Comprehensive Group Mediclaim Policy: Health Insurance for Employees

Group health insurance or a mediclaim policy is an insurance package which employers buy for their employees. Not only does it provide tax benefits to employers, but it also helps retain employees and create a good corporate culture.

With group mediclaim policy capturing 50.47% of the insurance market in India, according to ET Edge Insights, the time has come to clear the fog about this policy.

In this blog, let’s decode the most misunderstood health insurance policy and learn about its features and how it differs from other policies.

What is a Group Mediclaim Policy?

A group mediclaim policy is a health insurance policy providing coverage to a group of people, usually employees of an organisation, and their dependents. The policy covers medical expenses incurred by the insured individuals in case of hospitalisation due to illness or injury.

The policy covers a range of medical expenses, including hospitalisation charges, room rent, doctor's fees, and pre-hospitalisation and post-hospitalisation expenses, among others. Group mediclaim policies are designed to provide comprehensive health insurance for employees and their families at an affordable cost.

The premium for the policy is usually lower than that of an individual health insurance policy, as the risk is spread across a larger group of individuals. The policy is usually renewed annually, and the premium is paid by the employer.

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What is an Example of Group Mediclaim Policy in Real Life?

Are you wondering how does group mediclaim policy work? Don’t worry, let’s clear that up.

Suppose Mr. Chopra owns a digital marketing agency with 50 employees. He decides to buy a group mediclaim plan for his employees, to protect them from unexpected medical expenses.

He approaches an insurance company and buys a plan for which he pays the premium. Now, Ravi, an SEO analyst, joins Mr. Chopra’s company. He gets coverage from Day 1 of his employment.

However, unfortunately, he met with an accident on the way to his work. He requires immediate hospitalisation and surgery. With the help of his group health policy, he can get treatment.

Thus, without worrying about his finances, Ravi can get better, thanks to the group mediclaim policy.

What is the Importance of a Group Mediclaim Policy?

Now that you know how group mediclaim policy functions, you must know why it is important for both employers and employees.

Benefits for Employers

1. Employee Retention: According to a report by ABP News, 21% of younger employees will leave a job if they feel that the workplace is toxic. Therefore, maintaining employee retention becomes a challenge for employers. By providing benefits like a group mediclaim policy, employers show that they care about their employees.

2. Attracting Top Talent: For an organisation, attracting top talent is the ultimate recipe for growth. But why will top talents work in an environment which doesn’t care about them? That’s why having a good health insurance plan contributes significantly towards a positive employee impression.

3. Tax Deductions: According to the Income Tax Act of 1961, you can claim tax deductions on the amount of premium you pay towards group mediclaims. This is because they count it as a business expense.

4. Value for Money: Buying corporate health insurance means you don’t have to buy individual plans for every employee. Individual plans are often costly. Since the risk is shared among many employees, group plans are cheaper and cost-effective.

Benefits for Employees

1. No Pre-Existing Disease Waiting Period: The PED waiting period usually lasts for 3 years in individual plans. However, with a group mediclaim policy, you get day 1 coverage for PED. So, even if you have diabetes, you can claim it without any hassle.

2. Families Get Coverage: Without investing any amount, you can get coverage for your family from day 1. Your spouse, children and parents will be covered under this plan.

3. Access to Cashless Hospitalisation: Bajaj General Insurance has 18,400+ cashless network hospitals, which help you get quality healthcare anywhere in India.

4. Recognition: As an employee, you know you are valued at your company when they offer you a group mediclaim insurance policy for employees.

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How to Choose the Right Mediclaim Policy as an Employer?

Choosing the right group mediclaim policy as an employer requires minute consideration of several factors, such as sum insured, premiums, etc. Let's dive into it deeper:

Workforce Age Range

Every demographic faces different kinds of health issues. For example, if your workforce is between 40 and 60 years, then they most likely require a policy which covers heart disease, arthritis, etc.

On the other hand, if your workforce consists of younger people, then lifestyle-related disease and mental health coverage are a crucial factor.

Sum Insured and Premiums

Choose a sum insured amount which can cover the needs of your entire workforce. Before buying, make sure to go through the brochure and policy wording so that you know what you are getting into.

Moreover, also look into how the premiums will fit into your budget. Group mediclaims are for full-time active employees. So make sure you have at least 7 to 20 employees before buying.

Network Hospital List

Since you will be covering a large group of people, choose an insurer with a wide network of hospitals. This will ensure that wherever your employees may stay, they get the care they need.

Also, choose an insurer with 24/7 customer service, so you and your employee don’t have to worry about any doubts regarding the plan during emergencies.

What is the Difference Between Group Mediclaim Policy and Individual Health Insurance?

You may wonder what is the difference between group mediclaim policy and individual health insurance.

This is a common misconception, as they both offer similar benefits. However, these 2 plans are designed differently for different target audiences. Let’s understand below:

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What are the Required Documents for Employee Group Mediclaim Claims?

The following documents are required to file a claim under a Group Mediclaim Policy:

1. A duly filled claim form is available on the insurer's website or at their branch.

2. A recommendation letter from a certified doctor indicating the necessity of hospital admission.

3. The hospital-issued discharge letter.

4. Medical investigation reports.

5. Original invoices detailing treatment costs, stamped by the hospital.

6. An FIR (in case of a road accident).

7. A cancelled cheque of the account designated for reimbursement payout.

How to Claim a Group Mediclaim Policy?

Here are the steps for a successful claim settlement:

1. The employee must inform the insurer about the hospitalisation within 48 hours of admission.

2. The third-party administrator (TPA) will assign a claim number, enabling the employee to track its status easily.

3. The employee must settle the bill and keep the original invoice ready for submission.

4. The insurer may request further details regarding the treatment or procedure.

5. Upon approval, the claim will be processed, and the amount will be credited to the insured employee’s bank account within three to four working days.

Also Read: What is TPA?

Final Thoughts

In conclusion, a group mediclaim policy is an essential employee benefit providing financial security to employees and their families in case of a medical emergency. It is also a cost-effective way for employers to provide health insurance to their employees, attract and retain talent, and reduce their tax liability.

You can provide coverage for pre and post-hospitalisation expenses, inpatient costs, AYUSH treatment and more at a cost-effective premium. Choose medical insurance from Bajaj General Insurance and join 14 crore+ happy customers!

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FAQs About Group Mediclaim Policy

1. Who can purchase a group health insurance policy?

Any organisation with a workforce of 20 or more employees is eligible to purchase group health insurance plans. These plans cater to the healthcare needs of employees in small, medium, or large-scale enterprises. Organisations should review the eligibility criteria specified by their chosen insurer for additional clarity.

2. Can I buy individual health insurance if I am covered under a group health insurance policy?

Yes, you can. If the coverage provided by your group health insurance feels inadequate, you can enhance your protection by purchasing an individual health insurance plan. An individual plan allows for a higher sum insured and the flexibility to add riders, making it beneficial for long-term healthcare needs.

3. What is covered under group health insurance plans?

Group health insurance plans generally offer coverage similar to individual health insurance policies. These include doctor consultations, hospitalisation expenses, prescription medications, and preventive care. Some policies may also include specialised benefits like eye and dental care.

4. What is a group insurance premium?

A group insurance premium is the amount an employer pays to provide health insurance coverage for employees. In some cases, the cost is shared between the employer and employees. This premium is paid at the time of purchase and renewed annually to keep the policy active.

5. What happens to group insurance coverage when an employee leaves the company?

Group health insurance coverage usually ends when an employee leaves the company. However, employees may have the option to continue their coverage by converting the group policy into an individual health insurance plan. The availability of this option depends on the terms set by the employer and insurer.

6. Do group health insurance plans cover the specific medical needs of employees?

The medical needs covered under a group health insurance plan are determined by the employer’s choice of coverage. Employees can review the policy details to see if it meets their needs. If not, they may upgrade the policy or purchase an individual health insurance plan for added benefits.

7. Is my family covered under a group health insurance policy?

Family coverage under group health insurance depends on the policy terms. Many group plans include coverage for spouses, dependent children, and parents. However, certain plans may impose restrictions based on the age of family members. Always check the policy details for specifics on family coverage.

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