What is Group Health Insurance Policy?

Introduction to group health policy definition in India and basic features


Group health insurance is a health insurance policy for a group of people. It is more often purchased by a corporate or an employer to provide health insurance coverage to their employee base. A single insurance cover is used to include the targeted base of employees, to incentivise the best talent, for example. Only in some cases, as it is not necessary, will the group medical policy buyer provide cover to the family members of the designated employees.

Who is Eligible for Coverage?

Individuals benefitting from the group health insurance policy must be in an employee-employer relationship. An employer will buy the policy on the employees’ behalf, as he chooses it to be.

However, the group health insurance policy coverage can be deliberated to include non-employer-employee groups as well. In this case, the group can be of specified interest like same credit card holders, saving bank holders, or members belonging to a common social association. In short, they should together seek to cover a potential risk. Such a policy cover is also subject to IRDA guidelines, monitoring and regulations.

Coverage of the Group Health Insurance Policy

Even though each individual is not covered separately under the group policy, and they have to abide by the general terms and conditions (fixed by the employer at the time of buying the policy), the employer in most cases, ensures that a comprehensive healthcare cover is provided to the select base of employees.

As it happens, all employees are given an equal coverage status under the group health insurance policy cover. By default, all employees are covered without any further medical reference checks. So, if an A employee has a pre-existing disease and a B employee is a healthy individual, he/she will be given equal coverage under the group health insurance policy scheme. This feature of group policy is completely different from an individual health insurance policy cover.

Both have their merits and demerits. Like in case of group policy, an individual may not have to pay the premium instalment for the health coverage and can even file the claim within 30 days of incurring the expense. An individual policyholder, on the other hand, can make an instant claim only in case of medical emergencies and has to bear the total premium cost.

Common Features of Group Health Insurance  Policies

The various group health insurance policies have some common features and this includes:

  • The insurance facility is cashless
  • The insurance policy covers pre-and post-hospitalisation expenses incurred under a specified period
  • Some policies also offer Maternity Benefit
  • The cost incurred towards 24-hours hospitalisation for certain procedures like chemotherapy, eye surgery, and listed hospital visits
  • Your policy may offer an extended coverage to include critical ailments. This is over and above the standard hospitalisation expenses
  • The group health policy cover can be extended to cover the employer or group administrator as well, with an extra premium payment

Group health insurance policy is an affordable option in many ways. To put the employee queries and doubts to rest, the insurers will usually assign a relationship manager.

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1 Comment

  1. Varun Vijay says

    Great Insight !! Thanks for sharing .

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