Life is the most precious gift that one can be blessed with. However, people often take it for granted, until and unless there is some uncontrollable threat to it. Unseen sickness and accident can really be the biggest enemy of your happy and safe life. Thus, you should do everything in power to protect it from these uncontrollable circumstances.
The first thing that might come to your mind to protect yourself and your love ones from ill-health and accident are health and accident insurance policies. However, what if, the need arises to protect the group of people who are neither your family nor loved ones, but are very important to you? Say, your employees or member of your organization or community? What will you do then? Will you ignore the people who might turn out to be the biggest asset for your company or your organization or will you bear the high expenses to cover each and every employee or member of your group individually? Confused? Let’s make it easy for you. There is another option that is not only economical, but beneficial too, Group Medical Coverage (GMC) and Group Personal Accident (GPA).
Group Medical Coverage
What is GMC?
GMC or Group Medical Coverage is a plan that offers medical coverage to the group of people. The group of people can be employees of any company, members of any community or social group. The medical benefit offered is uniform. In short, similar benefits are offered to each and every person of the group.
Scope of Coverage
The group medical insurance policy has wide scope of coverage. Most of the group health policies offer-
- Hospitalization Expenses- Group medical insurance covers the expense on behalf of any member covered for the treatment of ill-health or accident. These expenses include room boarding rent, doctor and nurse fee, cost of anesthesia, blood bottles, oxygen, drugs, etc required in the treatment of the patient.
- Pre Hospitalization Expenses- group health plan not only covers the hospitalization expenses, but it also endures pre-hospitalization expenses. All the tests, diagnosis, consultation expenses related to the treatment before the person is admitted in the hospital are covered under the plan as well. The group health plan will cover the expense on behalf of the patient only for 30 to 90 days, depending on the terms and conditions of the company and the policy chosen.
- Post Hospitalization Expenses- The group health plan also pays for the money spent on the consultation, tests or diagnosis after the treatment of the patient to analyze and interpret the progress of the treatment. The health plan shall endure the expenses only for 30 to 90 days after the treatment, just like in case of pre-hospitalization expenses, depending on the terms and conditions of the company and policy chosen.
- Day Care Treatments- Nowadays, because of advanced medical technology, some of the treatments can be taken care of within 24 hours, but the expense of treatments can be high. However, group health plan, just like an individual or floater plan, also covers day care treatments.
- Domiciliary Treatments- The group medical coverage also offers to pay for the domiciliary treatment of any ill member of the covered group. In short, if the need arises to treat the patient at home, then the plan shall cover for the doctor and nurse fee and medical equipments, medicines required for the treatment.
- Optional Benefits- Beside these, many group health policies also offer additional benefit in return of extra premiums. These benefits can be dental care, maternity benefits, coverage of the family member of the employees, etc.
Exclusions and Exceptions
- Waiting period for pre-existing diseases
- No treatment outside India.
- AIDS, HIV, etc. are not covered.
- No coverage for illness or accident caused due to consumption of drugs and alcohol.
Group Personal Accident
What is GPA?
GPA or Group Personal Accident is a policy specially designed to protect the group of selected people from the consequences of unexpected accident. These consequences can be death, disability, etc. The group of people covered can be the employees of the company, the family members of employees or members of any social group or community.
Scope of Coverage
The group personal accident coverage offers the insured, basic to comprehensive coverage, depending on the requirements of the proposer-
- Basic Coverage- It includes accidental death coverage only. Here, the nominee of the dead member is provided with compensation mentioned in the policy.
- Wider Coverage- Besides providing accidental death coverage to the nominee, the wider coverage reimburses in case of permanent and total disablement or permanent and partial disablement of any covered member of the group.
- Complete or Comprehensive Coverage- The complete or comprehensive coverage as the name suggest offers total protection to the insured and his family members. It offers compensation not only for accidental death, permanent and total disablement and permanent and partial disablement, but also temporary total disablement.
- Accidental Death Coverage- 100% of the sum insured to the nominee of the dead member as compensation in case of death due to an accident.
- Permanent and Total Disablement- 100% of the sum insured to the insured in case of permanent and total disablement due to an accident.
- Permanent and Partial Disablement- Compensation is given to the insured as mentioned in the policy chosen, in case of permanent and partial disablement due to an accident.
- Temporary Total Disablement- 1% of the sum insured or Rs.5000, whichever is less, is given to the insured for maximum 104 weeks, in case of temporary total disablement.
Exclusions and Exceptions
- No coverage for natural death
- No coverage for accidents occurred outside geographical boundaries
- Accident caused because of the intoxication will not be covered
Benefits of GMC and GPA
The benefits of GMC and GPA over individual policies are as follows-
- Lower premium rates
- Covers each and every member of the group or employee uniformly
- The policy is often customized
- Cover the group member form the day one of joining the group covered
In order to motivate your employees or the member of your group to work and perform better and to ensure their health and safety; it has become important to buy group medical coverage and group personal accident coverage that uniformly covers each and every member and that too economically. So, what are you thinking? Compare and buy ASAP.
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