Home > Fire Group Health Insurance
Group Health Insurance
Enhance your team's well-being with group health insurance. Enjoy premium benefits for your employees while enjoying tax advantages as an employer.
What is Group Health Insurance?
Group Health Insurance is an insurance policy tailored fora collective of
employees within the same company.This plan encompasses an extensive array of medical expenses, from
ambulance services, medications, to specialist consultations.Under this policy, the coverage begins the moment an employee joins the
company and persists until their departure.Premiums for these group medical insurance plans are borne by the employer.Such plans are typically procured by companies or organizations as a value-
added benefit, ensuring medical coverage for their workforce.
Features of Group Health Insurance Plan
- The primary intent of this policy is to grant medical benefits to employees. Extended coverage can also be provided for spouses, children, and dependent parents as additional beneficiaries.
- Many plans accommodate pre-existing health conditions and maternity care provisions.
- Cashless hospitalization is generally facilitated at affiliated network hospitals.
- Provisions exist in some plans to compensate specialists and various medical practitioners for post-hospitalization consultations.
- A distinctive feature of group health insurance, as opposed to individual health plans, is the lack of a prerequisite for medical screenings.
Who needs
Group Health Insurance?
Business owners: with an official registration can consider offering health
insurance to their employees. Regardless of the business size, from startups to
large enterprises, ensuring your team has health coverage promotes well-being
and health security for all members of the organization.
Early-Stage Startups: Investing in a group personal accident insurance policy
for your team can accelerate growth by both attracting and retaining top-notch
talent.
SMEs Group health insurance aids SME employees in navigating healthcare
expenses and obtaining quality healthcare services. SMEs have the opportunity
to purchase tailored healthcare plans and simultaneously enjoy tax benefits.
Large Organizations It's customary for large organizations to extend group
health insurance to their employees. Such policies offer uniform coverage to all
members, independent of age, gender, or hierarchical position.
Why get Group Health Insurance?
Corporate health insurance stands as a pivotal strategy to attract and retain
premier talent within your organization.An exhaustive health insurance policy alleviates the burden of hefty hospital bills,
bestowing peace of mind upon employees.This not only curtails turnover but also fosters a nurturing work place
environment.
Benefits of Group Health Insurance
For Employers for Employees
Tax Benefits
Comparable to other business insurance premiums, the expenditure on Group health insurance premiums is tax-deductible as a legitimate business expense.
Fostering a Healthy Workplace Culture & Amplifying Productivity
A comprehensive insurance plan underscores your commitment to your employees' health and welfare. The more palpable your care, the healthier and more efficient your workforce becomes.
Employee Retention
In an age where companies are extending myriad benefits, retaining talent poses a formidable challenge. Group Health Insurance acts as a strong incentive, enhancing employee loyalty.
Coverages & Exclusions in
Group Health Insurance
Coverage for pre-existing diseases
A pre-existing disease is a medical condition or illness that an individual already
has before seeking insurance coverage. Group health insurance coverage starts
to cover pre-existing diseases from the very day an employee joins the company.
Usually, there is no waiting period as such for any pre-existing disease.
Maternity coverage
Group Health Insurance policy offers financial protection for childbirth-related
expenses for both C-sections and normal deliveries. Usually, there is no waiting
period for maternity coverage in these policies. However, some providers may
have a 9-month waiting period. Expenses covered may include hospitalization for
childbirth, room charges, nursing fees, operation theater charges, and other
medical services specific to the delivery. The policy may have a specified sub-
limit for such expenses. Group Health Insurance policies often cover pre and
postnatal care expenses as well.
Newborn baby coverage
New-born babies are covered from the moment they are born. The coverage
includes medical expenses incurred for the baby during the coverage period.
This can include hospitalization expenses, consultations with pediatricians,
vaccinations, diagnostic tests, medications, and any necessary medical
treatments related to the baby's health. However, such expenses may have
certain limits and sub-limits.
Ambulance costs
The insured can claim the cost of a road ambulance to travel to the hospital or
from the hospital to the place of residence under this cover. The policy may cover
both emergency and non-emergency ambulance services. The policy specifies
the criteria for availing ambulance coverage, which can include the distance of
transportation, the severity of the medical condition, and the recommendation of
a medical professional. A defined coverage limit is usually set for ambulance
expenses.
Pre and post-hospitalization expenses
The policy specifies a predefined period of pre and post-hospitalization coverage,
typically ranging from 30 to 90days before and after the hospitalization. The
coverage may include the costs related to diagnostic tests, consultations,
medications, and other medical services directly linked to the hospitalization,
within this specified period. It may also include follow-up consultations,
rehabilitation services, and other necessary treatments after hospitalization.
Expenses for domiciliary and daycare
Domiciliary coverage refers to the reimbursement of medical expenses incurred
for treatment received at home when hospitalization is either not possible or not
medically necessary. The policy specifies the criteria for availing of such
coverage, which may include the need for continuous medical supervision and
the recommendation of a medical professional. Similarly, daycare treatment
refers to medical operations that do not require 24-hourhospitalization. These
include cataract surgery, tonsillitis surgery, and others.
Most Popular Extensions:
Upon purchasing group health insurance, employers can opt for enhanced coverages:
- Immediate maternity cover, devoid of waiting periods.
- Newborn coverage within the maternity limit.
- Optional OPD (Outpatient Department) coverage.
- A corporate buffer, in case an employee's existing sum assured is depleted and further funds are needed.
Exclusions
Certain standard exclusions exist :
- Some policies might exclude employee's parents, but extensions are available for parent coverage.
- Non-allopathic treatments like homeopathy or Ayurveda aren't covered.
- The policy's validity is restricted to the employee's tenure with the company.
- Treatments for AIDS, and congenital defect-related conditions usually aren't covered.
- Alcohol or drug abuse-linked complications and illnesses aren't included.
- Immediate maternity cover, devoid of waiting periods.
- Newborn coverage within the maternity limit, Optional OPD (Outpatient Department) coverage.
- A corporate buffer, in case an employee's existing sum assured is depleted and further funds are needed.
About Group Health Insurance Policy
What is the difference between group med claim and retail health insurance?
The primary distinction between group health insurance and individual health
insurance is that the former provides coverage shared among a group of
individuals connected under specific conditions. In contrast, individual health
insurance exclusively covers the individual policyholder.
Is medical insurance part of employees' expense? How does claim admissibility vary by room type?
For group med claim policies, claim admissibility might differ based on the room
type selected by the insured during hospitalization. Sub-limits (specific
percentages of the sum insured amount) often apply to various hospital
expenses, like room rent. Therefore, policyholders are advised to adhere to the
room rent limit to ensure hassle-free claim admissibility.
Is group health insurance for employees’ mandatory?
On 15 April 2020, the Ministry of Home Affairs issued an order (No. 40-3/2020-
DM-I (A)), where point no. 5 in the associated Standard Operating Procedure
(SOP) mandates medical insurance for all employees.
What determines the premium of group health insurance?
Premiums in group health insurance are derived from several factors assessing
the risk of covering a group. These factors typically include:
a. Number of individuals in the group
b. Gender distribution within the group
c. Average age of group members
d. Family composition of the employees
e. The occupation or industry nature of the group members
f. Specified coverage limits for the group policy
g. Chosen additional benefits
a. Number of individuals in the group
b. Gender distribution within the group
c. Average age of group members
d. Family composition of the employees
e. The occupation or industry nature of the group members
f. Specified coverage limits for the group policy
g. Chosen additional benefits
What is group insurance room rent capping?
Group med claim policies often establish sub-limits or caps for diverse hospital
expenses, including room rent. Claim admissibility might differ based on the room
type an insured selects during hospitalization. Policyholders are advised to
adhere to the room rent limit to facilitate smooth claim admissibility.
How does group health insurance offer maternity benefits?
Group health insurance generally provides maternity benefits as follows:
a. Pre and post-natal expenses: Coverage often extends to60 days before and 90 days post-hospitalization.
b. In-patient hospitalization: Hospitalization costs, such as doctor consultation fees, surgeries, and room rent, are covered.
c. Type of delivery: Both delivery types (natural and C-section) are included.
d. Vaccination costs: Expenses for baby vaccination spots-birth, aligned with the WHO schedule, are covered
e. Lawful pregnancy termination: Costs related to legal terminations fall under the maternity coverage. It’s crucial to review the insurance policy comprehensively to grasp the exact maternity benefits offered.
a. Pre and post-natal expenses: Coverage often extends to60 days before and 90 days post-hospitalization.
b. In-patient hospitalization: Hospitalization costs, such as doctor consultation fees, surgeries, and room rent, are covered.
c. Type of delivery: Both delivery types (natural and C-section) are included.
d. Vaccination costs: Expenses for baby vaccination spots-birth, aligned with the WHO schedule, are covered
e. Lawful pregnancy termination: Costs related to legal terminations fall under the maternity coverage. It’s crucial to review the insurance policy comprehensively to grasp the exact maternity benefits offered.
Do we require a pre-existing disease waiver?
A pre-existing disease waiver within group health insurance can be invaluable. It
ensures coverage for treatments and costs related to pre-existing conditions from
the policy's outset, devoid of specific waiting periods or exclusions. Such a
waiver guarantees immediate medical treatment and services access for any pre-
existing conditions.
What distinguishes a cashless claim from a reimbursement claim in Group Health Insurance?
In a cashless claim, policyholders visit a network-affiliated hospital, where the
insurer authorizes an initial amount and settles the rest post-treatment. In
contrast, are imbursement claim involves the policyholder paying hospital bills
post-treatment and subsequently seeking approval from the insurer by submitting
these bills and any related medical documents.
How do you file a cashless claim for Group Health Insurance?
To initiate a cashless claim in group health insurance, adhere to the steps below:
a. Complete a pre-authorization form at the TPA counter during admission
and notify your insurance company beforehand for ultimate approval.
b. Present necessary documents at the TPA counter, such as the cashless
healthcare card from your insurer and KYC document copies for
verification.
c. The insurance company, upon reviewing these documents, provides
cashless approval for your hospitalization and retains all treatment-related
documentation.
d. It's prudent to procure a personal copy of these documents for your
records. Retain all medical reports, test outcomes, discharge summaries,
etc., as they are pivotal for seamless claim processing and future
referencing.
e. Cashless hospitalization enables the insurer to bear your treatment costs,
with the policyholder accountable for any charges not covered per
insurance guidelines.
