May 23, 2022

Group Hospicash Insurance

Group Hospicash Insurance

Group Hospicash Insurance is an employee health insurance policy purchased by a business for its employees. It provides employees with a daily cash benefit for each full day of hospitalization.

Accidents and illnesses can happen at any time. And sometimes, they can result in the long term hospitalisation of an individual or an employee, which can be incredibly expensive and draining for their family.  

While getting a Group Health Insurance policy can take care of some medical bills, several expenses related to hospitalisation are not always covered. And these can easily drain an employee’s finances. Therefore, to cover the risk of unexpected hospitalisation, a special insurance plan known as Group Hospicash Insurance comes into play.

Hospicash Insurance, also known as Hospital Daily Cash Plan, is a micro-insurance product that covers the insured and their family’s hospitalisation expenses for a specified period of time. This insurance plan offers a slew of benefits like lump sum pay-out, daily allowance, and cover for extra expenses and lost wages.

Hospicash Insurance when purchased by businesses for their employees is known as Group Hospicash Insurance.

  • Hospicash Insurance is a defined benefit plan. This means it works by providing the insured with a fixed benefit amount for each day of hospitalisation, irrespective of the actual medical costs. However, this policy only covers hospitalisation for a continuous period of more than 24 hours.  This sum is decided and fixed at the issuance of the policy based on the daily allowance chosen by the insured. The amount of cash thus paid daily can be anywhere between ₹500 to ₹6,000.
  • This policy has a period of 1 year. However, the maximum number of hospitalisation days on which the cash benefit will be payable is limited under this policy. This period depends on the kind of plan chosen by the insured and can last 30 days, 60 days, 90 days, or in some cases, 180 days.
  • The initial waiting period for Hospicash Insurance is 30 days for all illnesses. However, waiting periods for specific illnesses differ depending on the insurer

  • Hospicash - daily cash allowance
  • Day care procedure cash - daily benefit for a day care procedure as an inpatient for less than 24 hours when such treatment is medically necessary
  • Sickness hospital cover - daily benefit for hospitalisation due to an illness when such hospitalisation is medically necessary
  • Accident hospital cover - daily benefit for hospitalisation due to an accidental injury when such hospitalisation is medically necessary
  • Personal Accident - accidental death or permanent disability is covered if the accident occurs during the period of the cover

Some insurers also offer the following covers under this policy :

  • Vector Borne Disease Benefit - hospitalisation for medically necessary treatment of specific Vector Borne diseases (such as Malaria, Dengue, Filariasis,etc.) is provided for as long as the diagnosis is made after the commencement of the policy and post the waiting period
  • Broken Bones Disease Benefit - hospitalisation due to fractures suffered due to an accident during the period of the cover is covered
  • Parental Care - under this benefit, the Sum Insured is payable to the surviving parents of an insured person who suffers an injury due to an accident that directly results in his/her death or permanent total disablement.

In addition to the above, the following optional benefits are also available :

  • Convalescence Benefit – Under this benefit, a one-time lump sum is payable towards the insured and their family’s convalescence due to the same accident or illness over and above the daily cash benefit
  • Double Accident benefit (DBA) - Under this benefit, in the event of hospitalisation due to additional injury / illness caused by the initial injury /illness suffered during an accident, the daily cash benefit is doubled
  • Double ICU cover - Under this benefit, if the insured is admitted to the Intensive Care Unit (ICU) due to any illness or accidental injury, the daily cash benefit is doubled and payable for every completed 24 hours in an ICU
  • Recovery Benefit - Under this benefit, if the insured is hospitalised for medically necessary treatment due to an accidental injury for more than 15 consecutive days, then a one-time lump sum amount is payable beyond the daily cash benefit
  • Maternity Benefit Expense Cover, with and without 9 months waiting period– This benefit covers hospitalisation treatment arising from or traceable to pregnancy, child birth including normal/ caesarean section.
  • Pre-Existing Disease Cover – This benefit covers any condition, ailment or Injury or related condition(s) for which the insured has been diagnosed, received medical treatment, had signs and/or symptoms, prior to inception of policy
  • Special cover for listed surgeries - Under this cover, in the event of hospitalisation due to certain listed surgeries, a one-time lump sum amount is payable subject to the maximum Sum Insured

In addition to the above add-on cover, various insurers also offer other benefits like Double Critical Illness Benefit, Sum Insured Restoration benefit, Deductible options and even Day Care benefits.

Some of the general exclusions of Hospicash Insurance are listed below :

  • Any hospital admission for investigative or diagnostic purpose
  • Infertility, External Congenital Anomaly and related Illness or defects
  • Non-allopathic medicines
  • Treatment outside India
  • Sex change treatment, cosmetic treatment and plastic surgery
  • Refractive error correction, dental treatment surgery of any kind unless requiring hospitalisation as a result of Injury
  • Organ donor expenses
  • Substance abuse, self-inflicted injuries, AIDS
  • Any Injury / Illness arising whilst under the influence of alcohol or intoxicating drugs or substance abuse of any kind
  • Any Accidental Injury / Illness directly or indirectly caused by venereal disease or insanity or mental, nervous or emotional disorder
  • Hospitalisation due to hazardous sports or war
  • Any injury that has occurred prior to the commencement of policy cover

Hospicash insurance works on the same principles as a Group Mediclaim policy and is subject to the same exclusions. Therefore, if a particular claim is not payable or falls under an exclusion in the main mediclaim policy, then it would also stand inadmissible in the related Hospicash policy.

  • Several expenses are not covered by a regular mediclaim policy. Through Hospicash Insurance, the insured can receive a lump-sum benefit which can be used to cover extra costs and even lost income due to hospitalisation
  • Group Hospicash Insurance can help preserve the No Claim Bonus of an employee’s regular Health Insurance policy. For minor injuries that require hospitalisation but entail a lower bill, the insured can simply use the Hospicash plan
  • Group Hospicash Insurance is incredibly cost-effective for businesses and employees, requiring a much lower premium than Group Accident Insurance

Hospicash Insurance is designed to help individuals and businesses cover incidental hospitalisation expenses that can arise at any time and may not be covered by other Health Insurance plans. Its lower premium and flexible coverage make this insurance ideal for SMEs and MSMEs.

Employee Benefits Insurance for Small Businesses

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.