Team AckoMay 20, 2022
Certain health insurance policies can be a bit tricky to comprehend. This is often the case when it comes to Group Medical Coverage (GMC) and Group Personal Accident (GPA) policies. They are similar but not the same. Whether you are an employer looking to pick a suitable cover for your employees or an employee wanting to understand more about your employer-offered health insurance policy, the following sections will clear the fog and lend clarity. Read ahead to know the meaning and difference between GMC and GPA insurance policies.
Before understanding the key differences between GMC and GPA policies, it’s vital to know the meaning of both types of group health insurance plans.
Group Medical Coverage or GMC is a health insurance policy that insures a group of people (employees in Corporate Insurance) in case of hospitalisation due to medical issues.
Group Personal Accident or GPA is a health insurance policy that insures a group of people (employees in Corporate Insurance) in case of disability due to an accident (including death).
Here’s a table distinguishing GMC and GPA based on important parameters. Please note the exact details can vary from insurer to insurer and from policy to policy.
Difference Between GMC and GPA Insurance:
|Parameters||Group Medical Coverage||Group Personal Accident|
|Other names||This policy also goes by names such as Corporate Insurance, Employer-employee Insurance, and Employer-offered Insurance.||This policy also goes by names such as Personal Accident Cover for Employees and 24-hour Worldwide Accident Policy.|
|Scope||The scope of this policy is related to medical issues and emergencies faced by the covered employees. In most cases, pre-hospitalisation and post-hospitalisation expenses and daycare treatments are also covered.||The scope of this policy is related to accidents faced by the covered employees. Whether these accidents are covered only on duty or on duty + off duty depends upon the terms and conditions of the cover.|
|Coverage type||In most cases, GMC coverage is based on an indemnity basis. This means the covered employee’s expenses shall be settled based on the expenses incurred as long as they are under the sum insured limit. For example, if the policy’s sum insured is Rs. 5 lakhs and the hospital bill comes at Rs. 2 lakhs, the bill shall be covered entirely (as per policy terms) as it is under the sum insured limit.||In most cases, GPA coverage is based on a benefit basis. This means the covered employee shall be provided with a lump sum amount based on the nature of the injury as per the terms and conditions of the policy. For example, if the policy’s sum insured is Rs. 50 lakhs and the covered employee’s accident results in permanent total disability; then the employee shall receive 100% of the sum insured amount.|
|People covered||GMC covers the employee and, in some cases, dependent family members such as spouse, children, and parents.||Generally, only employees are covered in a GPA; the cover is not extended to include family members.|
|Coverage range||GMC has a wider coverage range compared to GPA. Also, GPA can be included in a GMC as an add-on cover.||GPA has a comparatively lower range as it covers only accident-related scenarios.|
|Customisation||Often, GMC can be customised by the employer. In some cases, such as ACKO Health, GMC can be customised by the covered employees as well.||Often, the coverage, services, and features are not customisable by the employer offering the policy or the insured employees.|
|Inclusions||The exact inclusions will depend upon the policy coverage, chosen add-ons, and the terms and conditions. Here’s a list of common inclusions related to a GMC. Hospitalisation expenses (pre, during, and post), Maternity cover, Day-care expenses, Out-patient Department (OPD) expenses (in-built or as add-on)||The exact inclusions will depend upon the policy coverage, chosen add-ons (if any), and the terms and conditions. Here’s a list of common inclusions related to a GPA. Accidental death, Permanent total disability, Permanent partial disability, Temporary total disability, Child education cover, Repatriation of mortal remains|
|Exclusions||Here’s a list of common policy exclusions of a GMC. The detailed list shall be mentioned in the Policy Wordings. Treatments not covered by the policy, Drug and alcohol abuse, Self-inflicted injuries||Here’s a list of common policy exclusions of a GPA policy. The detailed list shall be mentioned in the Policy Wordings. Attempted suicide, Involvement in adventure sports, Involvement in illegal activities|
|Ideal for||GMC is ideal for a wide variety of employer-employee establishments irrespective of industry or nature of work.||GPA is more suited for industries where employees are exposed to the risk of accidents. For example, construction, oil and gas, travel, etc.|
As is evident from the table in the above section, both policies have a lot of differences. Their purpose is different. Therefore, it will be unfair to declare one policy as the best. Instead, the decision needs to be made based on the insurance requirements of the employer and the employees. Ideally, a Group Medical Cover with a Group Personal Accident add-on is a good option.
Here are some of the common queries and their answers related to a Group Medical Cover and a Group Accident Policy.
What is the meaning of off duty GPA?
GPA coverage can be specific to on duty or can be extended to off duty as well. In an on-duty cover, the employee shall be covered only in case of accidents encountered while being on duty. Whereas in an on-duty + off-duty cover, there is no such restriction. The employee is insured all the time as per the policy’s terms and conditions.
Can part-time employees be covered under a GMC or GPA?
Usually, only full-time employees are covered under a GMC or a GPA policy. However, there might be scope for including part-time or contract-based employees under the purview of a GMC or GPA based on the negotiations between the insurer and the employer.
Why is GPA considered as a benefit-based health insurance cover?
Usually, GMC is an indemnity-based cover, and a GPA is a benefit-based cover. The basic difference here is that in an indemnity cover, the employee is indemnified (payment made for losses) for the expenses made or to be made to address medical concerns. Whereas in a benefit-based cover, a pre-decided lump sum is offered to the employee. As GPA covers instances such as permanent disability, the employee is offered a lump sum amount as claim settlement.
Is it mandatory to insure employees under a GPA?
No, it is not mandatory to insure employees under a GPA. However, offering a combination of a GMC policy with a GPA add-on can be a good perquisite for the employees.
What determines the payable premium for a GMC and GPA cover, and who makes the payment?
The chosen coverage and the insurer from whom the policy is being purchased determines the payable premium. In most cases, the premium is paid by the employer. However, in some cases, the employer might ask the employees to contribute towards premium payment. And if the employees are enhancing the policy at an individual level by purchasing add-ons, then the premium for such enhancements is paid by the employee.
Also, read; Maternity cover in Group Health Insurance Policy
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