Group Health Insurance

A group health insurance plan refers to an insurance policy that covers the health of people under the same contract from the same organization which means the same type of coverage will be provided to all employees irrespective of their position in the office. The key features of the group health insurance plan are:

• It is a collective health insurance policy offered to a group of individuals who work in the same organization.
• The premium of the group health insurance plan is paid by the employer.
• Usually purchased as a perk given to employees.
• Covers benefits like hospitalization, critical illness, maternity benefits, daily cash while in hospital.
• The coverage can be extended to the family members also in some of the cases.
• This type of group health insurance plan is also known as corporate health insurance plan or employees health insurance plan.

For maintaining a perfect balance of the official work, every employee is a treasure for the organization and taking care of them becomes important. Each employer should understand the need for a group health insurance policy.

• Boost employee retention: People value the jobs that give them a sense of security. Above the medical coverage given by the companies, there is a sense of satisfaction that the employer cares about the health of his employees. Financial security for treatments of deadly diseases like Covid-19: The pandemic has brought a pay cut across the industry amid the pandemic. Having a company provided health insurance plan helps the getting treated for this critical illness ensuring a financial and medical assurance.
• Boosting enthusiasm: Happily motivated employees means happy workplaces and a company becoming a success story. For each person, motivation is required and it comes from assurance whether it is financial or medical. Also the medical costs are skyrocketing each day and having a corporate plan helps employees secure their financial resources from getting drained.
• Improved mental status: When there is a sense of security in the mind of employees regarding the expenses incurred on health of themselves and their family, the employees feel relieved and work stress-free at least from this side of their life.
• Tax benefits: To top it all, the employer gets tax exemptions for providing such types of policies to its employees.
• Affordable premiums: The amount of premiums are lower and coverage is wider in group health insurance plans which makes both employee and employer happy. It is a win-win.

There are certain benefits for employees also for having a corporate group insurance plan:

• Coverage for pre-existing diseases: The group health insurance plan is in effect from the day an employee joins an organization. This way he doesn't have to wait to get treated for any pre-existing disease like in the case of an individual health insurance plan.
• Wider coverage: A group insurance plan gives you wider coverage in comparison to an individual health plan. Costs of using an ambulance, fees for specialists doctors, medicines are covered in the comprehensive coverage.
• Wider maternity benefit: The young employees get the benefit of maternity coverage as the cost is touching the skies whether it is a normal delivery or a C-section delivery and extensive coverage helps the employee.

The group health insurance plans have a list of inclusions that have an add-on benefit and there are some exclusions also.

Inclusions of Group Health Insurance Plan

• Pre and post hospitalization cover
• Domiciliary and daycare charges
• Fees of medical practitioner
• Room rent and nursing charges
• Medical tests of any sort
• Coverage for pre-existing ailments
• Cashless claim
• Easy reimbursement

The company or organization can opt for some of the options that can elevate the group health insurance plan. Some of the options are:

• Maternity can be covered with a capping on charges at the time of childbirth.
• New born babies can be covered in the maternity limit.
• OPD (Out-patient department) coverage can also be added.
• Most important add-on that the employer must take is a corporate buffer in which an employee can take additional cover in case his existing limit is exhausted and some bills are left unclear.

Exclusions of Group Health insurance Plan

• Pre-pregnancy treatments
• Self medical check-ups or tests
• Dental treatments
• Any type of therapies like homeopathy or unani
• Dependants like parents are not covered. Separate policy has to be bought for them
• The validity of the policy is till the time you are part of the organization. Once you leave the company, the benefits also exhaust
• Congenital ailments and treatments for diseases like AIDS/HIV.
• Issues occuring due to consumption of alcohol and drugs.

You can go for a cashless claim in any of the partner network hospitals anywhere within the country. The procedure is as follows:

• Always have a list of hospitals ready with you where treatment can be availed or check at the reception if they are a partner of the company providing group health insurance.
• In case of emergency hospitalization, inform the insurer within 48 hours of hospitalization and in case of planned hospitalization, inform the insurer 3 days before the date of admission to a medical center.
• Keep your insurance card or policy details ready for a cashless claim.
• Show the card at the reception and your ID proof.
• Fill the pre-authorization form with correct details and submit a copy of your ID proof along with the form.
• Within two hours of sending the details, you will receive an email and a sms regarding the approval.

In the event of reimbursement claim the procedure is as follows:

• In case of emergency admission you need to notify the insurer within 48 hours of admission and pay all the charges of the hospital till then.
• Collect all the relevant documents and submit them as soon as possible. The time limit is 15 days from the discharge from the hospital.
• After reviewing all the documents, the group health insurance company can accept or reject the claim.
• If the request is approved, you will receive the amount directly in your registered bank account via NEFT and you will be notified about it on your registered mobile number and email.
• In case the claim gets rejected, then also the incumbent will be notified along with the reasons for rejection.