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.
|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.
Inclusions under the group health insurance plan include:
Given below are the steps to claim your group health insurance policy:
Here is the list of documents that are generally required to file a claim for a group health insurance policy:
Some common exclusions under group insurance plans are:
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:
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.
Here are a few factors to consider before purchasing any one of the group insurance types:
Individuals planning to obtain health insurance can consider Navi Health Insurance because of the following reasons:
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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.
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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