Overview of Group Health Insurance:
A group or corporate health insurance policy is purchased by an employer for eligible employees of a company. One of the key employee benefit packages provided by employers, a group health insurance plan, in some cases, may also provide cover to family members of employees.
- Some policies may cover boarding expenses apart from surgeon, anesthetist and consultant fees; charges for anesthesia, oxygen and diagnostic materials in addition to X-rays and dialysis costs among others.
- Offer cashless facility and direct settlement of bills with the hospital.
- Offer to cover pre and post-hospitalisation charges for a specific period.
- Some policies may offer maternity benefits.
- Less than 24 hours hospitalisation for certain procedures such as chemotherapy, eye surgery and tonsillectomy among others.
- Extended cover for certain critical ailments above hospitalisation benefits.
- Some policies may provide cover for pre-existing diseases after payment of extra premium.
- Some policies may cover domiciliary expenses.
- Some of the optional benefits include waiver of waiting period, first year exclusions besides reimbursement of ambulance charges among others.
Top Companies offering Corporate Health Insurance Policies:
Star Health - MediClassic Insurance Policy:
The key features of the Star Health and Allied Insurance MediClassic Insurance Policy are:
- The policy offers room, boarding, or nursing expenses at 2% of the sum insured subject to a maximum of Rs.5,000.
- Emergency ambulance charges up to a sum of Rs.750 per hospitalisation and overall limit of Rs.1,500 per policy period.
- Covers in-patient hospitalisation expenses for a minimum period of 24 hours.
- Covers costs incurred through surgeon, anesthetist, medical practitioner, consultants.
HDFC ERGO - Group Health Insurance Policy:
The key features of the HDFC ERGO Group Health Insurance Policy are:
- The policy covers hospitalization caused by sickness or accidents. And will include room charges, boarding charges, medicine and drugs costs including costs for specialists like anaesthetist, surgeons, specialist fees, and, consultation, etc. will be covered under the policy
- All related expenses for treatments will also be covered such as blood, diagnostic materials and x-ray oxygen, operation theatre charges, anaesthesia, surgical appliances, dialysis, and even chemotherapy.
- The HDFC Ergo-Group Health Insurance policy will cover pre and post hospitalization expenses.
- Day care and domiciliary hospitalization expenses are also covered.
Future Generali- Group Health Insurance:
The key features of the Future Generali- Group Health Insurance are:
- The policy covers everything from the time the insured is hospitalized to the time of discharge. All charges including room charges, boarding charges, medicine and drugs costs including costs for specialists like anaesthetist, surgeons, specialist fees, and, consultation, etc. will be covered under the policy
- Even the treatments related expenses like blood, operation theatre charges, diagnostic, anaesthesia, surgical appliances, materials and x-ray oxygen, dialysis, and even chemotherapy will be covered within the policy.
- The Future Generali- Group Health Insurance will completely cashless for the employee and doesn’t cause the employee any hassle of documentation and bills.
ICICI Lombard - Group Health Insurance Policy:
The key features of the ICICI Lombard Group Health Insurance Policy are:
- The plan provided for ICICI Lombard-Group Health Insurance Policy can be tailored made to suit your requirements.
- The plan will cover medical expenses that will be charged during hospitalization for minimum of 24 Hrs.
- The plan also provides a coverage for a 30 Days Pre Hospitalisation and 60 Days Post Hospitalisation expenses.
- The plan also cover 9 major critical Illnesses which will be optional.
- The plan will provide a cashless facility at all their partner hospitals.
Understanding Group Health Insurance Policy:
Why do companies offer health insurance?
It not only helps retain but also boost the performance of employees. Also, it goes a long way in creating a loyal workforce. In some cases, employees may accept better health benefits instead of higher remuneration. It helps reduce absenteeism in the company and improves morale of employees.
What are the other benefits companies enjoy for offering employees health insurance?
Companies get tax breaks for offering health insurance policies. In some cases, a health insurance policy is part of an employer’s statutory obligations.
How do employer health insurance plans fare in terms of pricing?
Low premiums may get more weightage but it could, in some cases, lead to exclusion of several important features.
How about co-payment clauses in the policy?
No co-pay plans are ideal for customers but insurance companies resort to co-payments to cut their costs. For instance, about 20 per cent of group health insurance policies offered by New India Assurance include a co-payment clause.
Do group or corporate health insurance policies cover a wide range of diseases?
Your policy may provide cover for a wide range of ailments in addition to accidents which need ‘in-patient’ hospitalization. Besides, you can opt for a critical illness cover as well.
Advantages of Employee Health Insurance Policies:
- It provides an additional health cover for employees who already have an family or individual health insurance policy
- Employees, by and large, are not asked to go for medical check-ups and usually get policy cover from day one.
- Employees, in some cases, can avail of certain maternity benefit.
- A group health insurance plan is cheaper (usually 30%) than individual health plans. Premiums in the former are lower in relation to the sum assured compared to individual health insurance policies.
- A group health insurance policy is, by and large, easily available to employees of a company.
- In many cases, pre-existing medical conditions of the employees are covered by group insurance policies.
- In most cases, employees are not denied health coverage based on their age or past medical history.
Who should buy this plan?
Group or corporate insurance is provided by employers to employees in an organisation as opposed to an individual health insurance policy. The insured employees pool into the policy and can, therefore, claim health coverage as and when the need arises.
- A group health insurance policy may offer limited coverage owing to sub-limits. An employee,therefore, may not be fully covered.
- A master policy offered by companies covers all employees in the organization under the same umbrella and therefore lacks customization.
- The policy is valid only for a certain period during which an employee is working in a company.
- Companies may reduce the health insurance cover at their discretion.
- An employee and his family are not covered in case of any interval between jobs.
- The policy may become invalid if a company does not pay the required premium or if an insurer backs out of the contract with the company.
- Many companies may not provide health cover to the employee’s parents.
Sunita Sehgal (name changed) a Bangalore-based HR executive and a to-be mother is worried about the medical expenses of hospitalization and other ancillary costs related to pregnancy. She is, however, covered under an ‘Employee First’ corporate health insurance scheme which provides private single rooms in hospitals besides other maternity benefits for newborns including vaccination coverage for her baby. What’s more, it also covers check-ups for her parents and in-laws as well.
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GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.