Back

Group Health Insurance Policy

Get Quote

A group health insurance scheme offers risk coverage to individuals belonging to a designated group. Typically procured by employers, this policy extends coverage to eligible employees as part of a benefits package, and in certain instances, may also include family members. The coverage encompasses hospitalization and medical expenses incurred within India, with the stipulation that hospitalization lasts for more than 24 hours, excluding treatments listed as day care procedures.

Coverage

The policy provides coverage for expenses related to diseases, ailments, and accidents incurred as an in-patient in a hospital, including:

  • Charges for room, boarding, and nursing services..
  • Fees for the surgeon, anesthetist, specialists, and operation theatre charges.
  • The expenses for diagnostic tests, medications, blood, oxygen, and the provision of appliances such as pacemakers, artificial limbs, and organs, etc.
  • Alternative treatment and expenses related to organ donation
  • All eligible expenses incurred 30 days prior to and 60 days following hospitalization are reimbursable (for which a claim is payable), except in the case of maternity benefits.
  • The Group Medi-claim policy can be expanded to cover the medical expenses of the entire family, including self, spouse, dependent children, and dependent parents, through a Family Floater under a single sum insured. The sum insured amount "floats" across the entire family.

Addition : For new employees, coverage begins either from the date of joining or the first day of the following month. The addition of dependents is permissible only in the case of marriage or the birth of a newborn.

Deletion : For employees whose employment with the insured ceases, regardless of the reason, coverage will automatically expire for that employee and their dependents from the date of employment cessation.

Moreover, the coverage scope encompasses protection from the policy's commencement, the waiver of excluded diseases in the first year, exemption from waiting periods for certain listed diseases (as specified in the standard health insurance policy), waiver of waiting periods for maternity cover, and coverage for a newborn baby from day one (as part of the mother's sum insured) by paying an additional premium.

Highlights

  • The company being insured is the primary contact for the designated group health insurance provider.
  • The policy can only be canceled by the employer.
  • Effective for the duration of the employee's affiliation with the respective organization.
  • The viability of a group health policy relies primarily on the organization's robustness, encompassing both financial stability and the number of employees.
  • The insurer does not conduct pre-medical check-ups.
  • Provide a cashless facility.
  • Provide coverage for pre and post-hospitalization expenses for a designated duration.
  • Certain policies may provide maternity benefits.
  • Hospitalization for certain procedures, such as chemotherapy, eye surgery, tonsillectomy, and others, lasting less than 24 hours.
  • Extended coverage for specific critical illnesses beyond hospitalization benefits.
  • Certain policies might offer coverage for pre-existing conditions upon the payment of an additional premium.
  • Certain policies might include coverage for domiciliary expenses.
  • Optional benefits may encompass the waiver of waiting periods, first-year exclusions, as well as reimbursement of ambulance charges, among other offerings.

More Covers

Maternity benefit with new born baby cover : This feature includes coverage for delivery expenses, both normal and caesarian, up to the specified Sum Insured in the Policy. This amount is incorporated within the overall sum insured.

Corporate Buffer : A uncommon benefit expanded by paying extra Premium wherein the Whole safety net provider can up topped up through the entirety safety net provider of corporate buffer in cases where the claim surpasses the entirety guarantor of the representative.

Cover for certain basic afflictions over hospitalization benefits.

Cover for pre-existing diseases.

Cover for domiciliary expenses.

Waiver of holding up period, to begin with year prohibitions , repayment of emergency vehicle charges, etc.

Requirements

In arrange to be qualified for bunch wellbeing protections , a company ought to have a least gather of 25 people .

Minimum age of entry : A child can be secured from day one inside the in general Maternity Restrain subject to acceptability of the Maternity claim .

Not Covered

  • Naturopathy or other shapes of neighborhood medicine .
  • Purposefulness self injury damage beneath the impact of liquor , drugs, Infections such as HIV or Helps .
  • Infections existing from the time of birth Innate infections .
  • Fetched of exhibitions , contact focal points , and hearing helps .
  • Dental treatment or surgery of any kind unless requiring hospitalization.
  • Charges caused at Clinic or Nursing Domestic fundamentally for demonstrative without any treatment.
  • Costs on vitamins and tonics unless shaping portion of treatment for malady or damage as certified by the therapeutic specialist .
  • Restorative , stylish , treatment unless emerging out of mishap .
  • Schedule therapeutic , eye and ear examinations.
  • Treatment of mental sickness .