Group Health Insurance / Group Mediclaim Policy
Group health insurance, also called a group mediclaim policy, provides health coverage to a group of people, typically employees, offering medical expense reimbursement and hospitalization benefits.
- No Pre-Policy Medical Check-Up
- Coverage Without Any Waiting Period
- Pay Premium in Installments
What is Group Health Insurance?
Group Health Insurance (GMI), also known as Group Mediclaim Insurance (GHI) or Group Mediclaim Coverage (GMC) , is a type of health insurance policy that provides medical coverage to a defined group of people and their dependents under a single policy. This group can be employees of a company, members of a firm, NGO, or any other form of group recognized by law. The insurance covers a range of medical expenses, including hospitalization, surgery, and various treatment costs, ensuring comprehensive healthcare access for employees/members and their families.
Who can buy Group Health Insurance?
Any legally recognized group or organization that employs or consists of minimum 7 individuals can purchase group mediclaim insurance to provide healthcare benefits to its members.
- Companies/Corporations/Small or medium enterprise/large corporation, Private limited companies, Public limited companies, Multinational corporations.
- Partnership firms and sole proprietorships
- Non-Governmental Organizations (NGOs):
- Associations and Societies/Professional associations/trade unions/cooperative societies/clubs/other registered groups
- Government and Public Sector Units/Government departments/Public sector undertakings
- Educational Institutions/Schools/Colleges/universities/other educational institutions
Condition to eligibility of such group
- Purpose of forming the group shall not be primarily only for getting such Group Health Insurance.
- Age of the group does not matter to take such insurance.
- Need not be employer-employee relation.
- Evidence of relation between group & member is sufficient.
Why Choose for Group Health Insurance?
Enhanced Employee Satisfaction and Retention
Offering group health insurance demonstrates that the company values its employees' well-being, leading to increased job satisfaction and loyalty, which can reduce turnover rates.
Attracting Top Talent
Comprehensive health benefits make the company more attractive to potential employees, helping to attract high-quality candidates in a competitive job market.
Cost-Effective Benefits:
Group health insurance policies are generally more cost-effective than individual policies, providing comprehensive coverage at a lower cost per employee.
Tax Benefits
Companies can avail of tax deductions on the premiums paid for group health insurance, reducing their overall tax liability.
Coverage for Pre-Existing Conditions
Group health insurance plans typically cover pre-existing conditions from the start, offering immediate protection to employees.
Improved Productivity
: Employees with access to health insurance are more likely to seek timely medical care, leading to healthier employees and reduced absenteeism.
Comprehensive Family Coverage
Many group health plans extend coverage to employees' dependents, ensuring that their families are also protected, which further enhances employee satisfaction.
Cashless Hospitalization
Employees can benefit from cashless treatment at network hospitals, reducing the financial burden during medical emergencies and ensuring quick and hassle-free care.
Preventive Healthcare Services
Group health insurance plans often include preventive care services such as annual health check-ups and wellness programs, promoting overall health and well-being.
Customizable Plans
Employers can tailor group health insurance plans to meet the specific needs of their workforce, including additional benefits like dental, vision, and mental health coverage.
Legal and Compliance Benefits
Offering health insurance can help companies comply with local labor laws and regulations, avoiding potential legal issues and penalties.
Enhanced Company Reputation
Providing group health insurance can improve the company’s reputation as a responsible and caring employer, enhancing its brand image and standing in the industry.
Higher Coverage Limits
Group mediclaim insurance can provide higher limits of sum insured and unrestricted coverages that individual policies typically do not offer, ensuring better protection for employees.
Comparison between Group Health insurance & Individual/Personal Health Insurance
| Feature | Group Health Insurance | Individual/Personal Health Insurance |
|---|---|---|
| Pre-Policy Medical Check-up | Not required | Required if the customer is above 35 years or has certain medical conditions, adding an extra step |
| Cost | Cost is highly negotiable & very economical | Very high and always increasing every year |
| Coverage Customizability | Highly customizable to the specific needs of the group, including additional benefits like dental and vision | Not customizable beyond the options provided by the insurer |
| Exclusions Customizable | Exclusions are always negotiable, allowing for waiving or modifying exclusions | Fixed and non-negotiable exclusions |
| Pre-Existing Conditions | Customer can choose to waive off waiting period | Fixed waiting period always applicable, usually ranging from 2 to 4 years |
| Various Waiting Periods | Customer can always choose to waive off the waiting periods | Fixed waiting periods for specific treatments, often not customizable |
Comparison between Group Health insurance & Individual/Personal Health Insurance
| Feature | Group Health Insurance | Individual/Personal Health Insurance |
|---|---|---|
| Pre-Policy Medical Check-up | Not required | Required if the customer is above 35 years or has certain medical conditions, adding an extra step |
| Cost | Cost is highly negotiable & very economical | Very high and always increasing every year |
| Coverage Customizability | Highly customizable to the specific needs of the group, including additional benefits like dental and vision | Not customizable beyond the options provided by the insurer |
| Exclusions Customizable | Exclusions are always negotiable, allowing for waiving or modifying exclusions | Fixed and non-negotiable exclusions |
| Pre-Existing Conditions | Customer can choose to waive off waiting period | Fixed waiting period always applicable, usually ranging from 2 to 4 years |
| Various Waiting Periods | Customer can always choose to waive off the waiting periods | Fixed waiting periods for specific treatments, often not customizable |
| Tax Benefits | Employers can claim tax deductions on premiums paid, reducing overall tax liability | Individual policyholders can claim tax benefits on premiums paid under Section 80D |
| Sum Insured | Higher coverage limits and unrestricted coverages possible, tailored to group needs | Limited as per product of the insurer, often capped at a lower amount |
| No Claim Bonus | Not applicable as premiums are negotiated at renewal | Available, rewarding policyholders with lower premiums for no claims |
| OPD Coverage | Possible with higher limits, providing extensive outpatient care | Very low/fixed coverage, often inadequate for extensive outpatient needs |
| Claims Process | Simplified through group management, often with dedicated support from the insurer | Individual must handle the entire claims process, which can be more cumbersome |
| Incentives and Rewards | May include wellness programs and preventive care benefits, encouraging overall health and productivity | May include wellness programs but often less comprehensive than group plans |
| Coverage Scope | Covers a group of employees/members and their dependents under a single policy | Covers the individual policyholder and possibly their family under separate policies |
| Policy Management | Managed by the employer or group organizer, simplifying administrative tasks for individual members | Managed by the individual policyholder, involving more personal time and effort |
| Employee/Member Satisfaction | Enhances job satisfaction and retention by providing comprehensive health benefits | Provides peace of mind to the individual but may lack the extensive benefits of group plans |
| Family Coverage | Usually extends to dependents (spouse, children), ensuring broad protection for the family | Can be extended to cover family members, but at a higher individual cost |
| Eligibility | Must be part of the group (employee, member, etc.), ensuring collective benefits | Available to any individual who meets the insurer’s criteria, providing personal flexibility |
| Employer/Group Benefits | Attracts and retains talent, enhances the overall employee benefits package, contributing to a positive work culture | N/A |
| Maternity Coverage | Available from day one, offering immediate benefits to employees/members | Comes with a waiting period, typically 9 months to 2 years |
Benefits of Choosing Group Health Insurance from GoInsureIndia.com
No Pre-Policy Medical Check-up
Employees/members are not required to undergo a medical check-up before enrollment, simplifying the onboarding process.
Coverage Without Any Waiting Period
Group health insurance can provide immediate coverage for pre-existing conditions and allow employers to waive various waiting periods, ensuring employees have access to necessary treatments from day one.
Pay Premium in Installments
Flexible payment options allow employers to pay the premium in installments, easing the financial burden. Coverage for LGBT Community or Same-Sex Partners Inclusive coverage options that extend health benefits to LGBT community members and same-sex partners.
Coverage for Mental/Psychiatric Ailments
Comprehensive coverage for mental health and psychiatric treatments, promoting overall well-being. Sum Insured Restore for Other Ailments Automatic restoration of the sum insured for unrelated ailments if the original cover is exhausted.
Coverage of NIL Deductions
Policies with zero deductions against usual non-payable expenses, ensuring maximum reimbursement. Ayush & Homeopathic Treatments Coverage can include limitless expenses for Ayush (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatments, offering comprehensive alternative healthcare options.
Cost-Effective
The cost is highly negotiable and very economical compared to individual health insurance plans.
Coverage Customizability
Highly customizable to the specific needs of the group, including additional benefits such as dental and vision coverage.
Customizable Exclusions
Exclusions are negotiable, allowing for waiving or modifying exclusions based on the group's requirements. Tax Benefits: Employers can claim tax deductions on the premiums paid, reducing overall tax liability. Higher Sum Insured Limits: Offers higher coverage limits and unrestricted coverages tailored to the needs of the group.
Extensive OPD Coverage
Possible with higher limits, providing comprehensive outpatient care services. No Capping on Ailments or Conditions Policies without capping on specific ailments or conditions, providing comprehensive coverage.
No Copayment Policy
Policies without copayment requirements, ensuring full coverage without additional out-of-pocket expenses. Option for Higher Category Room Limits Option to increase room category limits, offering better hospital accommodations.
Covid Day One Coverage
Provides coverage for Covid-19 related treatments from day one, ensuring immediate protection. Coverage for Bariatric Surgery Includes coverage for bariatric surgery, which is often excluded in standard policies.
Modern Treatment Methods
Covers advanced and modern treatment methods, ensuring access to the latest medical procedures. Critical Illness Cover Provides coverage for critical illnesses, offering financial support in case of serious health conditions.
Daily Cash for Attending Patient
Offers daily cash benefits for expenses incurred while attending to a hospitalized patient. Cashless Facility in Over 24,000+ Empanelled Hospitals Ensures cashless treatment in a vast network of empanelled hospitals across the country.
Claim Handling Through Dedicated Claim Manager
Offers personalized claim handling through a dedicated claim manager instead of a general call center. Paperless Claim Settlement Enables paperless claim settlement, eliminating the need to submit original claim papers.
No Age Limit Policy
Policies without age restrictions, ensuring coverage for employees of all ages.
Simplified Claims Process
Group management simplifies the claims process, often with dedicated support from the insurer.
Incentives and Rewards
May include wellness programs and preventive care benefits, encouraging overall health and productivity. Efficient Policy Management Managed by the employer or group organizer, reducing administrative burdens for individual members.
Immediate Maternity Coverage
Available from day one, providing immediate benefits for maternity-related expenses. These features highlight the comprehensive and customizable nature of group health insurance, making it an attractive option for employers.
Suggestions for Efficient & Cost-Effective Group Health Insurance
| Parameter | Small Enterprise/Group (7-100 members) | Medium Enterprise (100-500 members) | Large Enterprise/Group (More than 500 members) |
|---|---|---|---|
| Uniform Coverage | Should maintain uniform coverage across all hierarchy levels of members. | Should consider mildly flexible coverage across different hierarchy levels. | Should offer highly flexible coverage options tailored to all hierarchy levels. |
| OPD Coverage | Comparatively costlier. | Mildly economical. | Most economical. |
| Choice of Insurers (Based on Pricing) | Private insurers are more competitive. | Private insurers are more competitive. | Public sector insurers are more competitive. |
| Choice of Insurers (Based on flexibility/variety in Coverage) | Private insurers are more competitive. | Private insurers are more competitive. | Private insurers are more competitive. |
| Voluntary Top-Up Sum Insured Facility | Comparatively costlier. | Mildly economical. | Most economical. |
| Cost on Waiver of Waiting Period for Pre-Existing & Other Ailments | Cost is relatively the same | Cost is relatively the same | Cost is relatively the same |
Suggestions for Efficient & Cost-Effective Group Health Insurance
| Parameter | Small Enterprise/Group (7-100 members) | Medium Enterprise (100-500 members) | Large Enterprise/Group (More than 500 members) |
|---|---|---|---|
| Uniform Coverage | Should maintain uniform coverage across all hierarchy levels of members. | Should consider mildly flexible coverage across different hierarchy levels. | Should offer highly flexible coverage options tailored to all hierarchy levels. |
| OPD Coverage | Comparatively costlier. | Mildly economical. | Most economical. |
| Choice of Insurers (Based on Pricing) | Private insurers are more competitive. | Private insurers are more competitive. | Public sector insurers are more competitive. |
| Choice of Insurers (Based on flexibility/variety in Coverage) | Private insurers are more competitive. | Private insurers are more competitive. | Private insurers are more competitive. |
| Voluntary Top-Up Sum Insured Facility | Comparatively costlier. | Mildly economical. | Most economical. |
| Cost on Waiver of Waiting Period for Pre-Existing & Other Ailments | Cost is relatively the same | Cost is relatively the same | Cost is relatively the same |
| Other Benefits | Participation & Pricing are more effective with Private Insurers | Participation & Pricing are more effective with Private Insurers | Participation & Pricing are more effective with Public Undertaking Insurers |
| Effect of Claim Ratio in Renewal Pricing | Less Relative | More Relative | Very High Relative |
| Voluntary Selection of Members | Should avoid voluntary selections, as only a few insurers participate in such proposals. | ||
| Choosing Parents Coverage | a) No selection of parents – All insurers will be interested. b) Parents coverage for at least 40% of members – Only 6-8 insurers will be interested. c) Coverage for less than 40% of members – Fewer than 5 insurers will be interested. |
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Choice Between Private Insurers & Public Undertaking Insurers
| Parameter | Private Insurers | Public Insurers |
|---|---|---|
| Enterprise Suitability | More suitable for small & medium enterprises | More suitable for larger enterprises with over 1000 members |
| Premium Cost | Generally more flexible and competitive | Often standardized and less negotiable |
| Claim Settlement | Faster claim settlement with paperless processes in many private insurers | Slower claim settlement with more paperwork requirements in public insurers |
| Policy Customizability | Highly customizable policies | Standardized policies with lesser flexibility in non-traditional coverages |
| Innovative Products | Regularly introduce innovative products like Restore Benefit, Daily Cash, etc. | Less frequent introduction of new products like these |
| Network Hospitals | More empanelled hospitals | Lesser than private insurers |
This comparison highlights key differences between private and public insurers, aiding customers in making informed decisions based on their specific needs and preferences.
See all
Choice Between Private Insurers & Public Undertaking Insurers
| Parameter | Private Insurers | Public Insurers |
|---|---|---|
| Enterprise Suitability | More suitable for small & medium enterprises | More suitable for larger enterprises with over 1000 members |
| Premium Cost | Generally more flexible and competitive | Often standardized and less negotiable |
| Claim Settlement | Faster claim settlement with paperless processes in many private insurers | Slower claim settlement with more paperwork requirements in public insurers |
| Policy Customizability | Highly customizable policies | Standardized policies with lesser flexibility in non-traditional coverages |
| Innovative Products | Regularly introduce innovative products like Restore Benefit, Daily Cash, etc. | Less frequent introduction of new products like these |
| Network Hospitals | More empanelled hospitals | Lesser than private insurers |
| Agreed Packages with Empanelled Hospitals | Relatively less economical | More economical rates, leading to better claim ratios |
| Financial Stability | Financially strong but vary between companies | Generally very stable and backed by the government |
| Technological Integration | High level of technological integration and digital services | Moderate level of technological integration |
| Market Share | Lesser market share but growing | Larger market share |
| Policy Renewal Flexibility | More flexible with renewal terms and conditions | Less flexible with standardized renewal terms |
| Wellness Activities | Offer various wellness activities | Generally do not offer wellness activities |
Benefits of Taking Group Health Insurance from GoInsureIndia.com
- Industry benchmarking on coverage and pricing.
- Comprehensive assessment of employee health needs and risk profiles.
- Tailored policy design to meet the specific requirements of your organization.
- Assistance in selecting the most suitable insurance plans from leading insurers based on current trends, their offerings, servicing, and financial stability.
- Ensuring customers pay reasonable costs for their choice of insurer and coverages.
- Seamless Customer Onboarding
- Access to our mobile-cum-web app for employees to view their policy benefits, digital health cards, network hospitals, claim status, and more.
- Conducting thorough policy awareness sessions onsite or online modes.
- HR and Employee Education
- Educating the HR team about their role in policy administration and management.
- Training employees on using the mobile app for policy usage and administration.
- Guiding employees on the claims process, understanding policy coverage and exclusions, best practices (do’s and don’ts), and how to contact us for assistance when needed.
- Policy awareness emails to keep employees informed about their benefits.
- Customer Service Towards Employees from GoInsureIndia.com
- GoInsure Mobile App access to all members of the policy.
- 247 dedicated contact center team.
- Dedicated Service Manager ensuring no need to route special concerns through the general call center team.
- Ticket Management System to handle employees’ emails.
- Dedicated WhatsApp number for customer service and engagement, equipped with Artificial Intelligence.
- Escalation matrix including representatives from the management board, ensuring top-level attention to customer concerns.
- Immediate resolution in situations like claim deduction and rejection, using our deep industry experience to reassess and reprocess claims when necessary.
- Paperless claim settlement.
- Claims ExpertiseOur professionals have been part of the industry since the privatization of insurance in India, witnessing the sector’s evolution. We believe the insurer’s opinion on a claim is not final and diligently assess their decision, seeking reprocessing when appropriate.
- Customer Service Towards HR from GoInsureIndia.com
- GoInsure Mobile App includes functionalities for HR teams to access data for all their employees.
- Paperless and email-less policy endorsement through our software.
- CD statements and endorsement copies available on the mobile app, providing constant access to data without relying on us for information.
- Multidimensional reports in their policy administration within the software.
- Periodic reviews, meetings, and advice on customer service and policy efficiency.
- GoInsure Mobile App can be integrated with HRMS tools of corporates to enable seamless endorsements in policy.
- High employee engagement through various health and wellness programs.
- Bi-monthly wellness webinars covering physical, emotional, mental, social, and financial health.
- Free doctor consultations, dental care, and mental wellness sessions.
- 20% flat discount on health check-ups with comprehensive diagnostic tests.
- Discounts on at-home nursing care and physiotherapy sessions.
- Free pre-surgery consultations and post-hospitalization benefits if surgery is booked through Pristyn Care.
- Free wellness health assessments and access to therapy sessions in multiple languages with a network of specialized therapists.
- Access to a wide network of empanelled hospitals.
- Up to 20% discount on prescribed medicines with free home delivery.
- Daily emails on health and wellness to all members of the policy.
- HR can use the GoInsure Mobile App to arrange onsite or online wellness events in their organization.
Group Health Insurance FAQs
Protect Your Team, Empower Your Growth
Provide comprehensive healthcare coverage to your employees or group members with Go Insure India's Group Health Insurance plans. Affordable, inclusive, and designed to cater to diverse needs, our policies ensure the well-being of your workforce while boosting morale and productivity.