Modern Treatment Methods in Group Health Insurance: Are You Covered Enough?

Is Your Group Health Insurance Policy Keeping Up with Modern Treatment Methods?

As an HR professional, you know that a robust group health insurance policy is more than just an employee insurance scheme—it’s a cornerstone of your company’s employee benefits and plays a major role in attracting and retaining top talent. For many organizations, the group health insurance plan is central to showing commitment to employee well-being and supporting a healthy workplace environment.

But as healthcare evolves, so do the needs and expectations around Group Health Insurance for employees. In recent years, the Insurance Regulatory and Development Authority of India (IRDAI) has raised the bar for both corporate health insurance and group mediclaim policies by standardizing coverage for modern treatment methods. This means that today’s office health insurance or corporate insurance policy must go beyond basic hospitalization and embrace the latest medical technologies.

What Are Modern Treatment Methods in Group Medical Insurance?

The IRDAI defines and mandates coverage for 12 modern treatment methods within all group health insurance plans for employees. These procedures reflect significant advancements in healthcare and are now standard offerings in the best group health insurance policies:

• Uterine Artery Embolization and High-Intensity Focused Ultrasound (HIFU)

• Balloon Sinuplasty

• Deep Brain Stimulation

• Oral Chemotherapy

• Immunotherapy – Monoclonal Antibody to be given as injection

• Intra Vitreal Injections

• Robotic Surgeries

• Stereotactic Radio Surgeries

• Bronchial Thermoplastyw

• Vaporization of the Prostate (Green laser or Holmium laser treatment)

• Intra-Operative Neuro Monitoring (IONM)

• Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions

If your team insurance policy or group mediclaim insurance policy for employees doesn’t mention all these procedures, it might be time for a review.

The Sub-Limit Challenge—How Coverage Really Works

While IRDAI regulations make it clear that these modern treatment methods must be included in every group medical insurance policy, there’s a hidden detail HR professionals can’t afford to miss: sub-limits. A sub-limit is a specific cap, either as a percentage of the sum insured or a fixed amount, that restricts how much claim can be settled for certain modern medical procedures under your corporate health insurance plan.

Sub-limits can greatly affect the value of health insurance benefits for employees during critical treatments. Even if your group insurance policy for employees technically covers all IRDAI-defined modern treatment methods, the actual group health insurance policy for employees might have different sub-limits for each procedure and insurance company.

Example: How Sub-Limits Differ across Insurers for Oral Chemotherapy

Here’s a practical illustration using the Oral Chemotherapy procedure in three leading Health Insurance Companies in India:

• Oriental Insurance (a PSU insurer): Oral Chemotherapy is covered up to 25% of your sum insured, capped at ₹50,000 per claim.

• New India Assurance (also PSU): Provides coverage for Oral Chemotherapy at 10% of the sum insured, up to a maximum of ₹1,00,000.

• Private Insurers: Most offer coverage for Oral Chemotherapy at up to 50% of the coverage amount as part of their group medical insurance policy for employees.

This approach is not limited to Oral Chemotherapy. Nearly every modern treatment method in your group policy may have similar (or even stricter) caps—sometimes varying by insurer and product. That’s why it’s crucial to evaluate the fine print in your group health insurance policy for employees or corporate medical insurance plan.

Why This Matters for Corporate HR and Employees

Simply ticking off “modern treatment coverage” on your company insurance policy checklist isn’t enough. Health insurance benefits for employees are only valuable when they’re actually usable in practice.

• Managing Employee Expectations: Employees often assume “covered” in their group medical insurance means “fully paid for.” Sub-limits can lead to disappointment and financial strain when claims get partially settled.

• Safeguarding Financial Well-being: Your group insurance for employees must deliver real-world value in medical emergencies. Low sub-limits can leave employees and their families under-insured, defeating the very purpose of medical insurance for employees in India.

• Getting the Best ROI: Organizations invest heavily in business health insurance small and large. Making sure you have the best claim settlement ratio in health insurance—and truly comprehensive modern treatment coverage—means optimal use of your benefits budget.

• Boosting Employer Brand: Corporate group insurance plans that genuinely protect employees help companies stand out in talent acquisition and retention.

Actions for HR: How to Evaluate and Improve Your Group Health Insurance Plan

Before renewing your office health insurance, group mediclaim policy, or corporate health insurance policy, consider the following steps:

1. Request a Detailed Sub-Limit Table: Insist on full disclosure from your insurer or broker, listing each of the 12 modern treatment methods and their respective sub-limits (both percentages and monetary caps). Don’t rely on generic statements in your group health plan documentation.

1. Benchmark Insurers: Use a comparison chart to review differences among the top 10 health insurance companies in India for 2025. Especially compare PSU insurers and private insurers for sub-limits on each modern medical procedure, as demonstrated for Oral Chemotherapy above.

1. Negotiate for Comprehensive Coverage: Advocate for the removal or increase of sub-limits—aim for sum insured coverage across all listed procedures in your group medical insurance policy for family and employees.

1. Reference IRDAI Guidelines: Always check your group insurance policy is compliant with IRDAI’s specified list of modern treatment methods and advancement in technologies.

1. Communicate Clearly: Regularly update your team on the features of your group medical insurance policy for employees, including claim limits for advanced treatments. An informed workforce can make the best use of their company health plans.

Conclusion

A modern group health insurance policy for employees should not just meet compliance requirements—it should provide meaningful, financial protection that employees can count on in their times of need. Don’t let restrictive sub-limits or ambiguous wording in your corporate insurance policy undermine your investment and your team’s trust.

Is your office health insurance or group plan offering what’s truly needed? If you’re unsure, we can help you review or design a group health insurance plan that’s transparent, robust, and future-ready for your organization’s unique needs.