Parameters To Choose Employees Group Health Insurance
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Updated on Jul 09, 2025 4 min read
Group Health Insurance Policy for Employees
A group health insurance coverage can protect a group of people who are members of a company, organization, association, or community. Group health insurance is a type of health insurance that provides coverage to the employees working for an organization. It is a necessary service supplied to all employees in order to protect them from any potential health problems. Because the premiums are paid by the employer, it is a vital benefit for any employee who works for a corporate organization.
The Indian work culture is completely interlinked in terms of processes where people and work require constant discussions, communication and coordination on a regular basis. Therefore, various companies, working on the work from home model, have either reverted to work from the office or introduced a hybrid model where selective employees are being called to the office.
While, the employees are inching back towards their workplace, but, with a worry in mind that what if they catch the infection and above all if they infect their family members as well. Therefore, the employer must take the initiative to ensure the safety of the lives of their employees with the help of Employee Group Health Insurance.
Employee Group Insurance is a service provided to the employees of an organization in the form of a health insurance plan. In an employee insurance policy, the employees get insurance cover at a reduced cost as the provider’s risk is spread across a big number of policyholders.
This initiative will help workers in working with a free mind and without any tension worrying about the medical expenses to meet in case they catch the coronavirus. Also, in times when the life requirements and priorities have changed, employee health insurance can help the organization in increasing the retention rate, employees’ motivation, their physical health and mental well-being.
Ideally, the organization should offer a health care plan to their employees that seriously turns out to be a supportive entity at the time of emergency as well as come affordable for the employer. Hence, here are some parameters to consider at the time of buying an employee group insurance:
Accurate Sum Insured
Sum Insured is the amount that is allotted to each employee in the case of hospitalization. The sum insured allotted to each employee should be enough to manage the expenses of medical requirements of any disease, especially in the times of COVID19 when the medical inflation has increased. Also, the sum insured should be finalized as per the residing city of the employees as the medical cost varies from metro cities to Tier I & II cities.
Room Rent Limit
Room rent is the bill for the hospital rooms except for the cost of medication, doctors’ visits and medicines. It is generally seen that the room rent limit has been kept the lowest to save the cost. However, in an employees group insurance, the lower room rent limit can cost high to the employee who is admitted in the hospital, if they take a room with a higher cost. In this case, the employee will have to pay from his pocket which can create a burden on his/her shoulders. Hence, the health insurance plan for employees must cover the cost of up to a single private room.
Network Hospitals
A health insurance plan can come at a very low cost as well but they might not be able to serve employees with a sufficient number of hospitals for the cashless facility. The health insurance service provider must offer a long list of network hospitals located in different parts of cities to be accessed by all employees.
Suitable Additional Riders
Adding riders into the plan is a good option to enhance the plan to make it more helpful and supportive for employees. The organization can select riders depending upon the nature of the business or the majority of staff members. For instance, if a company has a huge number of riders then accidental rider benefit can be clubbed with the plan or if the company has a majority of young employees then maternity benefit can be taken for the employees.
Waiting Period Waive Off
The biggest distressing aspect of insurance plans is the waiting period where some diseases are put under the cap of a certain duration for compensation by the insurance company. But a medical emergency can arise anytime without any prior intimation. Employees Group Scheme helps in eradicating the waiting period by paying an extra premium. As a rule of thumb, it is strongly advised to opt for waiver of waiting periods in group health insurance plans.
What Is Group Health Insurance?
Group mediclaim policy is not only limited to cover the employees of an organization but the benefit is also extended to their family members like self, spouse, dependent children and dependent parents. This plan is also known as corporate health insurance or employee health insurance by individuals across the globe. A plethora of features and benefits are offered under the group health insurance like hospitalization expenses, pre-existing diseases, pre and post-hospitalization, daycare expenses, maternity expenses, and more.
Difference Between Group and Individual Health Insurance
| Group Health Insurance | Individual Health Insurance |
| The organization is the one-point contact for all the necessary details required by the insurance provider | Individuals are themselves responsible to disclose their personal information and fill out their details correctly in order to avail an individual health insurance |
| Individuals can not cancel their policy on their own, the employer has the right to discontinue any health insurance policy purchased for the employees | Individuals can cancel their own health insurance policy |
| Group Health Insurance Policies are valid for an employee as long as he/she is the part of the organization | Individual health insurance policy is valid for the policy tenure mentioned in the policy after which individuals must renew their health insurance policy |
| Group health insurance policy is relatively affordable | Individual health insurance policy is comparitively expensive |
| No pre-policy medical check-ups required to avail a group health insurance policy | Pre-policy medical check-ups may be required under certain terms and conditions in an individual health insurance policy |
What Is Covered By Group Insurance for Employees?
Employee Health Insurance provides coverage for the following things depending on the requirements of an employee:
- Pre-existing diseases (PED)
- Pre & Post Hospitalization
- Maternity Cover
- Day Care Treatments
- New Born Baby Cover
- Road Ambulance Cover
- Pre & Post Natal Care
- In-Patient Expenses
- Covid-19 Hospitalization
- Accidental Hospitalization
- Daily Cash Allowance, etc.
What is Not Covered in Group Health Insurance?
Group Health Insurance Policy does not cover the following:
- Injuries due to war
- Death or Injury due to illegal activities
- Suicide or any treatment required due to self-harm
- Dental Treatments
- HIV/AIDS or other STDs
- Cosmetic or obesity treatments
- Injuries caused under the influence of any intoxicants
Key Features of Group Health Insurance Policy
There are multiple key features surrounding a group mediclaim policy through which an employee and their family member can benefit from that are listed below:
- Group health insurance is not limited to covering just the employee associated with the employee but also covers the family members of the employee like spouse, dependent children, and dependent parents.
- A lot of group mediclaim policy offers maternity and newborn baby cover.
- Pre-existing diseases are covered from day 1, unlike other health insurance plans where a waiting period is compulsory.
- No health check-up is required for the group mediclaim policy.
- Premiums for employee health insurance are comparatively more affordable than an individual health insurance plan
- Group insurance for employees offers a cashless network hospital facility just like an individual or family floater health insurance policy.
Why is Group Health Insurance Necessary?
Organizations cherish their employees and with a global pandemic destroying several enterprises owing to staff loss, the corporate industry has realized the importance of being employee-centric even more.
Employees and organizations profit from being employee-centric and putting themselves and their immediate families under the protection of group health insurance. We have mentioned a few reasons why group medical insurance is essential below.
- Employee Retention
Employees want job stability, and businesses want employees who will stay with them for a long time. Employee retention is a major goal for any organization because hiring and training are costly. By providing complete Group mediclaim coverage to an employee and their family, an employer, and employee can develop a symbiotic relationship, enhancing the organization’s trust and retention rate. - Extensive Coverage
Group Health Insurance provides substantial coverage to employees and their families, including hospitalization coverage, pre and post-hospitalization coverage, daycare treatment coverage, maternity coverage, newborn infant coverage, accidental coverage, and more. - Affordable Coverage for Employees
Group insurance for employees is a boon as it offers multiple coverage features at zero premium costs as it is borne by the employer. - Facility to Customize
Group health insurance policy provided by employers has provided employees with the facility to customize their health plan by opting for their own choice of coverage. - Supporting Women Employees
Group medical insurance provides maternity as well as newborn baby coverage to its women employees making sure the women workforce feels supported and valued which benefits the organization in the long run by creating an inclusive environment.
Advantages of Group Health Insurance Policies
We have listed below the benefits of group health insurance policies:
- No-Pre policy medical check-up required
Under group health insurance employees do not require to undergo a pre-policy medical check-up. - Coverage for all sizes of organizations
Group Health Insurance has no constraint over the number of employees that need to be covered. Many group’ mediclaim policies offer coverage to organizations of varying sizes be it a small association consisting of 10 employees or a new start-up consisting of 25 to 50+ employees. - Lifestyle Health Support
Many individuals today are facing illnesses due to their sedentary lifestyle and work-related stress, a group health insurance ensures that your employees are covered against all of these diseases and also have access to wellness programs in order to push them towards a healthier lifestyle.
How Does Group Health Insurance Work?
The first step to understanding the working of a group health insurance is to understand that first and foremost, a group Health Insurance provider is selected to cover the employees of an organization. After the selection of the insurance provider, the working plan is selected and customized based on the industry the organization belongs to. For example, if someone works with a mining company the coverage of a group medical insurance will replicate the risks taken by the employee. The premiums are paid by the organization providing the group mediclaim policy.
The organization provides a uniform mediclaim policy to all its employees. However, the employee has the freedom to opt for additional coverage for their spouse, dependent children, or parents on an additional premium.
Understanding the Claim Process Of Group Health Insurance
To understand the claim process of a group health insurance read the points given below:
- Fill out the pre-approved form set by insurance providers via a TPA counter at a network hospital.
- Fill in your policy details and the TPA will inform the insurance provider.
- Verification of your claim request is carried out by the insurance provider.
- On approval the cashless claim settlement is carried out between the hospital and TPA.
What Are The Documents Required For Claim Settlement Process?
There are certain documents required for the claim settlement process of a group health insurance that is mentioned below:
- Medical Reports
- Doctor’s Prescription
- Form Filled with the doctor or hospital’s signature
- Hospital Bill
- If it is an accident case the police report is required
- Discharge Report
- Other Documents Required by the insurance provider or TPA
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How to choose group health insurance plan : FAQs
1. Is my spouse covered under group health insurance?
Yes, as an employee of an organization you can opt to provide cover for your spouse under the group health insurance your employer has provided for you.
2. Do group health insurance plans cover Covid-19?
Yes, some of the group health insurance policies do cover Covid-19. However, you must read the coverage features before purchasing a group mediclaim policy.
3. Is Individual health insurance cheaper than group health insurance?
No, in fact, it is usually the contrary. Group health insurance is on the cheaper side than individual health insurance as group health insurance covers multiple individuals in an organization.
4. Are small start-ups eligible to purchase a group health insurance policy?
Yes, Group health insurance policies are available for organizations of every size. It doesn& 039;t matter if the organization is a big conglomerate or a small start-up with 50 employees.
5. Do employees have to undergo a pre-medical check-up to purchase a group health insurance policy?
No, group health insurance plans do not require employees to go through a pre-policy medical check-up.
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Written By: Simran Kaur Vij
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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