Group Medical Insurance
Personal Health Insurance
Group Health Insurance operates like any other health insurance plans usually cover treatment costs for hospitalization where patient is required to be admitted for 24 hours including day care procedures. However, In Group Health Insurance, Corporate gets choice to include many other additional benefits as well by paying additional cost.
Some of the examples of customized benefits are:
Every Insurance Company has got criteria for minimum employee count. However, Keeping entire industry in mind, it is necessary to have at least 5 employees in group to initiate a Group Medical Insurance.
No. Group Health insurance necessarily not to be same for every corporate. Every Corporate has their own financial & Human resource budget, Planning, Culture & policies, which sets parameters for choosing benefits under Group Medical Insurance. Therefore, Every corporate Group Medical Insurance most likely differ from each other.
Yes, Likewise any other health insurance policy, cashless facility is also covered under Group Health Insurance Policy.
Yes, TPA facility is covered under Group Health Insurance for those almost all insurance companies except few who has their own internal set up for processing health insurance claims such as HDFC ERGO, STAR HEALTH, RELIGARE, & some few more.
Premium under Group Health Insurance is based on demography, coverage, Industry , exclusions as chosen by Corporate. Therefore Cost of Group Health Insurance is not always pre-fixed for any corporate or industry. Pricing gets worked out once member data & coverage is provided by Corporate.
Once Group Health Insurance is started in any corporate. On Monthly basis, Corporate may add new comers in company and also delete left employees, from their Group Health Insurance. New Addition Premium is usually charged on pro-rata basis and similarly, left employees premium is refunded to corporate on pro-rata basis subject to no claim is made by respective left employee. By keeping certain advance premium deposited with insurance company, a Corporate ensures that their new joinees in company should get covered from their joining date.
Now a days, Every Hospital bill amount is basically depend upon category of room occupied by Patient. Higher the room rent, higher is going to be bill amount. For an example, If two patients for similar ailment & treatment are admitted in same hospital but in two different room rent then it is most likely that Hospital bill is going to be higher for the patient who has occupied costlier room category. Therefore, Insurance Company also pays all hospital bill for what patient room rent eligibility is as per insurance contract.
Taking another example, If an Employee room rent eligibility is Rs 3000/- per day as per his health insurance Plan and he/she occupies room costs Rs 6000/- per day during hospitalization then Insurance Company is only going to pay for what his hospitalization bill could have been at category of Rs 3000/- per day in same hospital. If hospital does not have any category of Rs 3000/- per day then Insurance company is going to be deduct approximately 50% of over hospital bill since policy eligibility is 50% of what is being occupied.
Since customers are usually not aware of Hospital billing practice and their policy coverage over room rent difference therefore disputes over such areas occur very often.
Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which there were signs or symptoms, and / or were diagnosed, and / or for which medical advice / treatment was received, prior to inception of policy.
Capping/co payment are certain limitation imposed as per policy terms & condition on claim amount which is supposed to be borne by insured.
For Example:-
Every Insurance Company excludes some charges which are consisted of mostly of hospital administration fees, and consumables & other charges. These charges are standardized by IRDAI and every insurance company is bound to deduct those charges only which are allowed by IRDAI to deduct. You may download list of Non Payable charges under Health Insurance as directed by IRDAI at this link.
In case of group mediclaim policy for employees, only employer can claim the premium paid for the group health insurance policy as a tax deduction. An employee is not entitled to income tax exemption under the group health insurance provided by an employer. Only under individual health insurance bought diretly by an employee will get a tax exemption under Section of 80 D of the income tax.
These exclusion are common but policy wording & scope may vary from insurance company to insurance company.
Every Insurance Company has got criteria for minimum employee count. However, Keeping entire industry in mind, it is necessary to have at least 5 employees in group to initiate a Group Personal Accidental Insurance.
Insurance Company usually provides 5 times of Annual Gross Salary for respective employee as coverage amount. This may be extended for up to 10 times of Annual gross salary as well by few insurers.
Personal Accidental Insurance is mostly depends upon Industry of Corporate and work profile of employees. For example, Group Personal Accidental Insurance cost is more costlier for manufacturer, mining , drivers, related industries than IT, BPO, consulting firms. It may also be considered that Blue Collar employees premium cost is always going to be higher than while collar employees.
Group policies can always be customized thus a corporate user pays what they choose for their Group Personal Accidental Insurance. Apart from basic coverage, Corporate customer may have below additional coverage under their Group Personal Accidental Insurance program.
Once Group Personal Accidental Insurance is started in any corporate. On Monthly basis, Corporate may add new comers in company and also delete left employees, from their Group Personal Accidental Insurance. New Addition Premium is usually charged on pro-rata basis and similarly, left employees premium is refunded to corporate on pro-rata basis subject to no claim is made by respective left employee. By keeping certain advance premium deposited with insurance company, a Corporate ensures that their new joinees in company should get covered from their joining date.
No
Yes, Personal accidental insurance occurs worldwide there accident occurred anywhere is covered.
No, Personal accidental insurance are basically benefit based policy which has no claim excess/deductible. Thus, for whatsoever coverage amount, insured is assured for, is paid at event of claim.
Premium of a group personal accident insurance plan is treated as an expense deductible from the profit and loss of a company. And so an employer can claim the premiums paid under this plan as a business expense and can claim tax deduction on such expense under Section 37. Employee cannot avail any separate deduction for the same.
Personal accidental insurance is basically a benefit based insurance therefore, in case of accidental death, All personal accidental insurance policies whether taken by employer or employee, will pay claim, if cause of accident is admissible in all policies.
Similarly if there are other term life insurances available, similarly above, all term life insurances will also pay claim along with all personal accidental insurances.
Employee legal beneficiary receives coverage amount in case of death of employee.
Additional Benefits
1. Permanent Total Disability Rider
2. Permanent Partial Disability Rider
3. Accidental Death Benefit Rider
4. Critical Illness Rider
These are general exclusions under term life insurance and may vary from insurer to insurer
1. Suicide. Usually Insurers now cover same but with waiting period of 12 months
2. Death while being involved in illegal activities
3. Death due to accident while driving under influence of alcohol or drugs.
4. Death while being involve in hazardous sport activities
5. Death due to Sexually transmitted ailment such as HIV, AIDS
Every Insurance Company has got criteria for minimum employee count. However, Keeping entire industry in mind, it is necessary to have at least 30 employees in group to initiate a Group Term Life Insurance.
Group Term Life insurance pays compensation to Employee family in case of Employee Death. If such death occurs while employee being on duty, then compensation given against this policy can also be assumed as replacement of Workmen Compensation Act Compensation. Also, Such Compensation out of this policy also builds trust & good credibility among employees towards their employer.
A free cover limit is a sum insured limit, below which an insured is not required to submit any medical questionnaire and also need not to go through any medical underwriting/Medical check up.
Yes, Medical check up may be asked by insurance companies for very few members of the group whose sum insured is more than free cover limit.
Age demography, Industry, Free cover limit, gender, Higher coverage amount are usually parameters on which premium cost is worked out.
Once Group term Life insurance is started in any corporate. On Monthly basis, Corporate may add new comers in company and also delete left employees, from their Group Personal Accidental Insurance. New Addition Premium is usually charged on pro-rata basis and similarly, left employees premium is refunded to corporate on pro-rata basis subject to no claim is made by respective left employee. By keeping certain advance premium deposited with insurance company, a Corporate ensures that their new joinees in company should get covered from their joining date.
For Employer-Premium of a group term life insurance plan is treated as an expense deductible from the profit and loss of a company. And so an employer can claim the premiums paid under this plan as a business expense and can claim tax deduction on such expense under Section 37. Employee cannot avail any separate deduction for the same.
For Employee-claim amount paid under this scheme is exempted from income tax under sec 10(10 D) of the Income Tax Act, 1962
Term life insurance is basically a benefit based insurance therefore, in case of death, All Term Life insurance policies whether taken by employer or employee, will pay claim, if death cause is admissible in all policies.
Similarly if there are other personal accidental insurances are available and cause of death was accident then, similarly above, all personal accidental insurances will also pay claim along with all term life insurances.
Under Sec.17(2A) of the Act, the employer may be exempted from contributing to this scheme, if he/she has provided for better insurance benefits through alternative scheme.
EDLI insurance through Life Insurance Companies instead of Employees Provident Fund Organisation, is considered to be a better alternative because of
Since EDLI scheme under EPFO is applicable for Corporate having minimum count of 20 employees thus minimum 20 employees are required to EDLI insurance from any life insurance policy.
Maximum amount under EDLI scheme from EPFO is Rs 6 lakh. However, Corporate may take Rs 6 lakh or higher sum insured while EDLI policy directly from Life insurance companies.
Employee legal heir is only going to be beneficiary of claim amount under this policy.
For Employer : Premium of a group term life insurance plan is treated as an expense deductible from the profit and loss of a company. And so an employer can claim the premiums paid under this plan as a business expense and can claim tax deduction on such expense under Section 37. Employee cannot avail any separate deduction for the same.
For Employee : claim amount paid under this scheme is exempted from income tax under sec 10(10 D) of the Income Tax Act, 1962.
Under section 1 of the Payment of Gratuity Act, group gratuity insurance is applied to:
Every mine, factory, oilfield, port, plantation & railway corporation.
All establishments or shops that has more than 10 employees in the preceding twelve months.
The law shall continue to be applied to establishments or shops once the provisions of the Gratuity Act 1972 is applied, even if the strength of workers/employees falls below 10.
Gratuity amount =.((Last drawn Monthly Basic Salary +D.A) *15. * No. of years service)/26
Group Gratuity Insurance can be considered as a fund which employer keeps with insurer, in order to pay their future Gratuity Liability to employees. Under this policy, Fund given to life insurers by employer, is kept invested in Market(Equity or Debt) by Insurers after duly discussion & Employer consent of Investment fund options. At any time, Insurer is liable to pay not more than what is available under fund.
Defined Benefit Scheme: In this scheme, Employer provides a specific retirement benefit based on salary and years of service. Plan in this scheme are funded by employer contribution only. It is also called Non Linked non participating annuation plans.
Defined Contribution Scheme: In this scheme, Employees & employer both, can contribute towards fund accumulation. Contribution to fund is in proportionate to salary.
For Employer: Any amount received by Trust (Fund Administrator) on behalf of approved Superannuation fund is exempt under Sec 10(25)(iii). The amount of deduction available under any ordinary superannuation fund shall not exceed 27% (Including Provident fund contribution) of the employee basic salary for each year of his service under Section 36(1) (iv) of the Income tax Act 1961
For Employee: Employees’ contribution towards an approved superannuation fund is eligible for deduction under Section 80C. The payment received from the superannuation fund is tax-free subject to conditions under Section 10(13).
Step 1 : Employer creates a trust for administration of fund under Superannuation Plan.
Step 2 : Finalize whether to go with “Defined Benefit Scheme” OR “Defined Benefit Scheme”
Step 3 : Discuss investment preference & strategy with Insurance Broker & Insurance company
Step 4 : Contribute into fund and review investment return & fund growth in periodic manner.
It is not mandatory under law. Corporate provides these benefits to their employee only to attract and retain talent in their company.
In such case, Employee may either transfer his scheme to organization if similar scheme is available under new organization. Else Employee may withdraw from fund. However, tax provisions may change in this case.
Accumulated fund will be released to legal heir of demised employee.
Needless to mention that Management of any company is utmost important human resource capital for any organization and their sudden absence of services could give a huge financial strain to company which may occur due to immediate reduction in profits/revenue or towards expenses to be incurred for replacement of such keyman employees.
Insurance cannot cover their voluntary choice of leaving organization but however, Insurance can cover such financial strain if absence of services of keyman employees arise due to their death.
Therefore, Need of keyman insurance arises to cover such financial losses due to un timely death of key employees of the company.
Anybody with specialized skills, whose loss can cause a financial strain to the company, is eligible for Keyman Insurance. For example, they could be: Directors of a Company, key sales people, key project managers, people with specific skills etc.
Sum Insured(Coverage amount) is restricted to either of three condition as below:-
For Employer : Premium paid by company for a keyman insurance is an allowable business expenditure and enjoys tax benefits under Section 37(1) of the Income tax Act. However, Claim proceedings are taxable as business income.
For Key Employees Insured : Since neither premium is paid by employees nor proceeding are coming to them thus there is no tax implication for these members under this insurance.
No, Company does not need to provide any evidence of losses of expenses after death of key employee insured. After death, Coverage amount will straight away be paid to company.
Corporate can have a customizable travel insurance with self chosen benefits. Once Benefits are decided, Corporate deposits premium to insurer on a fixed rate of travel per day. Before beginning of journey, Every employee/employer may issue travel policy certificate through multiple convenient modes. Since premium is already paid in lump sum by employer, thus no need of payment of premium at every policy certificate issuance. At end of policy year, Corporate gets refund of premium from insurance company on balance of travel days.
Travel Insurance covers customer against certain financial losses which occurs during travel. Risk, which are covered travel insurance are majorly which are covered under General Health Insurance, Personal Accidental along with bouquet of additional coverage against travel related risks such as Baggage loss, fight delay etc.
Key Benefits under Travel Insurance:-
For Employer : Premium paid by company for a keyman insurance is an allowable business expenditure and enjoys tax benefits under Section 37(1) of the Income tax Act. However, Claim proceedings are taxable as business income.
For Key Employees Insured : Since neither premium is paid by employees nor proceeding are coming to them thus there is no tax implication for these members under this insurance.
No, Company does not need to provide any evidence of losses of expenses after death of key employee insured. After death, Coverage amount will straight away be paid to company.
IRDA Registration Number : 948 | CIN : U66220DL2023PTC421813 | Category : Direct Broker (Life & General including Health) | License Period : 11-03-2024 to 10-03-2027
IRDA Registration Number : 948
CIN : U66220DL2023PTC421813
Category : Direct Broker (Life, General, Health)
License Period : 11-03-2024 to 10-03-2027