August 30, 2022

Group Health Insurance

Group Health Insurance

Group Health Insurance is a type of Business Insurance policy that provides collective health coverage to a group of individuals usually a company's employees. This policy offers a number of benefits to businesses as well as their workers, providing comprehensive coverage in the event of an unexpected illness, injury, or hospitalisation.

Also known as Corporate Health Insurance or Employee Health Insurance, this policy can help businesses in a number of ways–

  • It promotes employee retention as workers feel safe and valued at the workplace knowing that they are covered for any illness, injury or medical expense that may unexpectedly arise
  • It offers tax benefits to the business as it can claim the entire premium paid for Group Health cover as ‘Profit in lieu of salary’
  • It is an excellent tool to attract new hires as it forms part of the company’s overall Benefits Programme giving it a competitive edge

The premiums for group policies are borne by the employer on behalf of its employees, and can be paid either monthly, quarterly, or annually. The coverage under these plans can also be extended to the employee's spouse, children, and dependent parents.

Getting a Group Health plan is often cheaper for a company than getting individual Health Insurance policies for each of its workers, as the risk is spread across a group of people, lowering the overall cost. Furthermore, unlike individual Health Insurance, group plans do not require pre-medical screening to determine any pre-existing diseases as an employee is automatically covered on joining the company.

What does Group Health Insurance cover?

Group Health Insurance offers a great number of benefits under a single policy. Although these differ depending on the type of plan opted for, some common covers are :

  • Critical Illness Cover
  • Coverage for pre-existing diseases from day one (offered by some insurers)
  • Maternity Cover that includes both C-section and normal deliveries
  • Coverage for newborn babies from day 1
  • Accidental hospitalisation
  • COVID-19 hospitalisation
  • Illness related hospitalisation
  • Pre- and post-hospitalisation expenses
  • Coverage for domiciliary and daycare expenses
  • Coverage for anaesthesia, drugs, medicines, oxygen, blood, etc.

Most insurers offer additional benefits like coverage for ambulance charges, reimbursement for doctor visits and follow up check-ups, coverage for radiotherapy or chemotherapy as well as cashless services at partner hospitals.  

What does Group Health Insurance not cover?

This policy will not cover employees or their dependents for :

  • Non-allopathic treatments like Ayurveda, Homoeopathy, etc.
  • All expenses incurred in the treatment of congenital disease, AIDS, or related ailments
  • Complications that arise due to drug or alcohol abuse
  • Prenatal and postnatal medical expenses, unless it leads to hospitalisation of the employee or their spouse
  • Hospitalisation without doctor’s recommendation

In addition to the above, some policies do not extend coverage to an employee’s dependent parents. Moreover, ​​a group insurance policy is only valid for the employment period of the insured, i.e., the coverage terminates when the employee leaves the company or dies.

What are the documents needed to file a Group Health Insurance claim?

An employee who wishes to file a claim under this policy must keep the following documents handy :

  • Duly filled claim form with a sign of the concerned hospital or doctor
  • Final investigation and medical report
  • Doctor’s prescription
  • The final bill which contains all the break-up details
  • Discharge summary with the suggested line of treatment
  • Cash memos and itemised bills

Group Health Insurance policies can be taken by  corporates, clubs, associations, firms, institutions, and even small businesses that are employee-led. These plans are highly flexible and customisable with comprehensive coverage for all employees.

With premiums of regular Health Insurance plans on the rise, companies that offer a Group Health cover to their workers lend themselves a compelling advantage over their competitors. With relatively cheaper prices and an added tax benefit, a Group Health Insurance policy has become an absolute necessity for today’s businesses.  

Further Reading

Find out how employees get covered against accidental injuries: Group Personal Accident Insurance

Opinions, conclusions and statements of intent expressed in this article are that of the author and Verak does not accept liability for the views expressed unless confirmed by an authorized representative of the Company independently of this communication.