Types Of Group Health Insurance In India & Its Coverage
Group health insurance policies offer coverage benefits to a group of individuals such as employees of a company or members of an organisation. This type of health insurance comes in various forms. To be eligible for this insurance type, an organisation must employ more than 20 individuals. Nonetheless, there are exceptions for microfinance companies, where the provision of group health insurance is made available if they employ more than 5 individuals.
This particular insurance policy usually covers accidental hospitalisation. As an added perk, employees often get the opportunity to include their family members in the policy as well.
Types of Group Health Insurance Plans
| Plans | Features |
| Small employer group | Eligible for companies with less than 50 employees. Covers services like primary health care, and physical and laboratory examination. Some policies include annual claim benefits. In some cases, insurance companies group several small groups in the same industry into one large master policy. This enables small business employees to get coverage at affordable premium rates. |
| Fully insured employer group | In this plan, an employer will pay for the insurance premiums fully or partially. The insurer is responsible to pay any additional costs related to the benefits as per the policy terms. Fixed annual premium rate. Employees might need to pay a part of the total premium amount. Their contributions vary depending on the number of participants enrolled in the plan yearly. |
| Self-funded health care | An employer covers all employee healthcare costs and other benefits. Employers also need to pay the administrative costs related to this group insurance. Suitable for large companies. |
| Health Maintenance Organisation (HMO) insurance plan | This is a prepaid health plan where policyholders pay for the health benefits in advance via monthly premiums. Affordable compared to other group insurance types. Policyholders can avail treatment from doctors and medical facilities that are included in the HMO list. |
| Preferred Provider Organisation (PPO) | More flexibility in terms of choosing doctors and other medical facilities compared to HMO plans. Policyholders can get treatment from hospitals that are not included in the PPO list. |
These group insurance types take a look at the coverage under these plans.
Group Health Insurance Coverage
Inclusions under the group health insurance plan include:
- Pre-existing diseases.
- Maternity cover (Some plans come with a waiting period of 9 months).
- Infant cover.
- Some group health insurance policies include ambulance charges.
- Pre-and post-hospitalisation charges.
- Daycare and domiciliary expenses.
- Medical practitioner and specialist’s fees.
- Charges of room rent and nursing.
- Costs of anaesthesia, blood, oxygen, medicines, drugs, OT charges and diagnostic expenses such as X-rays.
- Radiotherapy, chemotherapy, and cost of a pacemaker.
What is the Claim Process of a Group Health Insurance Policy?
Given below are the steps to claim your group health insurance policy:
- Step 1: Inform the insurance provider about your hospitalisation/medical expenses as soon as possible.
- Step 2: The customer care executive of the insurer will contact you. He/she will give guidance with regard to the procedure and convey the documents required for the claim.
- Step 3: You can download the claim form from the insurance provider’s official website. You can also ask the customer care representative for the same.
- Step 4: Fill out the form and attach the necessary documents.
- Step 6: Upload the claim form along with the requisite documents on the insurer’s website.
- Step 7: Await the insurer’s approval for the processing of the claim.
Documents Required for Claiming Group Health Insurance
Here is the list of documents that are generally required to file a claim for a group health insurance policy:
- Claim-form/pre-authorisation form duly filled and signed
- Doctor’s prescription
- Final investigation report
- Medical reports
- Final bill with the breakup of expenses
- A copy of FIR, in case of an accident
- Discharge report with suggestions for further treatment
- Cash memos, itemised bills, etc.
- Any additional documents that might be requested by the insurer.
Exclusions under Group Health Insurance Plans
Some common exclusions under group insurance plans are:
- Coverage benefits are not available for parents in some plans.
- Alternative treatments such as homoeopathy.
- Coverage is available till the employee works in the organisation.
- Congenital diseases and AIDS treatment costs.
- Drug or alcohol abuse treatments.
Also Read: How To Use A Health Insurance Premium Calculator To Choose The Best Policy For You
Why is Group Health Insurance Necessary?
Reading about group insurance types helps in the selection of the best plans but then you must also know why it is important to maximise benefits. Let’s take a look at the same:
- Wide coverage
It is evident from the above section that group insurance covers a number of health benefits and guarantees financial security to the policyholders. - Customisable options
Group insurance policyholders can customise their plans as per their requirements. For instance, they can choose a plan that offers maternity or OPD covers. - Affordable premiums
In an individual health insurance plan, policyholders get limited coverage for a high premium. However, group health insurance plans offer high coverage against the same premium amount.
Alternatively, now you can also choose to avail comprehensive health benefits coverage for you and your family in under 5 minutes from Navi. Download Navi App if you consider buying a plan from Navi and avail yourself of the same via an entirely paperless process with benefits from over 10,000 plus network hospitals.
Factors to Consider before Buying Group Health Insurance
Here are a few factors to consider before purchasing any one of the group insurance types:
- Sum insured amount
An employer should look for a high sum insured before purchasing group health insurance. A high sum insured means higher coverage, which makes it convenient for employees’ medical treatment. - Premium amount
One should factor in the premium amount of a group health insurance policy to ensure that all the features are available at affordable rates. - Hospital network
Medical emergencies can arise anytime, and a large network of cashless hospitals ensures that individuals can seek treatment easily. - Purchase policy online
Buying a group insurance policy online is less time-consuming and hassle-free than the offline procedure.
Also Read: Is Your Employer Provided Health Insurance Policy Sufficient To Safeguard Your Family?
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- More than 10,000 network hospitals across 400 locations in India.
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Final Word
Even though there are several types of group insurance policies available, offering a wide scope of coverage, it is better for individuals to have other comprehensive health insurance policies in place. It’s advised to compare different group insurance policies mentioned in the aforementioned section and choose one best suited to the employee’s benefits.
FAQs
Ans: Most of the group health insurance policies offered by companies also provide medical coverage to the immediate family members of an employee. However, a married couple can also get individual group health insurance policies from their respective companies.
It is also possible to file separate insurance claims at the same time. However, please note that you can only claim the excess amount from your second policy that hasn’t been paid under the first.
Ans: All types of organisations such as startups, new and established businesses, associations, groups and companies with more than 20 members are eligible for a group health insurance policy.
Ans: As per Section 80D of the Income Tax Act, organisations/companies who pay premiums for the group health insurance policy can avail of tax benefits.
Employers are eligible to claim the entire premium amount, which is treated as ‘profit in lieu of salary’ as deduction. On the other hand, employees can claim a deduction u/s 80D if they also contribute towards the premium amount. However, they cannot claim any tax benefit for the premium paid by the employer on their behalf.
Ans: Some of the group health insurance policies cover Covid-19 treatment costs. However, you should check with your insurance company before settling for a plan.
Ans: No. This is a standard exclusion with most insurance providers. However, one can waive off this exclusion and include it in his/her group insurance plan.
Ans: The premium of a group health insurance depends on the number of employees in an organisation, their age, location and number of dependents.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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