What is Covered in a Group Health Insurance Policy?


A Group Health Insurance policy provides insurance coverage to a group of people, typically a set of employees or members of an organisation. These plans are offered to employees by banks, business groups, private organisations, employers, housing societies, et cetera, with the organisation or employer bearing the cost of the premium. Corporate Health Insurance is another name used for Group Health Insurance.

The key benefit provided by companies under a Group Health Insurance coverage is that employees frequently have the choice of including immediate family members such as their spouse, children, and, in some situations, their parents. Group Health Insurance is a helpful policy for both companies and employees. A Group Health Insurance plan offers employers advantages such as lower costs, tax advantages, engaged staff, and increased employee retention.

How does a Group Health Insurance Plan Work?

  • A Group Health Insurance plan typically provides a fixed amount of money that covers the expense of accidental hospitalisation, medical treatment for specific conditions, etc.
  • Depending on the insurance and the employer, immediate family members may also be insured under the same plan.
  • The sum promised is determined by the pay package and varies from company to company and employer to employer. An additional premium must be paid to raise the insured amounts.

Advantages to Employee

  • Employee happiness and improved health benefits are ensured through Group Health Insurances.
  • Since the insurance coverage applies to all group members, it is good for those who wish to get a medical-claim policy but cannot afford the premium. Typically, the company pays the premium as a benefit to its employees.
  • To be eligible for the benefits of group insurance coverage, you must be an employee of that organisation. Employees joining the organisation/employer are automatically protected under a Group Health Insurance coverage.
  • Before purchasing an Individual medical-claim coverage, a pre-medical screening is required to discover pre-existing medical issues. A group medical insurance coverage, on the other hand, does not require any such medical examination.
  • A Group Health Insurance policy’s claim procedure is straightforward. Given the reputation of the employer/organisation, the dispute is resolved quickly and painlessly. To initiate the claim, the employee needs to accept the health insurance coverage and show the health card.

Advantages to Employer

A Group Health Insurance provides an employee numerous benefits that an individual health insurance policy cannot provide:

  • Premiums are less expensive: In the case of Group Health Insurances, one of the direct benefits to the business is that they must pay a lower premium rate.
  • Tax advantages: Group Health Insurance plans provide tax deduction benefits under several sections of India’s Income Tax Department.
  • Employee retention and loyalty: Retaining employees is very critical for every firm. As a result, corporations are becoming increasingly concerned with their employees. Group Health Insurance plans are intended to instil loyalty in the employees. It also aids in the retention of long-term personnel, which benefits the company’s reputation. Employees are motivated when relieved of tension. As a result, they are motivated to do better.
  • Premium payment flexibility: Companies can pay the premium monthly, quarterly, or yearly.

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What is Covered in a Group Health Insurance Policy?

  • Unintentional hospitalisation: In the event that your employee or a dependent is involved in an accident, this covers all pre- hospitalisation and post-hospitalisation fees such as ambulance charges, room rents, diagnostics, daycare treatments, and et cetera.
  • Hospitalisation for illness: Some diseases demand hospitalisation. The insurance will cover all treatment and hospitalisation costs for your employee and their immediate family.
  • Daily hospital cash protection: If your employee or a dependent is hospitalised, the expenses stretch beyond the hospital fee, and the policy helps people meet those costs.
  • Psychiatric illness insurance: According to WHO research, at least 6.5% of the Indian population suffers from significant mental conditions. Fortunately, health insurance will cover your employee’s psychiatric care.
  • Critical illness insurance: These plans include a Critical Illness benefit, so your employee and their immediate families will be covered if they are diagnosed with any critical illnesses.
  • Maternity insurance with newborn baby coverage: This benefit can be used to cover childbirth costs for your employee or their spouse. It also covers costs for infertility treatments and medically required terminations.
  • Other advantages: Group health insurance plans cover benefits for Alternate Treatment (AYUSH), Organ Donation Expenses, Infertility Treatment, and Bariatric Surgeries.
  • Free annual health examination: It is critical to be conscious of one’s overall health and well-being. Group health insurance plans provide payment for any medical testing your workers or their families may require during the course of the year.

What is Not Covered in These Policies?

  • Pre- and post-natal costs: Prenatal and post-natal medical bills, unless the employee or their spouse is hospitalised.
  • Waiting period for PED: In the case of a pre-existing ailment, the claim cannot be lodged until the waiting time has expired.
  • Hospitalisation without a doctor’s prescription: Any ailment for which your employee is hospitalised that does not correspond to the doctor’s prescription is not covered.

Medical expenditures are growing, and fair access to high-quality healthcare has become an urgent demand for all. Employees need a Group Health Insurance policy as a requirement rather than a bonus. As a responsible employer, you can offer health security to your workforce with Plum Insurance to boost employee morale and take the organisation to new heights.