Group Medical Coverage (GMC)
The Group Medical policy covers expenses by the insured persons on account of hospitalisation due to sickness or accident. The policy covers expenses incurred on room rent, medicines, surgery, etc. Expenses for hospitalisation are payable only if a 24-hour hospitalisation has been taken. (Except for named day-care procedures, which do not require a 24-hour hospitalisation). Under such schemes, the typical expense heads covered are; room/boarding expenses as provided by the hospital, nursing expenses, surgeon’s fee, anaesthetist’s fee, medical practitioner fee, consultant fee, specialist fees, anaesthesia, blood, oxygen, operation theatre charges, surgical appliance, medicines, and drugs, diagnostic material and x-ray, dialysis, chemotherapy, radiotherapy, cost of the pacemaker, artificial limbs, and similar admissible expenses.
These policies are tailormade to the individual requirements of the company. The major factors taken into account while building the policy structure are the employee experience, market benchmarking, long term strategic alignment with company philosophy and pricing considerations.
Hassle-free claim management: Fast, fair, and transparent claim procedure, third-party administration for claims processing, with largest network strength for seamless cashless support hospitals in the network list, and customer support services.
Frequently asked questions (FAQ)
What is group health insurance?
A group's medical needs are covered through a group health insurance plan. Because employers are responsible for paying the group medical insurance plan's premiums, it is typically acquired by businesses or organisations to offer additional medical coverage to their employees as a benefit.
Why is group health insurance required?
Organisations today are focused on their employee wellbeing more so than ever. They provide employees with health insurance policies. Group health insurance programs are advantageous for both employers and employees for a variety of reasons, including the following:
- Broad coverage and better benefits: Most group health insurance plans offer their employees broad coverage and extensive benefits.The ability to have customised coverage is available with group and corporate health insurance policies. An employer might select a plan that offers OPD or maternity coverage, for instance.
- Reasonably priced premiums: When comparing group health insurance with individual health insurance, the group plans are more reasonably priced. This is because group health plans always have greater rates of coverage one receives.
- Tailormade: Since group health insurance plans are tailor-made, they can extend day 1 coverage for pre-existing diseases, and waive off all other ailment-specific waiting periods.
- Financial support: It acts as a financial support to employees and their dependents in case of medical needs as well acts as a retention tool for employees.
What are the advantages of group health insurance?
Benefits of group health insurance for employers:
- Broad coverage and better benefits: Most group health insurance plans offer their employees broad coverage and extensive benefits.
- Supports in employee retention: Retaining employees has become challenging in the present era due to the job market demands. However, the chances are high that employee stays with the company in if they are offered advantages like health insurance coverage to themselves as well as their families.
- Tax benefits: Because both the employer and the employees are entitled to gains under a group health insurance plan, as was already indicated, the employer benefits financially by offering such policies to its staff.
- Motivated employees: Having a business health insurance plan today, when medical costs are at their highest, inspires employees.
- Better benefits at low cost: Employee health insurance offers better benefits at a comparably lower cost.
What are the key features of group health insurance?
Benefits of group health insurance for employers:
- Broad coverage and better benefits: Most group health insurance plans offer their employees broad coverage and extensive benefits.
- Supports in employee retention: Retaining employees has become challenging in the present era due to the job market demands. However, the chances are high that employee stays with the company in if they are offered advantages like health insurance coverage to themselves as well as their families.
- Tax benefits: Because both the employer and the employees are entitled to gains under a group health insurance plan, as was already indicated, the employer benefits financially by offering such policies to its staff.
- Motivated employees: Having a business health insurance plan today, when medical costs are at their highest, inspires employees.
- Better benefits at low cost: Employee health insurance offers better benefits at a comparably lower cost.
What are the key features of group health insurance?
There are numerous group health insurance plans and company health insurance options on the market. The following are some elements that all employee health insurance plans have in common.
- Employer-sponsored health insurance often provides medical coverage for the insured (themselves), spouse, children, and parents who are dependent on them.
- Provision to cover maternity related expenses and pre-existing conditions.
- At network hospitals, employee health insurance provides cashless hospitalisation.
- Additional expenses like ambulance costs may also be covered by group health insurance.
- Some health insurance plans for employees reimburse specialists' and other medical professionals' fees for subsequent examinations.
- The group health plan does not need any prior medical examinations.
- Group health insurance is more affordable when compared to standalone health insurance plans. It assists in lowering the risk and liability associated with employee claims for the business.
- There are provisions to introduce voluntary solutions for coverage enhancement or parental enrolment with flexible age bands going all the way up to 100 years.
- D&I based benefits can also be included, which extends to same-sex partner, live-in partner, infertility, adopted child, surrogacy, dependent sibling, mental health counselling etc.
- Provision to cover outpatient (OPD) related expenses which involve routine consultation with a general practitioner or a specialist, pharmacy expenses for disease management, and diagnostics.
How to claim group health insurance?
To submit a cashless claim for group health insurance, follow these steps.
- Complete the pre-authorisation paperwork at the hospital's TPA desk.
- A pre-approval is disclosed to the insurer by the TPA.
- The insurer provides approval along with an initial sum.
- Following the completion of treatment, the final pay-out is made by the terms and conditions of the insurance plan.
For a reimbursement claim under the group health insurance plan, follow the procedures below.
- After being hospitalised, notify your insurance company right away.
- Send in the claim form and any other paperwork within stipulated time of being discharged.
- Submit a voided check to transfer the funds.
- After receiving all the information, the insurer will transfer the money within 15 days.
Note: It is advised that the policyholder keep a copy of all relevant paperwork and claim forms on hand. Some insurers support paperless processing of claims.
