Group Health Insurance

Wed 7 Mar 2018 00:00:00 UTC

aka Employee Mediclaim Insurance

A core part of employee benefits is an insurance plan for your employees, specifically a health insurance plan. A group health insurance plan(aka employee Mediclaim insurance, or employee health insurance) as the name suggests is an insurance plan that provides healthcare coverage to a group of people, usually employees. The employer generally pays the premiums on behalf of the employees, although some companies have a partial share basis.

A group mediclaim policy usually covers most of the eligible employees of a company, although it can also be availed by housing societies and associations as long as it covers all the members. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group; however at large group sizes(>100 primary members), certain customizations become possible.

Group health insurance has many advantages over individual health policies, and it is more cost effective. This is because the risk is spread over the entire group, rather than one person and for this reason insurance providers usually waive medical checkups, which makes it even more attractive.

In India, where a vast majority of people are not covered by any kind of health insurance, such a scheme is attractive. It is often included in employer benefit packages as a means of attracting top talent. A fitter, healthier workforce is also far more productive, motivated, and easier to retain. Benefits are also flexible, and can be customized. This flexibility allows the group health insurance to be tailored to a company’s budget and specific requirements.

Group Health Insurance vs Individual Health Insurance: The Advantages

Group covers have many advantages over health insurance; here are the top 5:

No Waiting

Every health policy has a myriad number of waiting periods, from a 4 year waiting period for pre existing conditions, a 2 year waiting period for specific diseases, and a 30 day wait until the policy kicks into effect. A group health policy generally has none of these wait periods, allowing for immediate and comprehensive coverage. These benefits have to be opted for, but are generally a feature in almost every policy.


Many health policies either don’t cover maternity, and those that do impose a 9 month waiting period until it is covered. Group policies allow maternity to be covered from day one. This has to be opted for, but , is salient feature of almost all group health policies.

Baby day 1 cover

Newborn children can only be added after they are 90 days old, in an individual policy. As the name states, group Mediclaim policies have an option to have a newborn baby covered from day 1.

Spouse + 2 kids + 2 parents

Many health policies do not allow you to cover three generations in one policy. You can either cover yourself and your kids, or yourself and your parents. Doing both is possible only with multiple policies, which can be cumbersome, not to mention expensive. A group health policy allows for up to 5(in some cases 6) dependents on the policy, including both parents and children.

No Medicals

An individual policy, above a certain age or sum insured bracket requires the policyholders to undergo a medical before the policy can be issued. There are also extra medicals done when pre-existing conditions are declared. Group health policies do not require medicals.

All these advantages are, of course, over and above quite a significant price advantage as well.

Disadvantages of Group Health Policies

There are generally only two disadvantages to group health insurance:

Sum Insured

Usually group cover is set by the company, and a set sum insured is fixed per employee family. This is usually not very high, and is often around the 3-5 lakh range, sometimes at 10 lakh for established, larger firms. However, this is often not enough, especially if you have your parents, spouse and children covered. This is usually solved by taking a super-top up policy.

Duration of Policy

Group Mediclaim policy only covers an employee as long as he/she is employed with the company. Once an employee leaves, health insurance is no longer offered.It is also possible, while switching employers, that the new company doesn't have the same benefits that the old firm did.

What to have in a Group Mediclaim Policy

In a nutshell, a group health plan should offer the following benefits as a minimum:

  1. The plan should pay a substantial part of the claim with a reasonable out of pocket expenses in the form of deductible excess and minimum or no co-pay. A co-payment of 20% or more reduces the benefits to employees and should be avoided.

  2. Coverage of all major costs including reasonable doctor’s fees, bed-charges, consumable costs, OT costs, surgery related expenses, etc.

  3. Coverage of day-care procedures that usually mean less than 24-hours hospitalization.

  4. Coverage of pre- and post-hospitalization costs and cashless facility for settlement of bills.

  5. Reasonable sub-limits that do not restrict amount per claim, amount per day, room rent limits, etc.

Perilwise offers real time customization and price estimates online, which allows you to select your Group Mediclaim Benefits while keeping track of how much it impacts your budget. Get a quote now!