The Quick Guide to Group Health Insurance
Think about when people face health emergencies—it can drain their savings and cause stress. Recent events like the COVID-19 pandemic have shown us how important it is to have health insurance. But here’s the thing: In India, around 30% of people don’t have any health insurance. Why? It’s because it can be expensive, and the rules are often tricky.
That’s where group health insurance in employee-friendly companies comes in as a smart choice. When a company cares about its employees’ well-being as much as its goals, it makes for healthier and happier teams. It also sets a good example for leaders. When your team knows you value their health, they’re more likely to care for themselves and do their best at work.
And the cool thing about group health insurance? It not only helps your team but also shows that your company cares about people and understands their needs.
What Is Group Health Insurance?
It is a healthcare policy that benefits a group of people, typically employees of a company or members of an organisation. Employers often offer this type of insurance as part of an employee benefits package. Additionally, medical coverage is given to a large number of individuals under a single policy.
Group health insurance plans tend to be cheaper for policyholders than other forms of private insurance. This type of plan typically offers comprehensive group medical coverage, including medical procedures, preventive care, maternity benefits, prescription drugs, and other healthcare facilities.
At iCare Insurance, we offer group health insurance plans for employees with additional perks such as health education and wellness programs.
Why Invest In Group Health Insurance?
Group health insurance is a great option for employees and employers. With iCare Group Insurance Mediclaim, everyone gets equal access to good quality healthcare without worrying about increasing medical prices.
For Employers
- Attract Top Talent
Employees are less likely to bid goodbye to an organisation when they experience happiness and satisfaction within a culture focused on people-centric policies. Providing health insurance as an employee benefit shows your concern for their well-being and cultivates a positive perception of your company.
- Tax Benefits And Value For Money
Employers receive tax benefits for providing group health insurance. Premiums paid by the employer are usually tax-deductible as a business expense.
- Boost Focus And Job Satisfaction
Offering health insurance demonstrates a commitment to employees’ well-being. Healthy employees showcase more productivity and can contribute positively to the company’s overall performance.
For Employees
- Easy And Smooth Claims
Employees don’t have to worry about tedious settlements. They can simply direct their hospital bills through the employer for easy and hassle-free reimbursement.
- Zero Cost Family Coverage
With a group insurance policy, employees have the benefit of adding their family members, including their parents, to the plan. All these benefits are available at zero cost. This, in turn, boosts the company’s goodwill.
Features Of Group Health Insurance Plans
Below, we have enlisted a few key features of a group health insurance plan:
- Medical Coverage Group health insurance plans offer a comprehensive coverage for all medical expenses, including hospitalisation, hospital visits, and other essential treatments.
- Cashless Process This type of plan comes with a cashless process. It enables the insured to be treated at any network hospital without upfront payment. This feature extremely benefits employees as it helps them get medical treatment without financial burden.
- Pre And Post-Hospitalisation Several medical expenses are incurred before hospitalisation and post-discharge. All these expenses are covered under a group health insurance plan.
- Network Of Healthcare Professionals You can access a network of healthcare providers with potential cost savings or full coverage when using in-network services.
How Do You Claim Your Insurance?
Below are the steps to understand how a group insurance plan works and how to obtain it:
- Selecting The Insurance Policy
Check all the details of the insurance policy you select for the employees. Understand what benefits are being offered, including medical benefits, preventive care, maternity benefits, and other crucial health treatments.
- Payments Of Premium
The employer or organisation pays for the group member’s health insurance. Generally, after a year, the employer reviews the group health insurance policy terms and may negotiate renewal terms with the insurance provider.
- Cost-Sharing
Employers and employees may agree on a cost-sharing arrangement where both parties contribute to the overall cost of the insurance. The employer typically covers a significant portion of the premium, while employees may contribute through payroll deductions.
- Access To Medical Benefits
Once enrolled, you enjoy multiple benefits outlined in your group insurance plan. It may include routine medical check-ups, preventive care, prescription medications, and other covered services.
- Filing Claims
Group members request reimbursement by submitting a claim by notifying the insurance company. You are also required to submit the necessary documents and complete claim forms.
- Cashless Claim Settlements
Once your claim is approved, you get access to medical treatments without any upfront cash payments, where the insurer makes the payment directly to the healthcare provider.
Documents Required To Obtain Group Health Insurance
Below, we have mentioned the list of documents you need to file for reimbursement of health insurance claims.
- Original claim form duly completed with your signature.
- Valid identity proof like an Aadhaar Card, Voter ID, PAN card, and more.
- Doctor’s prescription suggesting medical treatment
- Doctor’s prescription advising medicines or consultation
- Original pharmacy bills
- Policy details include the policy number, name of the insured, address, and disease for which treatment is undergoing.
Types Of Group Health Insurance Plans In India
Further, we have highlighted the different types of group health insurance plans that can be selected based on the needs and preferences of the employer and organisation.
1. Group Health Insurance
A Group Health Insurance Policy or Group Mediclaim Policy allows an employer to offer health insurance coverage for employees. It is one of the most common benefits provided to an employee by an employer. There are also cases where a group health insurance plan includes family members or dependents of the employee.
2. Group Personal Accident Insurance
Just like an individual Personal Accident Insurance, this insurance also enables the employer or an association to provide coverage to the employees or members in the event of an accident causing disablement or death of the insured.
3. Group Pension/Superannuation Insurance
This is a type of plan which caters to the retirement needs of an employee. The employees offer group pension insurance. It is a great alternative to other retirement plans, such as the Employee Provident Fund (EPF) and the National Pension System (NPS).
4. Group Term Life Insurance
This type of insurance is provided to an employer by an employee. It provides coverage to the employees in the case of death.
5. Group Travel Insurance
Group travel insurance is another type that combines accident, health, and liability insurance. Under this insurance plan, a group of travellers are covered against the risk of loss of luggage, accidents, third-party liabilities, and more. This is wider than just a group of people travelling together. Employers can opt for this for employees who travel several times a year.
6. Workmen’s Compensation Insurance
This insurance plan is offered by employers to workers under the Employee Compensation Act. It encompasses the legal responsibilities of an employer in the event of an employee’s death or injury resulting from a workplace accident. Workmen’s compensation insurance aims to provide financial assistance to workers engaged in contractual or seasonal work, acknowledging the risks associated with their profession.
Steps To Claim Settlement In Group Health Insurance
The procedure for settlement of claims in a group health insurance involves the following steps:
- Search for a network hospital nearby and get the treatment done.
- Inform your insurer about the medical emergency within 24 hours of admission to the hospital.
- Fill in the claim form and submit all the documents required.
- The hospital will send the claim form to the insurance company for the claim settlement.
- The insurance company will send a team who will look into the details provided by the insured. Then, the insurer will inform us of the approval or rejection of the claim.
- Once the claim gets approved, the insurer pays the hospital on behalf of the insured.
- If the claim gets rejected, the insured needs to pay it.
Reasons Behind Rejection Of Group Health Insurance
Now that we have looked into the steps to claim settlement let’s also shed light on the reasons for the rejection of the group health insurance if it occurs:
- If the insurance company detects fraud activity.
- If the claim raised by an insured is an exclusion to the policy.
- If the insurance policy expires.
A group health insurance plan is a strategic move for employers looking to enhance the well-being of their employees during health emergencies. It is also a great step to foster a workplace culture that values the individuals contributing to organisational success.
For organisations seeking a reliable partner to provide comprehensive group health insurance, iCare stands out as a trusted service provider. iCare is committed to simplifying the complexities associated with health insurance, making it accessible and beneficial for employers and employees.
FAQs
1. What is group health insurance?
It is a type of insurance plan that covers a group of people under the same plan. It also provides coverage to the family or dependents of the member, such as a spouse, kids, etc.
2. What are the advantages of group health insurance?
Group health insurance is the best way to attract and keep good employees by offering them a valuable benefit.
3. What are the various types of group health insurance plans in India?
Some common types of group health insurance plans include term life cover, group personal accident insurance, group pension, group travel insurance, and more.
4. What are the documents required for claim settlement in a group insurance plan?
Some important documents needed for the claim settlement include an original claim form, valid identity proof, medical records from hospitals, policy details, and more.
