Home / Group Health Insurance: Group Mediclaim Policy for Employees
Group Health Insurance is an insurance policy that offers coverage to multiple people working for the same company. A Group Plan or Group Medical Coverage (GMC) is usually sponsored by the employer as a benefit for the employees. This benefit of having health insurance coverage invokes a sense of financial security in case an employee needs medical attention.
Different members of the family like the employee’s spouse, dependent children, and parents/parents-in-law can be insured under the Group Medical Cover. It is also known as Employee Health Insurance, Employer Group Health Insurance, Group Medical Coverage (GMC), or Group Mediclaim Policy.
After the COVID-19 pandemic, the Indian Ministry of Home Affairs has mandated all industrial and commercial establishments, workplaces and offices to provide group medical insurance coverage to their employees. This is as per the order issued by IRDAI.
Providing an employee with the required medical coverage invokes a sense of financial safety during a medical emergency. Employees consider this one of the on-job advantages of working for a particular company.
Here are the reasons employers must choose an ACKO Group Health Insurance Policy for the employees. As our policy is customisable by the employer, the exact plans, features, services, etc., can be decided at the time of policy purchase or renewal.
Administration of Group Medical Coverage for employees can be a hassle. Some employees leave, new ones get on board, and the list of their dependents can also change.
ACKO Group Health Insurance Policy seamlessly integrates with popular HRMS solutions to provide easy policy administration. From enrollment to claims — everything is handled from our app.
ACKO has a tie-up with more than 7000 hospitals PAN India. This enables cashless claim settlement where employees don't have to worry about arranging treatment funds. Because we will settle a major part of the bill directly with the hospital.
Employees can simply show their ACKO Health Card to the TPA (Third Party Administrator) at the hospital's front desk and get started with treatment covered under their Group Mediclaim Policy. The significant advantage is, we will settle the bill directly with the hospital, and employees just have to pay the applicable deductible.
Studies suggest that very few employees raise a claim against their Group Health Plan. While we take every measure to give the best claim experience to these employees, we have added a host of benefits for those who may not raise claims. Employees get access to high-quality primary care and wellness initiatives like Outpatient Department (OPD), free doctor teleconsultations, discounted pharmacy & diagnostic lab tests, fitness challenges, and more under the Group Medical Insurance for employees.
Unlike a regular health insurance plan where a person must wait for a fixed time to avail of coverage, under the Group Health Plan, your employees get coverage from day 01. This includes maternity benefits and pre-existing diseases.
Usually, if a higher number of employees claim insurance, the premium for employers goes up next year. Using machine learning, ACKO keeps nudging employees towards preventive care to help them stay healthy. It is better for the health of the employees, and it saves employers extra premium expenses during Group Mediclaim Policy renewals.
No two employees are the same. Their health insurance should not be the same either. With ACKO, employers can give their employees the freedom to customise their Group Mediclaim Policy’s benefits and coverage. While employers take care of the essentials, the employees can choose to pay for added benefits.
Nobody likes to push papers from one team to another. So, we have digitised our claims process entirely. For raising a Group Mediclaim Policy claim, the employees just need to upload the required documents on the app, and we'll take it from there. They can track their claim status on the app, and there will be no need to submit any physical papers.
Group Mediclaim Policy enrolment, policy customisation, end-to-end claims processing, OPD benefits, doctor consultations, diagnostic tests, fitness tracker, and digital health cards are available on the ACKO app.
Following are the key features of ACKO Group Health Insurance Policy. Note that these features are indicative as they can differ based on the customisation chosen by the employer while deciding the scope of insurance for company employees.
|Key Features||ACKO GMC Advantage|
|Waiting period||No waiting period, coverage starts from day 01|
|In-patient hospitalisation||Covered up to the sum insured|
|Maternity benefit||Normal and c-section deliveries covered|
|Pre-post natal care||Covered up to 10% of Maternity Limit|
|Pre-hospitalisation||Covered for 30 days before planned hospitalisation|
|Post-hospitalisation||Covered for 60 days after planned hospitalisation|
|New born baby||Covered from day 1|
|Day care procedures||Covered|
|AYUSH Treatment||AYUSH treatment is covered up to 25% of sum insured in a govt. recognized hospital|
|Ambulance Charges||Covered up to Rs. 2,000, per person per incident|
|Insured members||Self + Spouse + 2 Dependent Children + parents/parents-in-law|
|Coverage for disabled children||Covered without any age limit in the policy|
|Multiple births||For 1st or 2nd delivery with twins/ triplets, coverage for third & fourth child in the policy|
|Injuries from act of terrorism||Covered as per terms and conditions|
|Treatment for coronavirus||Covered|
|Nominee||Covered under the plan|
The benefits of group health insurance for employees refer to additional features of the policy. These provide value-added services and are over and above the basic health insurance coverage offered by the plan.
Connect with Google Fit/Apple HealthKit and track fitness activities on the mobile app.
Complete fitness challenges to get ACKO Coins. Redeem these Coins against curated rewards.
Plan a diet chart by consulting a nutritionist right from the app.
Never let a medical question go unanswered. Get unlimited free consultations with specialist doctors.
Get exclusive discounts on pharmacy when ordering prescribed medicines.
Book diagnostic lab tests from anywhere simply by logging in to the app.
These features are usually not available under Group Mediclaim Policy for employees. However, with ACKO, the employees get access to benefits at the time of policy activation.
A comprehensive list of medical insurance benefits for employees is mentioned in the ‘Why choose ACKO Group Health Insurance Policy for employees’ section on this page. But wait! There are more benefits. Read on.
As per the provisions of The Income Tax Act, employers are eligible for tax benefits if they provide health insurance to their employees. The exact amount of tax benefit will depend upon the premium paid for each employee.
As mentioned earlier, employees value a company that cares for them. Providing a medical insurance plan for the employees (and dependents) can help them financially during a medical emergency.
As we are a digital-first organisation, we can offer low-cost Group Health Insurance plans. We have successfully embedded technology in our various departments, which has reduced our operational costs. Thus, we can pass on the benefit to employers in the form of lower premiums.
The following conditions are covered under our Group Medical Coverage. Note that a full set of inclusions is available in the policy wordings of the plan. Going through the policy wordings is essential to understand the entire scope of health insurance for company employees.
✅ In-patient hospitalisation : This coverage refers to the costs incurred while an insured person is admitted to the hospital for treatment. To raise a claim, the insured must be admitted for in-patient hospitalisations for at least 24 hours.
✅ Worldwide hospitalisation: The coverages of our Group Health Insurance Policy are not limited to the boundaries of India. The insured person can be hospitalised outside the country, and we will bear the hospital bill per the policy's terms.
✅ Daily hospital cash benefit: The insured members of the family members can use the additional money provided under this benefit of the Group Mediclaim Policy to buy food, medicines, or to travel as they deem fit.
✅ Day Care treatment cover: Medical procedures that do not require 24-hour hospitalisation come under Day Care treatment. Employees can claim for such treatments under the health plan. Examples of these treatments include cataract surgery, tonsillitis surgery, etc.
✅ Road Ambulance: The insured can claim the cost of a road ambulance to travel to the hospital or from the hospital to the place of residence under this cover. Each insured member is entitled to Rs. 2,000 for one event.
✅ Compassionate visit: We will bear the cost of transporting the immediate family member from India to the place where the insured person is hospitalised under our employee health insurance plans.
✅ Loss of pay due to hospitalisation: Under this plan, employees can claim a specified amount of money for a fixed number of months in case of loss of pay due to hospitalisation.
✅ EMI Protection: If an employee suffers from an illness and is unable to pay the EMI against a loan, then they can claim the amount under their Group Medical Coverage. The number of months for which we will pay the EMI on an employee’s behalf will be as per the terms and conditions of the plan.
✅ Maternity: The costs related to childbirth are covered as per terms of the Employee Group Health Insurance Policy.
✅ Donor expenses: Employees can raise a claim against their Group Health Plan for the cost of hospitalisation from donating an organ.
✅ Covid-19: Expenses related to treating COVID-19 can also be covered under this policy based on the applicable terms and conditions.
Inclusions are things policyholders can raise a claim for. On the other hand, exclusions are situations when they cannot raise a claim. Here are some standard exclusions of Group Health Insurance plans for reference.
❌Undisclosed pre-existing diseases
❌Stem cell therapy
❌Dental treatments (unless recommended due to an accident)
❌Birth control procedures
❌Treatment for correcting vision other than for focal error of +/- 7 or prescribed as medically necessary
❌Psychiatric or psychological examinations or testing
❌Cost of hearing aids
❌Treatment of Sleep Apnea Syndrome (C.P.A.P.)
❌Treatment from an unauthorised medical practitioner
❌Cost of treatment after a suicide attempt
❌The cost of availing of treatment in a rehabilitation centre cannot be claimed against the Group Health Insurance Policy
❌Treatment for injuries due to taking part in a criminal activity
Listed below are two ways to buy a Group Health Plan from ACKO.
Here’s a step-wise process explaining how to buy a Group Health Plan from us.
Step 1: Visit our Group Health Insurance for Employees page.
Step 2: Click on Schedule a Demo.
Step 3: Follow the process
If you want to follow the good old method of contacting us, please write to us at [email protected] stating your interest to buy a Group Health Plan from us. Our team mates will get in touch with you and take things ahead.
Here’s how you can renew Group Health Insurance online with ACKO.
Usually, our sales executives/account manager will get in touch with you (company admin or Human Resources Manager) before policy expiry to renew a Group Health Insurance plan online.
In case you want to reach out to us, please send an email at [email protected]
Following is the step by step claim process for employees that have ACKO Group Health Insurance Policy.
Use the registered mobile number to log in to the ACKO account and click on 'Corporate Health Policy'.
Click on 'Claims' and select 'Register a Claim'. This will help raise a claim against the Group Health Plan.
Enter all necessary details and submit soft copies of the documents. Finally, submit the claim.
Our claims executive will place a call to the employee if any more details or documents are required to process the claim smoothly.
An employee can raise a cashless claim by getting admitted in a network hospital and informing us about the same. We will need details like policy number and details of the hospitalised insured member. Then raise a claim through the app using the steps mentioned above.
If an employee opts for a reimbursement claim, they must inform the insurance company as soon as possible. There are chances that the claim might get rejected if the treatment is not pre-approved by the insurance company.
After discharge from the hospital, employees need to pay the bill and raise a claim through our app. The employee must divulge all necessary details in this step. We will review their claim and begin the settlement process
The following documents are required to claim under a Group Health Insurance Plan. Note that we don't need any physical copies of the documents. Only upload digital copies of documents and provide details while raising a claim.
This can be a set of multiple bills and receipts paid for different services or equipment through the course of hospitalisation.
The attending doctor is usually responsible for creating a discharge summary. The doctor will list things like treatment details, post-hospitalisation care, health status at the time of discharge, etc.
This is important in case of a reimbursement claim under a Group Health Insurance Plan. Here the policyholder will clear all the pending dues and then raise a claim against their health plan.
Identification details of the patient and their relationship with the employee is required to process a claim.
The number of days a patient is hospitalised will help determine many things (like pre and post-hospitalisation, room rent, non-payable medical expenses, etc.) related to a claim.
The claim amount under a Group Health Insurance Plan can be the total (approved) medical expenses made by an employee.
The list given above is only indicative. The exact set of required documents depends upon the nature of the claim and the extent of the illness.
A health card is an identification card that contains details about the insurance policy and the insured member. It is similar to any other ID card anyone might be familiar with. Nowadays, insurers provide a digital version of health cards. This allows a person to download his/her health card and use it for cashless claim settlement.
To use the health card, simply provide policy details and the card itself to the TPA (Third Party Administrator) located at the hospital. The TPA will help in intimating the insurance company and raise a claim.
To download a health card, employees need to access their Group Health Insurance Policy. For example, employees covered under our Group Health Plan can access their health card via our app. Alternatively, they can run a quick search through their official email inbox. They will find an email with health cards in the attachments.
It is easy to choose the best Group Health Insurance Policy in India, if the company knows its employees' requirements. This will help in availing of useful coverages at a lower premium. Here are some tips that can help employers get the best health plan for their employees.
The best Group Health Insurance in India would be the one that caters to all types of employees in the organisation. This is because not all the employees will raise claims or make use of the group policy. Such employees can benefit from other features such as fitness tracking, discounts on lab tests, etc.
The insurance company must have a large network of hospitals where employees can avail of cashless claims. A network hospital nearby helps in starting treatment faster. This is helpful in case of medical emergencies.
This is true for buying any health insurance plan, be it a Group Health Insurance Plan or personal health plan. One way to find a feature-rich plan that costs less is to compare multiple options. Check features and quotes from a couple of insurance companies and compare them. Select the one that best suits employees' requirements.
The post-sales services of the insurance company must be up to the mark. This will reduce the hassle for employees during a medical emergency.
Traditional health insurance companies are known to involve cumbersome paperwork. It often leads to a lot of unnecessary back and forth, which eventually delays insurance-related processes.
A digital-first insurance company with a paperless process is ideal. Since employees can upload documents online, communication is faster if the insurer needs more details or documents related to a claim.
The insurance company must offer services like 24x7 customer care, a fast turnaround time for claim settlement, etc. If the claim settlement process is smooth and without multiple follow-ups, employees will spend less time worrying about their claims.
Even though employers provide a financial backup in the form of a Group Health Insurance Plan, employees' health must be looked after. Choose an insurance company that nudges employees to take proactive measures by incentivising fitness activities to maintain good health.
Employees might need to update their dependents. This can happen in case of death or childbirth. Insurers must provide an easy interface to update such changes.
Claims are one of the most essential parts of providing the employees with a health insurance policy. To ensure a smooth claims experience, it will be helpful if an employee is able to track an active claim. They should be able to understand the status of their claim, the documents required for further processing, and the time required for claim settlement, etc.
A Group Health Insurance Plan can have limitations due to its type; it covers numerous employees with different requirements. The best plan an employer can choose is the one that meets most of the requirements. However, this may not be possible in all situations. Thus, employees must be given an option to increase the sum insured through top-ups. Employees can choose to do so by paying an additional premium from their pockets.
When you (as an employer or HR representative) compare Group Health Insurance Plans, make sure to check if the following features are available.
Every company wants to lower the expense. Going for lower premiums is like second nature. But you should keep an eye on the benefits as well. A marginal increase in premium can often turn a 'good' policy into a 'great' policy regarding benefits. A policy with poor coverage might make your employees suffer later.
ACKO Advantage: Being a digital-first insurer allows us to provide low-cost Group Health Insurance Plans.
It's the hard truth that most employees don't even remember which insurance company they are covered by because they never use the benefits outside of hospitalisation claims.
ACKO Advantage: We offer a one-stop solution via our Group Health Insurance Plans.
The most important thing to check is how easy it is for your employees to register and track their claims. Everything else is an additional benefit. We have digitised and simplified the entire claims process.
ACKO Advantage: Your employees can raise health insurance claims without submitting physical paperwork. All we need for claims for Group Health Insurance Plans are details and soft copies of the required documents.
A higher Claim Settlement Ratio (CSR) indicates that the chances of claim approval are higher. However, a CSR can decrease due to several valid reasons like fraudulent claims, claims against exclusions, or raising a claim during the specified waiting period. So, while CSR is one of the key metrics for finding a reliable insurer, it must not be the sole reason to choose that particular health insurance company.
ACKO Advantage: We offer continuous support to you and employees covered under Group Health Insurance Plans for a hassle-free experience.
It would help if you compared the network of hospitals and clinics that the insurance company empanels to ensure your employees get access to good healthcare services, no matter where they are.
ACKO Advantage: We have over 7000 network hospitals across the country, where employees covered under Group Health Insurance Plans can avail of cashless claim facilities.
Look for a policy that appeals to all of your employees. Check how easy it is for the employees to use those extra benefits.
ACKO Advantage: Our Group Health Plan provides additional wellness and preventive care benefits through the app.
Understanding how medical insurance plans work in India is quite simple. Before 2020, health insurance for employees was mostly a value-added benefit offered by people-first organisations to provide affordable healthcare to employees and their families. However, in 2020, the IRDAI has mandated organisations to offer medical insurance for their employees.
In India, employers have maximum control over the Group Health Plan they provide. They may sometimes allow employees to choose top-ups or add-ons at an additional cost. However, the employer bears the premium for buying a Group Medical Insurance plan.
We think about the health insurance needs of all your employees (even those who don't require a financial backup for medical treatments) while offering Group Medical Insurance. We have simplified the claim process for those who raise claims. Those who don't can use other benefits like fitness tracking, reward-based challenges, etc.
IRDAI rules for Group Health Insurance are specific guidelines that the insurance company and the policyholder must abide by. The Insurance Regulatory and Development Authority of India (IRDAI) is the regulator of the insurance industry/sector in the country. The regulatory body forms rules and regulations on all types of insurance policies being sold in India.
The master policy will bear the group or organisation’s name and be issued to the group’s manager.
A certificate of insurance is issued when the company is a part of the non-employer-employee group policy.
The certificate of insurance will contain the schedule of benefits, terms and conditions of the coverage and the premium charged.
The cover will cease once the employee leaves the group.
The group’s manager should disclose the premium charged by the insurer and the policy terms, including any discounts, which should be passed on to employees or members.
The group’s manager should disclose any administrative charges collected from employees or members over and above the premium rate charged by the insurer.
Apart from valuable benefits, the best Group Health Insurance plan should also provide excellent post-sales services such as servicing claims and swift settlement. The support team should also offer hassle-free and paperless transactions, making it easier for employees to provide insurance coverage for themselves and their families. Additionally, the insurance company should have a vast network of hospitals across the country to offer extensive coverage.
While shopping for a Group Mediclaim Policy for employees, an employer should focus on providing maximum coverage at a lower premium. Also, the insurance company should have the ability to service its employees during hospitalisation concerning claims, redressal of grievances and other related services.
While calculating the Group Health Insurance premium, we consider factors such as the age and number of employees, the location of the organisation, and the number of dependents of the employees. Previous claims history is also taken into account. However, these are just the primary factors ACKO will consider while calculating the premium. There are a lot more factors that go into pricing a policy.
All employees of the organisation can be covered under our employee mediclaim insurance policy. As an employer, you can define employees or workers eligible for the employer health insurance plan.
There's no lower or upper limit as such. Most insurance companies keep a lower limit of at least ten employees for group health coverage.
An employer health insurance plan is usually not costly for an employee as the premium is borne by the employer. An employee can be given an option to top up the sum insured or buy suitable add-ons. An employee will bear these additional expenses. Otherwise, employees don't have to pay for basic medical insurance coverage.
A health check-up refers to a complete health scan once a year. It helps to keep track of a person's current health status. Health check-ups are instrumental in detecting the early onset of a disease. This may help reduce the severity of an illness and provide a better chance of curing it.
The waiting period in Group Health Insurance refers to the time when the policyholder cannot raise a claim against the policy. Employees need to wait for a fixed amount of time before they are allowed coverage for a particular situation—for example, pre-existing illness or maternity benefits. The following are different types of the waiting periods in health plans.
Initial waiting period: Usually lasts 15 to 30 days from the first day of the policy period.
Pre-existing disease waiting period: Can last from 2 to 4 years after the policy starts.
Specific illness waiting period: An employee cannot raise a claim for a particular illness 2 to 4 years after the policy begins.
Maternity benefits: Usually lasts 9 months to 1 year after the policy start date.
Important note: The types of waiting period mentioned above DO NOT apply to ACKO Group Health Insurance Policy; all four conditions are covered from day 01 based on applicable policy wordings.
Yes, employees can have both employee medical insurance and Individual Health Plans. This will ensure that they have an adequate sum insured if an insured member suffers from a medical condition.
It is usually advised that an employee must opt for an Individual Plan or a Family-floater Health Insurance Plan and not rely solely on the employer health insurance plan.
Yes, hospitalisation and other benefits mentioned in terms of the plan are covered under Group Health Insurance.
Room rent capping in Group Health Insurance refers to the limit up to which an employee can opt for a particular hospital room. The insurance company will bear the room rent cost up to the specified limit. The employee must bear the rest. Note that opting for a room that costs higher than the allowed limit will affect the entire hospital bill. An employee must pay a percentage-wise hospital bill proportional to the additional room rent in this case.
Yes, vaccinations for an insured newborn baby are covered as per the terms and conditions under a Group Health Insurance policy.
Yes, commonly, a Group Health Plan is offered by an employer. The employees can create a solid health insurance portfolio by buying more coverage by purchasing plans like Individual Policy, Family-floater plan, or a Senior Citizen Insurance plan.
Apart from standard coverages under Group Health Insurance, employees can get the following coverages.
Rewards for completing challenges
Access to certified nutritionists
Option to order medicines through our app
Book lab tests
Generally, a major disadvantage of a Group Health Insurance Policy is that it ceases to exist once the employee leaves the employer. The arrangement is for insuring employees of a company; so, when a person is no longer an employee of the company, the policy does not cover the employee and their family members.
Having said that, such people can chart out an individual journey with the insurer offering such a Group Health Insurance Policy. They can seek coverage for themselves and their family by converting to a different health insurance policy and paying the associated premium.
Yes, senior citizens are covered under ACKO Group Health Insurance Policy. Employees' parents can be added to the health plan as dependents. The insured members have coverage for pre and post-hospitalisation, Day Care services, pre-existing diseases, etc. as per the applicable terms and conditions.
Disclaimer: Details such as the plans, services, features, processes, and other details mentioned on this page are subject to availability and changes. Please check the respective policy documents before making any insurance-related decisions. Feel free to reach out to us at [email protected] for any queries.
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