Dealing with medical expenses without proper health insurance can drain your lifelong savings. Medical plans are noted for covering various health-related costs such as medical bills, consultation charges etc. However, to avail of the one, you need to pay a certain amount in premium. But what if we told you that you get yourself covered under medical insurance without spending a rupee? It is possible with group health insurance. Here's what you must learn about them.

What is Group Medical Insurance?

A group medical insurance policy, also referred to as corporate health insurance, is essentially an employee medical insurance policy that covers a group of workers in a specific organisation. The premium under this plan is borne by your employer, and you do not have to contribute a penny towards it. Several organisations extend group medical insurance coverage to your dependent parents and children alongside your spouse.

Employee medical insurance has several advantages, including low cost and coverage without the need for a medical check-up.

Is Group Medical Insurance for Employees Compulsory?

Yes, in light of the pandemic and the nationwide lockdown caused by the coronavirus, the Insurance Regulatory Development Authority of India (IRDAI) has made it mandatory for all companies to cover their employees under this policy. However, there were no such rules in place prior to 2020. Let's take a quick look at the new guidelines.
 

• The IRDA circular dated - April 1, 2020, asked that companies should provide mandatory medical insurance to their employees.

• After the resumption of work post lockdown, companies were advised to follow Standard Operating Procedure, which included the requirement to provide medical coverage.

• The IRDA issued a circular to the providers of non life insurance plans urging them to develop cost-effective, comprehensive policies. They also advised insurers to provide prospects with simple policy wordings.

• The circular was sent to insurance companies in order for them to comply with Ministry of Home Affairs directives.

Benefits of Employee Medical Insurance
 

A mandatory health insurance scheme for employers offers a slew of benefits. A few of them are scribbled down. 
 

• Employee retention:
  
  

  In the age of start-ups, where there are countless job and business opportunities, retaining quality employees will be difficult if you do not provide basic perks. However, if you provide a healthy working environment and medical benefits to them and their family members, your employees are more likely to stay.
   

• Tax^* benefits:
   

  Employee insurance policies are advantageous to both employees and employers. Just as you save taxes on premiums with an individual health plan, the premium you pay for a corporate medical policy offers various tax^* benefits.
   

• Motivated employees:

  
  In today's world, where medical inflation is putting a dent in many people's wallets, it is also a major source of stress. As a result, if you provide comprehensive medical coverage to your employees and their families, their productivity will undoubtedly increase. 
   

• Cost-effective:
   

  Group insurance is significantly less expensive than individual plans. Furthermore, you are not required to undergo a medical assessment test to obtain coverage under them. Such policies also relax the waiting period requirements.
   

• Cashless benefits:
   

  Group health insurance, like individual and family floater plans, allows your employees to receive cashless treatment at network hospitals.
   

What is Covered under the Employer's Health Insurance?

The policy provides extensive coverage, some of which are specified below.
 

• This policy will cover pre-existing diseases from the first day your employer joins the organisation without requiring them to go through any waiting period.
• Every corporate health insurance policy covers maternity-related expenses. However, a waiting period may apply to the policy depending on the insurer and policy type.
• The policy covers pre and post-hospitalisation expenses. 
• Group health insurance also covers charges such as consultation fees, daycare treatment expenses, and domiciliary charges. 
• It will cover your employee's newborn babies from the day they are born.
• The policy covers nursing and room rent charges. Some policies also provide coverage for ambulance charges.
• It also covers diagnostic costs, pharma bills, anaesthesia, blood drip, and oxygen expenses.
• Various Group health policies also cover chemotherapy charges, pacemaker expenses, and other complex procedures. 
   

What is Not Covered Under the Employer's Health Insurance?
 

Various conditions are subject to policy exclusion depending on your corporate health plan. These are:
 

• Various types of group medical insurance do not cover the employee's parents.
• The sum insured provided by such policies is limited and may not always be sufficient to cover your medical needs.
• Such policies do not cover non-allopathic treatments such as Unani, homoeopathy, Ayurveda, and so on.
• Corporate health insurance is valid for any employee as long as they are a part of the organisation. Once they leave the company, they are no longer eligible for any perks.
• This policy does not cover cases of congenital diseases, STDs, and self-inflicted injuries. 
• The policy does not cover expenses incurred for the treatment of a drug or alcohol-related condition.
   

How to Submit a Claim Under Group Health Insurance?
 

Raising a reimbursement claim under group health insurance is a simple process that requires only a few steps. Here are the specifics.
 

• Visit your insurer's website to download the claim application form.
• Fill out the details required on the form and sign on to it. 
• Attach documents such as medical bills, hospital bills, and so on to the form and dispatch it to the insurer's address.
• After the necessary verification, the funds will be credited to your account shortly if everything is found to be satisfactory. 

Conclusion

Even though corporate health insurance is required and inexpensive, it lacks several benefits that an individual or family floater plan can provide. Thus, as an employee, look for a standard health plan and appropriate riders# to sail through a medical crisis in order to provide extensive coverage to you and your loved ones. We offer various plans with riders# for critical and terminal illness, so get the right plan today to protect yourself against any uncertainties.

L&C/Advt/2023/Jan/0141