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Group Personal Accident Insurance
Secure your employees' futures with Group Personal Accident (GPA) Insurance—your staff's safety net against accidental impairments or death.
What is Group Personal Accident Insurance?
A Group Personal Accident (GPA) Insurance policy helps protect you and your
family financially in case you suffer an accident that results in death or disability.It compensates policyholders in events such as accidental death, loss of limbs or
eyes, permanent partial disability, and permanent total disability.Whether your group is large or small, customizable GPA policies can meet the
needs of all members.Additionally, discounts are available based on the group's size.
Features of Group Personal Accident (GPA)
- Small to large organizations can avail themselves of GPA Insurance for their employees and board members.
- Coverage includes medical expenses, hospitalization
- In cases of permanent disability or death, an educational fund may be available for dependent children.
- Policy tenures generally last one year.
Who needs
Group Personal Accident Insurance?
Registered entities: such as companies, associations, educational institutions,
and government agencies should have GPA insurance for their employee’s.
Early-Stage Startups:
Even small startup teams can purchase GPA insurance,
an effective tool for attracting and retaining top talent.
SMEs As your company expands, managing insurance and employee benefits
becomes increasingly complex. GPA insurance helps you offer excellent medical
coverage to your employees.
Large Organizations Large organizations commonly provide GPA insurance to
their employees. Finvest India offers various benefits for such organizations,
covering all members uniformly, regardless of age, gender, or position.
Why get Group Personal Accident Insurance?
Accidents are unfortunate events that can financially strain families, especially if
the primary breadwinner is involved.GPA insurance provides financial support in such scenarios. It can deliver a
lump-sum payment or income replacement, helping cover medical bills, lost
wages, or other expenses resulting from the accident.For employers, offering this insurance underlines your commitment to employee
well-being and financial security.
Benefits of Group Health Insurance
For Employers for Employees
Employee Financial Stability
Protect your team members from unpredictable life events by offering GPA insurance.
Employee Well-being
Providing benefits like GPA insurance fosters a sense of belonging among your team, which in turn increases productivity and creativity.
Employee Retention
In an age where companies are extending myriad benefits, retaining talent poses a formidable challenge. Group Personal Accident Insurance acts as a strong incentive, enhancing employee loyalty.
Coverages & Exclusions in
Here are some incidents covered under the policy
Accidental Death
If the insured person dies in an accident, the insurer pays the sum insured to the
nominee.
Permanent Partial Disability
An employee who becomes partially disabled due to an injury will receive a sum
assured, usually ranging from 2%to 60%, depending on the policy terms and
conditions.
Permanent Total Disability
If an employee suffers an accident resulting in permanent disability, or a disability
lasting at least a month, the employee is entitled to compensation from the
insurer. This compensation can be up to the sum insured.
Educational Benefits
Should an employee suffer permanent disability or death, the insurance company
will cover the educational expenses for his/her dependent children.
Weekly Benefits
A company pays weekly compensation if an employee is fully disabled due to an
accident.
Bone Fractures
A lump sum payment is made for incidents involving bone fractures. The policy
clearly states which types of broken bones are covered.
Exclusions
Generally, GPA insurance does not cover:
- Natural death
- Injuries caused by alcohol or drugs
- Acts of law violation
- War and nuclear perils
- Pregnancy or childbirth
- Ionizing radiation or radioactivity
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?
In most scenarios, yes. The medical insurance premium that the company pays
on the employee's behalf typically factors into the CTC (cost to company)
structure presented to the employees when they join.
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 employee’s 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:
Pre and post-natal expenses:
a. Coverage often extends to 60 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 vaccinations post-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.
Pre and post-natal expenses:
a. Coverage often extends to 60 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 vaccinations post-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.
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 account able for any charges not covered per insurance guidelines.
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 account able for any charges not covered per insurance guidelines.
