Group Health Insurance

Also known as Mediclaim, or Group Mediclaim insurance, this policy provides health insurance to your employees. As an employer, ensuring the well-being of your employees is not just a responsibility but important for the success of the business.

Group medical covers provide monetary support for your employees if there is a crisis without putting a financial burden on the business.

Group medical insurance offers benefits more than many individual health insurance plans, including covers for pre-existing conditions, cover for an employee's family, reimbursements for day care procedures and maternity expenses, cashless facility, policy 'carry forward' facility (allows employees to convert their group policy to an individual personal cover when they retire or move to another company) and no age restrictions.

A Group Mediclaim product is known by multiple terms such as Group Health insurance policy or employee Mediclaim insurance and offers many benefits greater than the standard health policy.

Benefits of group medical insurance

  • Hospitalisation: In-patient treatment including room rent, ICU, nursing, medicines drugs & consumables is covered without any sub-limits, under an employee Mediclaim policy.
  • Ambulance charges: usually offered up to INR 1000/2000. Ambulance must be provided by a registered service.
  • Pre and Post Hospitalization medical expenses: Medical expenses incurred up to 30 days immediately before hospitalization and up to 60 days immediately post hospitalization. This can be increased, depending on the group health insurance policy.
  • Day Care Procedures: Most employee mediclaim policies cover medical expenses for multiple day care treatments which are procedures that do not require 24 hours hospitalization.
  • Maternity Benefit: Applicable for the first 2 children only. Both normal and caesarean delivery is covered for INR 50000. This limit will also apply for pre and post natal cover.
    • No 9 month waiting period (opted for)
    • Baby covered from day 1 (opted for)
  • Domiciliary Treatment: A group health insurance policy covers the medical expenses incurred for availing medical treatment at home on the advice of the attending Medical Practitioner which would otherwise have required Hospitalisation.
  • Organ Donor: most group medical insurance policies cover Medical Expenses on harvesting the organ from the donor for organ transplantation.
  • Dental Treatment (in case of Accident): Insurer will reimburse Medical Expenses of any necessary dental treatment from a Dentist provided that the Dental treatment is required because of an Accident. Maximum liability shall be limited to the amount specified in the Schedule of Benefits.
  • Room rent: Group health insurance policies generally have varying room rent limits; some insurers limit it to 1% of the sum insured(2% for ICU) and other generally allow any single standard A/C room. Suite rooms are usually not allowed. Claim charges that vary with room rent will be paid on a proportionate basis if room rent charged is higher than allowed. This means it is important to choose room rent limit carefully.
  • Specific OPD treatment: The OPD benefits vary the most amongst health insurance companies for various employee medical insurance policies. Out Patient Treatments are either covered at a high co-pay % or with a loading of more than 100%.
  • Portability: A few health insurance companies allow Group health policy to retail health insurance portability benefit at the time of retirement or resignation from the services (provided these events are falling within the policy period).
    • Standard coverage’s, terms, conditions, & guidelines of retail product would apply
  • Family: Family Definition is Employee + Spouse + 2 Dependent Children + 2 Dependent Parents/In-Laws. Only 1 set of Parents or Parents-in-law will be allowed to be covered. Mid-term change of dependents is not allowed. This means that in any group health policy, existing employees cannot add dependents to a policy mid-year, unless they get married or have a child.
  • Waiting periods: The biggest benefit of all group health policies is that there are no waiting periods, unlike in individual covers. In a group cover, there are no waiting periods for
    • Pre-existing conditions: individual policies have a waiting period of 4 years before pre-existing conditions are covered. You must be covered under a policy for 4 years continuously before this takes effect. Group health insurance has no waiting periods.
    • Specific illnesses: Individual policies have a list of specific illnesses which are only covered after a 2 year wait period. This includes cataract, gastro-intestinal issues, hernia, kidney problems, etc. Group Mediclaim policies have no waiting period.
    • 30 day waiting period: Individual policy cover kicks in 30 days after issuance (except for accident related hospitalisation). Employee Mediclaim insurance has no waiting period.

There are also other benefits available in a group health insurance plan, such as hospitalisation cash allowance, critical illness benefit, and other, specific OPD covers like lasik, dental, etc.

Terms & Conditions

Beneficiary name for issue of claim cheques will be assumed as name of the corporate unless otherwise specified.

  • Any additions for new employee, spouse / children would be allowed within 45 days of date of joining, marriage / birth respectively.
  • Additional premium for each additional member will be communicated, through the Perilwise policy manager dashboard.
  • Per person premium would be provided by insurer once the quote is finalized.
  • No Individual (Employee / Dependent) can be covered more than once in a policy.
  • The list of members submitted at the inception of the policy will be considered as final.
  • Claims servicing and processing will be done by a third party administrator
  • Exclusions will be as per your insurer’s Group Health policy wording.

Claims, Additions, Deletions and other endorsements

  • Perilwise provides you with a policy manager dashboard, that allows you to dynamically manage additions, deletions, claims and other endorsements at the touch of a button. This suite allows a company to manage all their insurance policies, from one suite.
  • Intimation within 8 Hrs will be required in case of emergency hospitalizations post admission; and all reimbursement claims have to be submitted within 7 days of discharge.
  • Adding an employee will require additional premium.
  • Departing employees will fetch you a pro-rata refund, if they haven’t made a claim.

With Perilwise you can now get group health insurance online! Our group health premium calculator allows you to enter simple details like number of employees, dependents you want to cover, etc. and allows you to customise all your benefits, to make sure you can choose benefits that you want and also make sure your budget isn’t exceeded!

Perilwise allows you to customise your group health cover benefits online and view tentative premiums as you do. This allows you to tailor make the best cover within your budget and allows us to figure out which insurer to go to a lot faster, thereby closing the entire deal in 70% faster than a traditional agent or broker! Get your estimate now!



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