Group Health Insurance

• Enjoy options to cover yourself, your spouse, kids and even your parents
• Enjoy access to 10,000+ hospitals for cashless treatment
• Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

A group health insurance plan is one which offers health insurance coverage for a group of individuals. All the individuals of the policy will be able to avail a common set of benefits.

Group health insurance policies are most commonly purchased by employers for their employees. However, the IRDAI has provided a set of guidelines which allows certain defined groups such as savings bank account holders, credit card holders, or cultural associations to purchase group health insurance plans. Health insurance companies may allow the beneficiaries to cover their spouse, dependent children and dependent parents under the same policy at an additional premium amount.

How is group health insurance different from individual health insurance?

First and foremost, individual health insurance plans and group health insurance plans differ in terms of the number of individuals that can avail benefits under a single policy. While individual policies cover only one person, group policies can cover a group of people up to a maximum number as mentioned by the insurance company.

An individual’s health condition affects the coverage and the premium payable of an individual health insurance plan. If he/she is found to have deteriorating health or is a smoker, the coverage and premium amount will be tweaked accordingly by the insurer. In case of group plans, on the other, the medical conditions of the beneficiaries have no effect on the coverage or premium.

However, individual plans offer wider coverage, higher sum insured, and the option to customise the plans. The same facilities are not usually offered under group plans.

Lastly, a member of the group health insurance policy can avail coverage from the very start of the policy term. The same might not be in the case of individual policies that have waiting periods for specific health conditions.

What are the benefits under group health insurance?

The coverage under a group health insurance policy is shared among the members of the group up to the maximum sum assured amount chosen by the master policyholder.

Beneficiaries of group health insurance plans usually have access to the below-mentioned benefits:

• Hospitalisation expenses
• Pre and post-hospitalisation expenses
• Day care treatments
• Chronic illnesses
• Pre-existing diseases
• Emergency ambulance charges
• Maternity expenses, under certain insurers
• Personal room rental, under certain insurers

How does a group health insurance policy work?

A group health insurance policy is typically issued in the name of the association or the employer who is handling the policy, as the master policyholder. The members can continue availing the benefits under the health insurance policy but he/she will have to ensure that the premiums are paid regularly pand he/she is an employee/member of the association.

The inclusions, exclusions, and features of the plans differ based on the insurance companies. In case of non-employer-employee groups, the members are required to be provided with a certificate of insurance.

According to the IRDAI, all members of the policy need to be informed of the benefits available, the premiums payable, and the terms and conditions of the policy.

Customisation of policies is possible under certain health insurance providers. However, only the master policyholder usually decides the details based on the requirements of his/her group members.

What are the advantages of group health insurance?

• No medical check-up: There is no need for any member of the policy to undergo a health checkup to enroll oneself to the policy.
• No waiting period: Group plans do not have waiting periods and members can make claims under the policy for any of the illnesses covered.
• Low premium: Group health insurance plans are much cheaper than individual health insurance plans. However, in most cases, the sum insured amount is also low in case of group plans.

What are the disadvantages of group health insurance?

• No coverage on exiting group: Once the beneficiary exits the group, he/she cannot avail coverage and will have to purchase a separate plan for health insurance coverage.
• No Claim Bonus unavailable: Health insurance companies offer a No Claim Bonus in the form of an increase in sum insured or discount on premium if the insured does not make any claim in a year. However, no such bonus will be made available under a group health insurance plan.

While group health insurance policies offer good coverage, it is always best for one to get a separate health insurance policy as well. This way, he/she will stay covered even after exiting the group. Moreover, an individual cover will be useful if the individual is hospitalised for a major illness.