  • These plans come with a tenure of one year after which they are renewable

Top Companies offering Corporate Health Insurance Policies

Group health insurance plans are offered by many general insurance companies. However, here is a list of the top companies which offer attractive group health insurance plans –

Religare Health Insurance – Religare is a standalone health insurance company offering a variety of health insurance plans for individuals as well as for groups. Its Group Care plan is a corporate health insurance plan meant to cover the employees of an organisation.

Max Bupa Health Insurance – Max Bupa is another private standalone health insurance provider with a reputation in the insurance industry. The company’s group health plan covers a large number of members under a comprehensive health insurance policy.

Reliance General Insurance – Reliance offers a group mediclaim insurance policy with good coverage benefits. The policy can be customised and it covers domiciliary hospitalisation, maternity related expenses, pre-existing illnesses and day care treatments.

IFFCO Tokio General Insurance – IFFCO Tokio offers a Corporate Health Insurance Plan which is designed for employees of a business organisation. At least 50 members and their families are required to be covered under the plan. Diagnostic expenses incurred, consumables cost, day care treatments, etc. are covered under the plan

Oriental Insurance Company – Oriental offers a range of group mediclaim policies for members of specified banks and also for employer-employee groups. The coverage is comprehensive and the premiums are low

TATA AIG General Insurance – TATA AIG offers Wellsurance Executive policy which is an employee mediclaim policy. The policy has low premium rates and covers hospitalisation as well as post hospitalisation expenses

Bharti AXA General Insurance – Bharti AXA also offers a group mediclaim policy which has good coverage benefits while the premiums are low

Future Generali General Insurance – Future Generali offers a range of group health insurance plans for registered groups. Personal accident plans, hospitalisation plans as well as hospital cash plans are offered by the company.

Understanding Group Health Insurance Policy

A group health insurance policy works in the following way –

  • The group decides to take a health cover for its members
  • The insurance company is approached with a proposal of insurance
  • All the members of the group are listed and a sum insured is quoted against each member. The sum insured is decided by the insurance company
  • After listing the members and the sum insured of each member, the premium is calculated
  • The premium can be paid by the group, its members or by both
  • The policy starts after the premium is paid
  • In case of a claim for any member, the policy pays the claims up to the sum insured of that member
  • Cover for other members continues
  • When the policy period comes to an end, the policy is renewed with renewed terms and list of members.

Group Health Insurance Policy Coverage

Coverage under group health insurance plans are offered for the following common instances –

  • Expenses incurred before actual hospitalisation takes place. This is called pre-hospitalisation expenses
  • Expenses incurred when the insured is hospitalised for at least 24 hours. This is called inpatient hospitalisation expenses
  • Expenses incurred after the insured is released from the hospital called the post hospitalisation expenses
  • Day care treatments where hospitalisation is not required for 24 hours
  • Maternity cover is also available in some plans
  • Domiciliary treatments

Group Health Insurance Policy Exclusions

The following instances are not covered under group health insurance plans –

  • Pre-existing illnesses are not covered from Day 1 of the policy. They are covered after a waiting period
  • Suicides or self-inflicted injuries are not covered
  • Injuries suffered due to participation in hazardous activities, acts of criminal nature, HIV/AIDS infection, alcohol or drug abuse, etc. are not covered
  • Cosmetic and dental treatments are not covered
  • Maternity expenses are not covered unless specifically stated
  • Mental disorders and congenital disabilities are not covered
  • War, riots, civil commotion, etc. and injuries suffered due to them are not covered