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Does Group Insurance Cover Pre-Existing Conditions?

Team AckoMay 4, 2021

If you are an employer, then offering a Group Medical Cover to your employees is a way of weaving a financial safety net for them. It is a declaration that you care for their well-being. However, choosing such a cover should not be a mere task. Pick a cover that offers wide-ranging benefits and be aware of the details. For example, you should know if a Group Insurance Policy covers pre-existing conditions of the employees. Read ahead to know the details surrounding pre-existing diseases coverage in Group Health Insurance.

Does Group Insurance Cover Pre-Existing Conditions?

Does a Group Insurance Policy for Employees Include a Pre-existing Disease Cover?

Yes, Group Insurance Schemes do cover pre-existing diseases. Most Company Health Insurance policies offer such coverage as a part of their generic plan. If not, then it can be availed by purchasing an add-on like a pre-existing disease waiver.

What is a Pre-existing Disease?

A pre-existing disease is a medical condition with which the policyholder is diagnosed before buying the policy. The period for such symptoms/diagnosis is within 48 months before policy purchase. As the name suggests, pre-existing disease’s meaning is that it already exists. For example, if an employee has diabetes, then it will be considered as a pre-existing disease when the employee is enrolled under the Group Mediclaim Policy. Examples of Pre-existing Disease include thyroid, hypertension, cancer, asthma, etc.  

Pre-existing Diseases in Group Mediclaim Policy:

If the policy cover includes pre-existing diseases, the corresponding details will be mentioned in the policy document/certificate of insurance. Unlike an individual cover, a Group Insurance Policy is not usually issued for all employees. Instead, a master policy is issued in the name of the employer or concerned authority. Employees often receive policy cards featuring their names. Employees can get in touch with the company’s Human Resource/Admin team to know such details.

How Do Pre-existing Diseases Get Covered in Group Health Insurance?

If you (any individual seeking health insurance) are buying an Individual Health Insurance Policy, you might be required to undergo a few tests and then the insurer will offer you a policy and charge the premium accordingly. However, in a Group Health Plan, there is no requirement of a test.

Insurance for employees is a generalised plan with the option to customise it at an individual level by paying extra for top-up plans or add-on covers. Pre-existing diseases usually get covered automatically in Group Health Insurance as per the terms and conditions. Employees might be required to declare these pre-existing diseases upfront before being covered under the plan. If you opt for additional coverage at an individual level, the appropriate protocol shall be applicable, and you might be required to undergo specific tests before pre-existing diseases are covered in the policy.

Can Pre-existing Diseases be Covered from Day One in Group Health Insurance?

Yes, pre-existing diseases can be covered from day one. You can cover your employees under a Group Medical Plan from ACKO to cover their pre-existing diseases from the first day of the policy. Please discuss and clarify the inclusions and exclusions of the policy before buying as ACKO’s Group Medical Cover is customisable. 

This means there is no waiting period for the diseases. For instance, employees can raise a hospitalisation claim without the restriction of waiting for the completion of a specific period.

Should One Choose the Pre-existing Diseases Waiver?

If the preferred Employee Health Plan is not offering pre-existing disease coverage as a part of the basic policy, then you should choose a pre-existing waiver to ensure that the employees get a wide-ranging cover.

For example, if the majority of the employees belong to the above-thirty age group, then they might have or might be susceptible to lifestyle-related pre-existing diseases. In such a scenario, it would be wise to cover them for such diseases even if it increases the payable premium by a margin.

Preferred Features of Company Health Insurance:

Gone are the days when a health insurance policy for employees was just another company-offered perquisite. Nowadays, its scope has widened. As a result, the focus is now on holistic wellness. Here’s a list of benefits that should be offered by a modern Corporate Health Insurance Plan.

Insurance Benefits:

  • Option to increase the coverage.

  • Option to include family members in the policy.

  • No waiting period for pre-existing diseases.

  • Insurance cover for COVID-19.

  • Coverage for out-patient treatment.

  • Smooth, paperless claims experience.

Wellness Benefits:

  • Telemedicine facility via a mobile app.

  • Discounts on lab tests and medicines.

  • Rewards for completing fitness challenges.

  • Access to sessions with mental health specialists and nutritionists.

ACKO Advantage:

ACKO provides a perfect blend of insurance and wellness benefits for your employees. All the above-mentioned features are available as a part of ACKO’s Group Health Policy as per the chosen coverage. ACKO has joined hands with 4,500 labs to enable diagnostics tests. Also, 35,000 specialist doctors are accessible for a virtual consultation. 

With the ACKO app, your employees can access all the above-mentioned benefits in one place. Plus, they can raise claims for their pre-existing diseases from their phone. This means no form-filling or tedious documentation, which will allow them to save time and stay stress-free during medical emergencies.

Significance of Group Health Insurance:

A well-rounded Group Health Policy offers several benefits to both the employer and the employee.

Significance for Employer:

Here are some points highlighting the significance of Corporate Insurance for the employer.

1) Enhanced Goodwill

Offering a comprehensive health plan to the employees is a sign of a people-first organisation. Such endeavours will lead to increased goodwill for the company.

2) Increased Employee Loyalty

When employees feel that they are valued and taken care of, it will likely have a direct and positive impact on their loyalty towards the company.

3) Healthy Workforce

With rewards for achieving fitness targets, free teleconsultations, and access to mental conditioning experts, the workforce will be healthier.

Significance for Employee:

Here are some points highlighting the significance of Corporate Insurance for employees.

1) Free Insurance Cover

The employee does not have to pay for this facility unless the cover is increased.  

2) Logistical and Professional Support

With a strong customer support team, the employee will always have someone to reach out to in a medical crisis.

3) Smooth Claim Settlement

With a wide network of hospitals aiding Cashless Claims, the employee will experience a smooth claim settlement process. ACKO has partnered with 6,000+ network hospitals for quick and easy access to high-quality medical care. 

Also, read: Pre-Existing Diseases and Conditions in Health Insurance

Frequently Asked Questions:

Read ahead to know the answers to some of the common queries surrounding Employer-offered Insurance Coverage.

Employer Related FAQs

1. Which insurer should I pick to insure my employees?

Pick an insurer that offers wide-ranging coverage along with top-level services, wellness benefits and enables smooth claim settlement. In doing this, do not forget to read the terms and conditions.

2. Which are the common pre-existing conditions?

Some of the common pre-existing conditions are diabetes, high blood pressure, high cholesterol, and asthma.

Employee Related FAQs

1) Do all group plans offer pre-existing diseases coverage from the first day of the policy?

Every policy might not offer such a feature. Some might offer it as an add-on cover. It is suggested to check the policy details before buying the cover.

2) Can I get tax benefits from Employer-offered Insurance?

No. The employee cannot avail of the tax benefits in a scenario where the complete premium is paid by the employer. Tax benefit can be availed of if the premium is paid by the employee. 

3) Is there an option to include my spouse in a group cover?

Yes, your spouse can be included in a Group Medical Cover.

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