ACKO’s Corporate Group Health Insurance policy is designed to optimise coverages to save costs along with flexible premium payment cycles. Employees can take advantage of seamless and paperless claims through a mobile app for a hassle-free experience. Apart from the basic hospitalisation cover, the policy focuses on easy access to high-quality primary care and wellness initiatives such as access to Out Patient Department (OPD), teleconsultations, fitness and rewards, emotional assistance, chronic care management, etc. Employees also have the option to choose from useful add-ons to enhance their basic coverage.
Group Health Insurance by ACKO
Compared to the traditional employer health insurance plan, ACKO’s new-age digital Group Medical Coverage (GMC) focuses on primary health care and wellness programmes which include coverage for Out Patient Department (OPD) consultations. For people-first organisations, the GMC Insurance by ACKO offers the following features:
- Up-front cost savings by eliminating low utilisation and optimising the coverages.
- Flexible premium payment cycles (Monthly/Quarterly/Semi-Annual/Annual).
- No upfront lock-in of premium for the year.
- Easy access to high-quality primary care and wellness programmes.
- Customisable add-on covers.
- Paperless claims by submitting soft copies through the mobile app.
- Reduced overhead cost due to HRMS integration for seamless onboarding and endorsements.
The ACKO Difference
How does ACKO differentiate itself from the traditional health and other group insurance providers? Below are the reasons that make ACKO different from others:
- Gross Written Premium (GWP) at Rs. 516 crore.
- 60 million+ customers.
- 600 million+ policies issued.
- 10,000+ claims settled per month.
Benefits of Buying Group Health Insurance From ACKO
Below are the benefits of buying Corporate Health Insurance from ACKO:
- Paperless Claims: Cashless approval in 30 to 60 mins vs. the industry average of 120 mins and Reimbursement Claim approval in 3 to 5 days against the industry average of 10 to 15 days.
- Easy Access to Primary Care: Get high-quality primary care and wellness programs such as teleconsultations, fitness and rewards, emotional assistance, chronic care management, etc.
- Customisable Add-ons: Employees can enhance the basic coverage by including useful add-ons such as top-up, financial protection, consumables cover that are not covered under the basic Group Health Insurance Policy.
- All Your Health Benefits in One App: Avail primary care services such as OPD, teleconsultations, pharmacy, lab tests, etc., health and fitness tracker and digital health card for employee and family all in one mobile app.
- Wide Network Across India: Get access to over 6,000 hospitals, 35,000 doctors and 4,500 laboratories spread across the country.
Utilising the advantages of technology, ACKO has digitised its operations, thereby reducing costs. Furthermore, ACKO believes in paperless experience and hassle-free claims, which has changed the way you buy and renew policies, and register and settle claims.
Why are ACKO Plans Low on Cost?
Traditional health insurance companies depend on agents or middlemen to sell or provide services to their customers. However, new-age digital insurance companies such as ACKO do not depend on agents, middlemen and have digitised the transactions for the ease of transacting. Since the operating costs are reduced, the benefits are passed on to customers. Premiums for health insurance by ACKO are comparatively lower than traditional insurance companies.
ACKO Claims Process
The procedure to raise a claim through the employer health insurance policy or Family Health Plan (FHPL) is simpler with digital-first insurance companies. From raising a claim to the settlement, the process is cashless through network hospitals. Primarily there are two methods to raise a claim. One, avail cashless treatment at any network hospitals, second, apply for reimbursement of the medical expenses arising out of hospitalisation. Below are the detailed steps to raise a claim through both methods:
Step 1: Inform the ACKO about the hospitalisation. In case of planned hospitalisation, you need to inform the insurance company at least 3 days before the date of admission and in case of unplanned hospitalisation, the insured person shall inform the insurer within 48 hours of admission.
Step 2: The hospital will inform the insurance company of the same and if the treatment is within the terms and conditions of the policy, cashless treatment will start.
Step 3: Prior to the discharge of the insured person, the insurer will pay the medical expenses directly to the hospital. The insured person will have to pay any deductibles as per terms and conditions.
Step 1: Inform ACKO about the hospitalisation and avail medical treatment at any non-network hospitals.
Step 2: Pay the medical expenses arising out of hospitalisation.
Step 3: Raise a claim with the insurance company for the reimbursement of the costs by submitting all the relevant documents required by the insurer to settle the claim.
FAQs about ACKO Corporate Group Health Insurance:
Health Insurance Policy is not complex if you understand and learn about some of the frequently asked questions listed below:
- Is it advisable to buy a corporate group health insurance policy for an organisation with a strength of 10 employees?
Yes. While other employer health insurance policies do not offer to cover a company with a size of 10 employees, ACKO offers GMC with additional benefits such as paperless claims, OPD cover, flexible premium payment cycles, customisable add-ons, faster claim settlement, guidance from experienced professionals all at a lower premium with wider coverage.
- Who is eligible for a group health insurance policy?
Organisations small and large, young and emerging startups are eligible to apply for a group health insurance. An organisation with more than 10 employees can apply for the corporate health insurance scheme.
- Who can be covered under the group health insurance plan?
All employees of the organisation can be covered under the ACKO employee mediclaim insurance policy. The employer can define employees or workers who are eligible for the corporate health insurance plan.
- Is COVID-19 (Coronavirus) treatment covered under the employee health insurance policy?
Yes. ACKO cover medical treatment of COVID-19 in India. It is important to check with the insurance provider if they cover COVID-19 before you raise a claim towards the expenses related to the treatment of the novel coronavirus.
- How is the premium for the group health insurance policy calculated?
While calculating the group health insurance premium, the insurance company will take into consideration factors such as the age and number of employees, the location of the organisation and the number of dependents of the employees. However, these are the primary factors which the insurer will consider while calculating the premium. The benefits of each insurance company may differ. The employer needs to understand the terms and conditions of the policy and how the premium is calculated before opting for the plan.
Why Group Health Insurance Policy is Important for Employees?
Employees can avail various benefits that were generally unavailable through traditional insurance companies. Below are a few of the reasons why the new-age digital group health insurance policy is essential for employees:
- Avail paperless claim approval in 30 to 60 minutes against the industry average of 120 minutes.
- Get reimbursement claims settled within 3 to 5 days against the industry average of 10 to 15 days.
- Get access to primary health care and wellness programmes such as teleconsultations, emotional assistance, fitness and rewards, chronic care management, etc.
- Opt for Add-on covers such as top-up, financial protection covers, consumables cover, etc.
- Full-digital experience.
- Get access to 6000+ hospitals, 35,000+ doctors and 4500+ laboratories.
- Get your health benefits in one mobile app.
What’s Covered in ACKO Corporate Health Insurance (Inclusions)?
ACKO is a new-age insurance company specialising in digital insurance and is at the forefront in simplifying different procedures for the policyholder. Below are the inclusions in the ACKO Group Health Insurance Policy subject to the terms and conditions:
In-Patient Hospitalisation Cover:
Hospitalisation due to an illness or an accident is covered under the Group Health Insurance policy. Also, planned or unplanned hospitalisation due to an illness is covered under the policy.
No hard copy or courier is required for the submission of hard copies of supporting documents. Claims are processed by submitting soft copies through the mobile app.
Access to Wellness Programmes
Get easy access to wellness programmes such as chronic care management, teleconsultations, fitness and rewards, and emotional assistance.
Flexible-Premium Payment Cycles
Apart from no upfront lock-in of premium for the year, you can pay the premium through monthly/quarterly/semi-annual/annual method.
Employees can enhance their group health insurance by customising add-on covers based on their requirements. These include financial protection cover, top-up, consumables cover, etc.
Integration of HRMS
Employers can integrate their HRMS for seamless onboarding and endorsements, thereby eliminating the need for monthly Excel files leading to reduced overhead expenses.
In-Patient Hospitalisation Fixed Benefits
ACKO will provide a fixed benefit amount, as specified in the policy document, in case of hospitalisation solely due to the illness or injury.
Daily Hospital Cash
If the policyholder or employee needs hospitalisation due to an injury or illness, then ACKO will pay the daily allowance amount as specified on the policy document. This benefit is available for a continuous and completed period of 24 hours of hospitalisation.
Daycare Treatment Cover
The group insurance scheme for employees offered by ACKO covers expenses arising out of daycare treatment or surgery. Daycare treatment is a term used for describing medical procedures that require less than 24 hours of hospitalisation.
The group mediclaim policy offered by ACKO covers expenses towards the use of an ambulance for transportation of the insured person to the hospital or daycare centre.
Maternity and New Born Baby Medical Expenses
In the event of hospitalisation of the employee or their family members for the delivery of a baby and/or related to medical treatment following pregnancy is covered under ACKO employee mediclaim policy. Also, expenses arising out of hospitalisation of a newborn baby up to 90 days from the date of birth are covered under the scheme.
Compassionate Visit and Stay
ACKO will cover charges towards one or two-way transportation of an immediate family member of the insured person as specified in the policy to the place of hospitalisation of the insured person in case he/she is hospitalised due to an illness or an accident.
Apart from the above-mentioned benefits of the group health insurance offered by ACKO, other benefits include coverage against loss of pay due to hospitalisation, EMI protection, Pre and Post-Natal check-ups, vaccination, repatriation of mortal remains and funeral expenses as specified in the policy wordings.
Exclusions of ACKO Group Health Insurance
Like every insurance policy, the group or the corporate health insurance policy also comes with certain exclusions. Below are the main exclusions of the ACKO Corporate Health Insurance Policy:
Any Involuntary Unemployment
In the case of involuntary unemployment or suspension of the employee/worker at their primary occupation, which is temporary in nature is not covered under the employee health insurance offered by ACKO.
There are medical conditions which the employee health insurance policy offered by ACKO that is not covered. This can be unemployment due to intentionally self-inflicted injuries, termination due to pre-existing diseases, unemployment due to consumption of alcohol or drugs and unemployment arising out of an insured person being on family leave or sick leave due to pregnancy or childbirth.
Any Pre-Existing Diseases Unless Disclosed
Under the ACKO employee mediclaim policy, the insurer will not pay for medical expenses due to hospitalisation for the treatment of the pre-existing diseases not disclosed by the employee.
Whether it is a suicide, attempted suicide or intentionally self-inflicted injury, the group health cover for employees does not cover such hospitalisation expenses.
Benefits of Buying ACKO’s Corporate Medical Insurance Online
ACKO is disrupting the insurance sector by utilising technology to digitise its operations to make the entire experience of buying, renewing and registering claims easier and efficient. Below are some of the benefits of ACKO corporate general insurance online policy:
- Upfront Cost Savings: Optimisation of coverages to save costs such as eliminating low utilisation coverages and flexible premium payment cycles and no upfront lock-in of the premium for the year.
- Better Care, Future Cost Control: The Group Health Insurance policy focuses on wellness programmes and access to high-quality primary care to reduce costs. Get access to the Out Patient Department (OPD) services such as teleconsultations, chronic care management, fitness and rewards and emotional assistance.
- Seamless Administration: Eliminate monthly Excel files to reduce overhead costs as the policy by ACKO integrates with the HRMS for seamless onboarding and endorsements.
- Paperless Claims Experience: No hard copy or courier submission of documents. All claims are processed through the submission of soft copy through the mobile app.
- COVID-19 Coverage: The pandemic has resulted in the loss of lives across the globe. Through the group insurance coverage, employers can offer health insurance for their employees to cover medical expenses arising out of hospitalisation for COVID-19 treatment.
- Single Point of Contact: With middlemen and agents removed between the insurance company and the customer, the gap between the insurer and customers has been eliminated. Customers can get in touch directly with the insurance company through several channels such as email, social media, chatbot, etc.
- Wide Range of Network Hospitals: Employees can avail medical treatment at various hospitals located across India. ACKO has tied up with some of the best and has a wide network of hospitals across the nation.
- Restoration of Sum Insured: Upon the exhaustion of the sum insured, employees can take advantage of the top-up amount, which offers further coverage once the sum insured is exhausted. Employees can top-up numerous times for any diseases.
- Corporate Group Health Insurance For Companies of All Sizes: ACKO offers group health insurance, which covers companies of different sizes. Companies who have a strength of 10 employees or an upcoming startup, which has an employee strength of more than 25 can buy ACKO Employee Health Insurance scheme.
Key Features and Benefits of Group Health Insurance by ACKO
It is essential to understand the key benefits of a group health insurance before you buy a cover for employees. Below are the main features and benefits of employee Group Health Insurance by ACKO:
|Particulars||Features and Benefits|
|Premium||One of the lowest offered by a digital insurance company.|
|Cashless Hospitals/OPD/Diagnostics||6000+ hospitals, 35,000+ doctors and 4,500+ labs spread across 102 cities in India|
|Claim Settlement Ratio||Competitive in the industry|
|Buying and Claim Process||A fully-digitised process with paperless claims|
|Treatment of COVID-19 (Novel Coronavirus)||Covered under the employee health insurance policy.|
|Point of Contact||Single point of contact|
|Add-on Covers||Choose from top-up, consumables cover, financial protection covers, etc.|
|Upfront Lock-in Premium||No|
|Mode of Transaction||Mobile app|
Group Insurance Plans
While shopping for a group health insurance for employees, it is important to learn about different plans offered by the insurance company. These plans are based on the terms and conditions as agreed with the insurance company. Below are a few of the Group Health Insurance Plans:
In-Patient Hospitalisation (IPD) Indemnity Category:
- In-patient hospitalisation cover
- Worldwide in-patient hospitalisation cover
- In-patient hospitalisation fixed benefit
- Daily hospital cash
- Daycare treatment cover
- Road ambulance
- Compassionate visit
- Compassionate visit stay
- Loss of pay due to hospitalisation
- EMI protection
- Missed bill payment
- Hardship allowance
- Income protection cover
- Maternity and newborn baby medical expenses
- Pre and post-natal
- Repatriation of mortal remains
- Funeral expenses
Personal Accident Category
- Accidental death benefit
- Permanent total disability
- Permanent partial disability
- Temporary total disability
- Child Education cover
- Disappearance cover
- Loan protector
- Outstanding bills protection benefit
- Convenient travel option
- Modification of vehicle/home
- Chauffeur benefit
Critical Illness Category
- Critical illness benefit
Out-Patient (OPD) and Wellness Benefit Category
- Out-patient treatment cover (OPD)
- Dental cover
- Vision expenses cover
- Preventive health check-up
- Prescribed diagnostics
- Domestic emergency evacuation
- International emergency evacuation
- Medical equipment cover
Documents Required To Make a Claim by Employees:
For the cashless treatment, the hospital and the third-party administrator will settle the claim by submitting the required documents. However, in the case of a reimbursement process, relevant documents are required to be submitted by the policyholder to the insurer. Below are the documents required for the reimbursement of the medical bill by the insurer:
- Duly filled and signed claim form by the hospital and the insured person.
- Photocopy of photo ID of the insured person.
- Original death/discharge summary.
- Operation notes (if any).
- Original main bill and breakup bill of the hospital.
- Original diagnostic reports (MRI, X-ray, CT Films, HPE).
- Medical practitioner’s prescription for investigations/pharmacy.
- Original bills from the pharmacy.
- MLC/FIR report/post-mortem report (if applicable).
- Other details that are relevant to the injury/illness/hospitalisation.
Important Things to Consider While Buying a GMC Plan
Before opting for a group health insurance, one must read the terms and conditions in detail so that an informed decision is taken. Here are important things to remember before buying a Group Medical Coverage (GMC) insurance plan:
Duty of Disclosure
In case the insured person does not disclose all information or if the insurer finds incorrect or untrue information, then the insurance company has the right to reject the claim and may even cancel the policy. All details and information must be revealed to the insurer to avoid rejection of claims.
Read the Terms and Conditions
It is important as an employer and employee to understand the terms and conditions listed in the policy to avoid any issues in the future.
While the employee health insurance policy does cover medical treatment of the employee in case of hospitalisation, the insured person understands and must agree to take all reasonable care in order to safeguard themselves against illnesses or injuries.
Alterations in the Policy
The group health insurance plan is a complete contract of insurance; however, no alterations or changes will be effective or valid until approved in writing and is endorsed by the insurer.
Free Look Period
Generally, insurers offer 15 to 30 days as a free-look period to review the terms and conditions and return the same if not acceptable. Free-look period does not apply to the renewal of the policy.
Download Group Health Insurance Wordings
To read the terms and conditions in detail, the employee health insurance policy wordings should be read and understood in detail. Download the policy wordings to learn more about group health insurance.
About Group Health Insurance
Group Health Insurance, also known as Group Mediclaim Policy, provides coverage towards medical expenses arising out of hospitalisation to a group of employees/workers of a particular organisation. Employee health insurance provided by the employer offers coverage to the employee and sometimes his/her family members which includes the spouse and dependent children and in some cases even dependent parents.
The group medical insurance for company employees can be availed by Small and Medium Industries (SMEs), corporates and startups. New-age digital insurance companies such as ACKO are redefining group health insurance policies and the services associated with it. Apart from the basic hospitalisation cover, they are providing access to primary healthcare services such as coverage for OPD teleconsultations, health check-ups, fitness and rewards along with zero paperwork for claims.
Health insurance for company employees is beneficial to both employees and employers. While employers benefit from low-cost health insurance, tax benefits, retain employees and even act as a motivation for its employees, employees have a sense of security with the coverage of health insurance for themselves as well as their family members.
Through the company medical insurance, employees can avail cashless treatment at any network hospitals anywhere in India. If the cashless facility is not available, employees can avail medical treatment from a non-network hospital and then raise a claim for reimbursement of the cost towards the treatment.
Types of Group Insurance
When a group of employees or persons are covered under a single insurance policy, it is called a Group Insurance Policy. In addition, they are further divided based on the type of requirement. Below are the types of group insurance available in India:
- Group Health Insurance: This type of group insurance policy covers the medical expenses arising out of hospitalisation. This policy covers the group of persons or employees of the organisation.
- Corporate Term Life Insurance: This type of group insurance plan provides life cover for the group of persons or the group working in the organisation.
- Employee Personal Accident Insurance: This group insurance covers the group of persons against an accident and provides compensation towards the same.
- Group Travel Insurance: This plan covers the hazards faced by the group of persons while travelling including theft of luggage and documents. It may even include health insurance.
How does a Group Health Insurance Plan Work?
The main objective of the Group Health Insurance Plan is to offer medical insurance to employees by the employer towards any medical treatment due to illnesses or injury. The following points offer insight into how the group mediclaim policy works:
Choice of Insurance Provider
The organisation or the employer chooses a health insurance company to cover their employees with a group or corporate health insurance plan. Generally, the premium is paid by the employer and offered to the employees as part of their benefits of working in the organisation.
Option to Add Family Members
The employee mediclaim policy is chosen by the employer for all employees of the organisation with the sum insured and plan, which is similar for all employees. Although it is a group health insurance cover, employees have the option to include their family members and in some cases dependent parents for an additional premium.
Need for Corporate Group Health Insurance for Employees
Corporate group health insurance is not only for large organisations, but it is also for companies as small as 10 employees or new-age startups. A group health insurance for employees is not only beneficial for employees but for employers as well. An employee health group insurance is indeed an excellent motivation factor for employees and retains the employee with organisations which offer health insurance for employees/workers.
Employees being the driving force of the company or organisation, a group mediclaim insurance will certainly add to their confidence about the company. It also lets the employee know that the company cares about them and their family when it comes to medical treatment. The following are some reasons why employers should offer mediclaim insurance for their employees:
Wide Coverage and Better Benefits
Generally, the employee health insurance policy covers pre-existing diseases, pre- and post-hospitalisation expenses along with a wide network of hospitals to choose from. Usually, the company’s group health insurance is provided at no cost to the employee and may include their immediate family members and in some cases even their dependent parents/parents-in-law.
It also offers daycare treatment coverage, add-ons, paperless claims, OPD cover, health check-ups, diagnostics, etc., making the group mediclaim policy an excellent coverage and beneficial for employees.
Option to Customise Cover
Employers have the option to customise the group health insurance, which suits their company and employees. From the option to cover dependent parents/parents-in-law to coverage of Out-patient Department (OPD) expenses, insurance companies offer the option to customise the coverage as per the employers’ choice.
Compared to individual health insurance policies, the premium for the group health insurance policy is much lower. New-age digital insurance companies have eliminated the need for agents or middlemen to sell insurance policies. This has resulted in reducing operating cost for the insurance company, which has aided them to offer low-cost employer health insurance compared to traditional insurance companies.
Advantages of a Group Health Insurance
|Cost||Avail high utilisation of coverages to save costs.|
|Lock-in of Premium||No upfront lock-in|
|Lower Overhead Cost||HRMS integration for seamless onboarding and endorsements and eliminate monthly Excel files.|
|Employee Retention||Employees feel a sense of security with the health insurance offered by the employer.|
|Employee Motivation||Medical expenses are always on the rise, a corporate health insurance plan helps motivate the employee to part of the organisation.|
|Tax Saving Measure||The employer can enjoy tax benefits by offering employee health policy.|
|Low Cost||Compared to the individual health insurance policy, the group mediclaim policy is inexpensive.|
|No Waiting Period||Pre-existing illnesses or diseases are covered from day 1, unlike individual health insurance plans.|
|Wider Coverage||Compared to individual health insurance, group health insurance offers broader coverage with no limit on illnesses or diseases.|
|Tax Benefits||Employees can avail tax benefits if they are paying the premium for the group health insurance.|
|Health Check-up||Not required|
|Maternity Cover||Offers a wider coverage|
|Premium||Lower compared to individual health insurance plans|
|Add-ons||Access to useful and customisable add-on covers.|
|Wide Hospital Network||6000+ hospitals, 35000+ doctors, 4500+ labs|
Who Should Buy a Group Health Insurance Plan?
Organisations or companies with not less than 10 employees should cover their employees with the group mediclaim policy. Organisations are generally categorised into three different types:
Small Sized Companies and New Startups
A company with a strength of 10 to 15 employees or a new startup should have a medical cover for its employees. If you are a young startup and looking to scale your business, you need to take care of your employees, especially their health. A health insurance solution for small businesses does not mean a large outflow of expenses. It can be customised to your requirements based on the company’s financial health and the size of the group.
Medium-Sized Companies and Expanding Startups
Choosing to protect your employees with a group mediclaim policy is never too late. Even if you have been in the industry for a while and the company is steadily growing, employee health insurance plans are never too late for your employees. By securing their medical needs, you can motivate your employees and may even help retain talent.
Large Organisations and Well-Established Startups
Employees who work in large organisations or a well-established startup, expect slightly higher benefits. Health insurance is one such benefit that employees look forward to when they want to be part of the organisation. As an employer, offering group health insurance for its employees is an additional benefit apart from the remuneration being provided.
How to Buy/Opt for Corporate Group Health Insurance for Employees Online?
Shopping for insurance has become hassle-free with digital insurance providers. Thanks to the internet, which has enabled the insurance industry to scale up their business model to cater to online transactions. Employers can opt for group mediclaim insurance policy for employees online. Follow the steps to buy employee health insurance online:
- Step 1: Visit the insurance company’s website. Example: www.acko.com
- Step 2: You will be required to enter your name, email ID and mobile number. Enter the details and click on submit.
- Step 3: A representative from the insurance provider will contact you with relevant details of the group health insurance. Choose the suitable plan based on the number of employees and the financial condition of the company.
Also, read: Health Insurance Premium Calculator
Steps to Download Employee Health Card Online:
Once the employer has bought the corporate health insurance for its employees, the health insurance company will issue a dedicated web portal for employees to access all their details. The process may differ from one insurer to another. Generally, the following steps are followed by insurance companies for downloading the Employee Health Card online:
- Step 1: Log in to the web portal provided by your employer or the insurer.
- Step 2: Once you have logged into your account, you may be able to download the health card online from the web portal.
Please note that this is a general method. Employees have to check with their respective employer to know the right procedure.
ACKO Health Card Download Online
You do not have to carry the physical copy of the employee health card all the time. Through ACKO, you can use the mobile app to download the digital health card to avail services at the network hospital.
What Employers Should Look While Buying a Group Health Insurance Policy in India?
While it is essential to provide health insurance for employees, employers should focus on the important factors to make an informed choice. Below are the main factors that employers should focus on while shopping for a group health insurance:
The premium is the outflow of funds from the company and that requires the utmost attention while buying a group mediclaim policy for employees. Just because a group health insurance offers several benefits at the cost of a higher premium, you may end up paying more than required. The goal is to get maximum coverage at a lower premium. Hence, as an employer, you need to be aware of the premium and how competitive it is in the market.
The main objective of a group health insurance for your employees is to provide healthcare that offers benefits. With substantial benefits, the objective of securing your employees with health insurance makes it valuable to both the employer and employee. Ensure the corporate health insurance provides valuable benefits for your employees.
Excellent Post-Sales Service
While the group insurance provided by the insurer is valuable and adds value to your employees, it is important to be aware of the post-sales service provided by the insurer. Procedures such as claims are serviced and employees are benefited from the coverage.
The insurance company providing the group health insurance should also be able to communicate effectively. Employees should be able to get their issues resolved in a hassle-free manner and find the entire process of claiming or altering the policy is easy and effective.
It is essential that the insurer can provide insurance coverage for employees not just where they reside but outside the geographical area. This ensures that employees are covered across the country through a wide network of hospitals that the insurer is tied-up with.
Difference Between Group Health Insurance and Individual Health Insurance
The following are the differences between group health insurance and individual health insurance:
|Group Health Insurance||Individual Health Insurance|
|Usually, the employer pays for the premium for the employee and their family.||The individual has to pay the premium for themselves as well as for their family|
|Lower premium||Higher premium|
|Only the employer has the right to cancel the policy.||Only the individual has the right to cancel the policy.|
|Insurance is valid until the employee is with the organisation post which it ceases to be valid for the employee.||Insurance is valid for the entire policy period.|
|Dependent on the organisation’s financial health and employee strength.||Dependent on the age, health and medical history of the individual.|
|No need for medical check-ups.||Medical check-ups might be required to get a health insurance policy.|
What Are The IRDAI Rules for Group Health Insurance?
The Insurance Regulatory and Development Authority of India (IRDAI) is the regulator of the insurance industry or sector in the country. The regulatory body forms rules and regulations on all types of insurance policies being sold in India. Here are a few things that the IRDAI says to be careful while opting for group health insurance:
- 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 if you are part of a non-employer-employee group policy.
- The certificate of insurance will contain the schedule of benefits, terms and conditions of the coverage and 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 terms of the policy, including any discounts, which should be passed on to employees or members.
- The group’s manager should disclose any administrative charges that he/she has collected from employees or members over and above the premium rate charged by the insurer.
More Frequently Asked Questions
Group health insurance need not be complicated. Here are answers to some of the frequently asked questions about corporate group health insurance for your reference:
Apart from valuable benefits, the best group health insurance should also provide excellent post-sale services such as servicing of claims. The staff insurance should also provide hassle-free and paperless transactions, making it easier for employees to avail insurance coverage for healthcare for themselves and their families. Additionally, the insurance company should have a wide network of hospitals across the country to offer extensive coverage.
Typically, organisations with more than 10 to 15 employees can opt for the corporate employee health insurance scheme. There is no cap on the number of employees as far as the insurance policy is suited to the financial health of the company.
Typically, there is a waiting period of about 15 days. However, insurance companies provide different benefits for different types of organisations based on the size of employees and the financial health of the employer.
There is no ideal time to buy a group health insurance for your employees. Whether it is a large organisation with more than 1000 employees or an upcoming startup with 10 or more employees, a group health insurance for your employees will increase their motivation and bring a sense of security to themselves and their families.
Yes. Corporate health insurance covers pre-existing diseases or illnesses from day one, unlike the individual health insurance policy. However, it may vary between insurance companies, hence, check the terms and conditions for more information.
Yes. In fact, it is beneficial to have wider coverage with two health insurance policies. In case of a job loss, the individual insurance will cover during emergencies since the corporate health insurance ceases to be valid once you are no longer an employee of the organisation.
Compared to the individual health insurance policy, the premium or the pricing for the group health insurance plan is lower and affordable. Since the insurer is providing insurance to a group and not to an individual, the pricing is lower.
No. The group health insurance or employee health mediclaim policy is offered by the respective employer to the employee working in its organisation. Typically, an organisation prefers to offer single corporate health insurance for its employees.
The full form of GMC in health insurance is Group Medical Coverage, a term used for health insurance that covers a group of employees or persons.
One of the main objectives of the organisation is to provide a mediclaim policy for its employees to ensure that it is taking care of their healthcare needs as well as for motivation and retention of its employees.
While shopping for a group mediclaim policy for employees, employers should focus on providing maximum coverage at a lower premium. Also, the insurance company should have the ability to service its employees during hospitalization concerning claims, redressal of grievances and other related services.
The process of renewing a health insurance plan varies from insurers to insurers. Generally, the employer will take care of the renewal procedure. For more information, retired employees can contact their respective employers about the exact process.
Insurance companies have designed group medical insurance for different organisations with different sizes. This includes small businesses as well. Contact the insurance company, and they will customise a group medical insurance for your small business based on the financial health and the size of the group.
While the Employee Mediclaim Policy offers benefits to both employee and employer, it does not provide exclusive benefits such as additional coverage for critical illnesses or inclusions of surgeries or treatment of specific illnesses such as cancer, among others. Employees should opt for the individual health insurance policy along with the corporate insurance provided by the employer to get wider coverage.
Certain insurance companies provide a percentage of the estimated cost of medical treatment in cash. This is beneficial to the insured person as he/she need not wait for the treatment to complete to be covered. However, this feature might differ between insurance companies.
The reimbursement that the employee received towards medical care treatment is not taxable. However, if the amount received as reimbursement is taxed and paid to the income tax department, they can file an Income Tax Return (ITR) for the same. The IT department will rectify and issue returns of the same.
The main factors that impact the premium of employee medical insurance are the size of the group, the average age of the group and the financial health of the employer.