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What is Group Insurance – All You Need to Know
Organisations take several initiatives to boost the morale of their employees and ensure their well-being. One such measure is providing them with group health insurance. As the policy is bought by the company, the employer bears the insurance cost, while employees can enjoy the coverage benefits. The coverage is similar for all employees with a uniform sum insured amount. If you want to know what group medical insurance is, read on to get your answer.
What is a group health insurance plan?
Group health insurance is a type of medical insurance coverage that secures a group of people, specifically employees of a company or members of an organisation. With a group health insurance plan, as an employer, you can cover multiple members of the company, which pools the risk and spreads the insurance cost. For the employees, the policy provides coverage against medical expenses incurred on doctor’s consultations, hospitalisation, surgeries, and more. The scope of coverage depends on the sum insured and specific features in the type of policy chosen by the employer.
How does the policy work?
Under a group health plan, the employer selects a standard medical insurance policy that employees can encash to treat various medical conditions. The employer bears the cost of premiums, offering the policy as a perk for being a part of their organisation. In some cases, the insurance costs are partially shared between employers and employees.
When employees need to use their medical policies, they simply need to inform the insurer and seek admission in a hospital. They must present their insurance card or employee ID number to the healthcare provider. Employees have the option to seek cashless treatment at network hospital or at their preferred healthcare centre, and file a reimbursement claim later.
Eligibility criteria for buying a group health plan
The standard eligibility criteria to qualify for group health insurance coverage are:
- Indian citizenship
- Employees aged between 18 to 65 years.
- The company offering group health insurance must have at least 20 employees.
Note: The eligibility criteria may vary from one insurer to another. Employers seeking to provide group health coverage must check the same on the insurer’s website or contact them for more clarity.
Factors to consider while buying a group health insurance policy
Now that you know what group health insurance is, you can consider the following factors to make an informed buying decision:
Coverage and wellness benefits
Customer support
Network hospitals
Claim settlement ratio
Policy limits
While deciding on a group health insurance policy, it is important to select sufficient coverage to address the average medical expenses of your employees. You can consider the demographics of employees to determine the suitable coverage. Additionally, you can look into wellness benefits like free consultations, mental health counselling, discounts on laboratory tests, etc.
The quality of customer support provided by the insurer plays a crucial role, especially when filing claims during medical emergencies. Hence, it is critical to evaluate the responsiveness, availability of helplines, and online assistance for clarification or doubts or to address concerns. You can check this aspect to choose the right insurance provider.
Insurance companies tie up with hospitals to form a cashless network, thereby facilitating smooth claim settlement. The policyholder can simply get admitted to one of the network hospitals, and the billing process is carried out by the insurer. This eliminates the hassle of clearing bills. As the sponsor of the policy, employers should check if the hospital network affiliated with the insurer is wide enough.
Claim settlement ratio refers to the percentage of claims that an insurance company successfully settles against the number of claim requests received. It is a measure of how effectively an insurance company processes claims. Comparing insurers based on their claim settlement ratio ensures efficient and hassle-free claim processing.
Reviewing the policy limits gives you clarity on the scope of coverage. Policy limits include exclusions, room rent limit, sub-limits for specific treatments or services, and the maximum sum insured amount. You can check these limits to ensure the coverage adequately meets the healthcare requirements of the employees and minimises the chances of unexpected financial burden.
How do you buy it?
You can follow the steps mentioned below to buy a group medical plan online and offline:
Online process
Research and compare different insurance providers online.
Visit the official website of your chosen insurance company.
Select the group health insurance plan.
Provide details about your company strength, demographics, age groups, and other requested information on the online application form.
Customise the plan by selecting the desired coverage options, policy limits, etc.
Review the insurance quote and policy terms carefully.
Once satisfied, pay the premium amount via online payment modes.
After processing your payment, the insurer will send you the policy documents via email.
Offline process
Reach out to your preferred insurance company via phone or email to inquire about the group health insurance plan.
Schedule an appointment with the insurance representative to discuss your requirements and explore suitable options.
Fill in the physical form with the required details of employees.
Coordinate with the insurance representative to customise the plan based on your requirements.
Review the proposal, which includes the coverage details, premium amount, and policy terms.
If you have queries about the proposal, you can get them resolved through the insurance representative.
If you are satisfied with the policy terms, make the premium payment to finalise the buying process.
After processing your payment, the insurer will send you the policy documents physically or via email.
Advantages of group health insurance
Some of the notable benefits of group health insurance are as follows:
No pre-medical health check-ups
No Streamlined claim process
Tax benefit for employers
Default healthcare coverage for employees
Cost-effective investment
When applying for a group health insurance policy, you will not come across a pre-medical health check-up requirement, which is generally the case with most health insurance plans. With no health check-up requirement, the group health insurance buying process is simplified and hassle-free. The employees need not go through the formality to get coverage.
The claim process in group health insurance is streamlined owing to various efficient services offered by the insurance provider. The cashless facility helps employees get medical attention without the hassle of paying bills. Besides, insurers have robust websites and interactive apps that make it easier to file claims and get prompt assistance.
The Income Tax Department allows employers to claim tax deductions for providing group health insurance coverage to their employees. Hence, a group health insurance policy proves to be a tax-saving investment for companies. The premium paid towards the group health plan can be specified as a business expenses in the company’s profit and loss statement to claim tax deduction.
As an employee, you need not initiate the group health insurance buying process, neither do you have to pay the premium. All the formalities are carried out by the employer. You get the insurance coverage as a default benefit for working in the company. You can enjoy the coverage benefits until the time you are employed with the organisation.
As the coverage in group health insurance is spread across a group of employees, the risk is shared across a larger group. Hence, insurance companies offer a lower premium on group health plans compared to individual insurance plans. Besides, non-consideration of the pre-existing illnesses of the employees before buying the policy further reduces the insurance cost.
Group insurance – what is the right way to go about it?
Now that you have a clear understanding of what group insurance is and the numerous benefits it entails, you can consider exploring its potential for your own organisation. The SBI General Group Health Insurance Policy provides excellent coverage, covers the cost of nursing expenses, provides individuals with tax exemptions and also does not require a medical check-up up to 65 years of age. Learn more about the Group Health Insurance Policy here.
FAQs
Who can purchase a group health insurance policy?
Any organisation with a team strength of 20 or more employees can purchase group health insurance plans to cover the medical needs of their organisation's members. Thus, companies can buy a group health plan for their small-scale enterprises, medium-sized businesses, or a large-scale organisation. They can check their chosen insurer's eligibility criteria for more clarity.
If I am covered under a group health coverage, can I still buy individual health insurance?
Yes, you can. If you feel that the coverage under the group health insurance plan is insufficient, you can opt for an individual health insurance policy. This way, you can enhance your coverage with a higher sum insured, which proves valuable during long-term ailments. Plus, you can customise the individual health insurance plan with add-on riders.
What is covered under group health insurance plans?
The extent of coverage under group health insurance plans typically mirrors regular health insurance policies. It includes a range of healthcare services, such as doctor visits, hospitalisation costs, prescription medications, preventive care, etc. Some policies also come with specialised coverage for eye and dental treatment.
What is group insurance premium?
The group insurance premium is the amount paid by the employer to cover the insurance coverage costs of their insured employees. In the case of a shared premium, both employers and employees partially pay the insurance premiums. The premium is typically paid while buying the policy and renewed every year to keep the policy active.
What happens to group insurance coverage when the employee leaves the company?
When an employee leaves the company, the group insurance undergoes a change. In most cases, the group insurance coverage is ceased after the employee's termination. However, if the employee chooses, they can continue the coverage. They can do so by converting the group health policy into an individual health insurance plan. The possibility depends on the company's and insurer's terms.
Do group health insurance plans cover employees' specific medical needs?
The medical needs covered under a group health plan depend on the type of coverage chosen by the employer. As an employee, you can check the coverage under the group health plan and assess if it aligns with your healthcare requirements. If not, most insurers provide the option to upgrade the policy. Alternatively, you can invest in an individual health insurance policy separately.
Is my family covered under group health insurance?
Whether or not your family is covered under group health insurance depends on the policy's terms. Most group health insurance plans cover family members, including the employee's spouse, parents, and dependent children. Other plans may consider the ages of all family members, thus restricting coverage if their age exceeds a threshold.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
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Health Insurance
How to File a Health Insurance Claim?
With the rising medical expenses and changing lifestyles, it has become imperative to purchase a comprehensive health insurance plan in today‘s time. Additionally, the recent COVID-19 pandemic has further established the importance of health insurance even firmly. A health insurance policy is the finest way to receive the best medical treatment without burning a hole in your pocket.
Be it an unforeseen medical emergency or a planned treatment, a health insurance policy can always come to your rescue. However, to avoid any last-minute hassle, you must be well aware of the process to file a health insurance claim beforehand. Below is a quick guide on how to file a health insurance claim.
But firstly, let‘s understand what a health insurance claim is.
Health Insurance Claim
A health insurance claim is a request that a policyholder must submit to the insurer for getting the services that are covered in their health insurance policy. Depending upon their convenience, policyholders can either opt for a cashless claim settlement option or reimbursement for the availed medical services.
Cashless Claims
For cashless claims, the insurance provider settles the hospitalization bills directly with the hospital. However, to get the benefits of a cashless claim, the policyholder should be hospitalized only at a network hospital of the insurer.
Reimbursement Claim
In case of reimbursement claims, the policyholder pays for the hospitalization expenses and later requests for reimbursement by the insurance company. The reimbursement facility can be availed at both network and non-network hospitals.
Now that you are well aware of the types of health insurance claims, let‘s understand how to file a health insurance claim
How to File a Health Insurance Claim?
1. Get in touch with the insurance help desk at the hospital
2. Show the ID card of the insured provided by the insurance company
3. The hospital will verify the insured‘s identity and will submit the pre-authorization form to the insurance company
4. The insurance company will then review all the documents submitted and process the claim as per the terms and conditions of the health insurance policy.
5. For reimbursement claims, you will also have to submit original bills to the insurance provider. The insurer will then evaluate the claim and make a payment to the insured. In case the treatment is not covered under the health insurance policy, the claim will be rejected.
Make sure that you have the following documents readily available with you before filing a health insurance claim.
Documents Required to Make a Claim
Valid photo ID cards such as Aadhaar, PAN, and Driving License
Copies of prescription for diagnostic tests, treatment advice, and medical references
Original set of investigation reports
Original hospital and pharmacy bill
Original discharge card or discharge certificate
It‘s always advisable to opt for an insurance company with a high claim settlement ratio and a large number of network hospitals. This makes the claim settlement process completely hassle-free.
Frequently Asked Questions (FAQs)
1. When can my health insurance claim be rejected?
Your claim can be rejected if you file a claim for an ailment that isn‘t covered by your health insurance policy. Moreover, your claim can also be rejected if you fail to submit the necessary documents or file a claim during the waiting period
2. What is the minimum time limit for hospitalization to make a health insurance claim?
You can file a claim if your hospitalization is for more than 24 hours. However, for certain treatments, such as dialysis, chemotherapy, etc., the stay could be less than 24 hours
3. What is claim settlement ratio?
The claim settlement ratio is the ratio of number of claims paid to the number of claims received
Health Insurance
All About Adding Spouse To Health Insurance After Marriage
Marriage brings a lot of changes in your life. Not only does it affect your lifestyle, but it also requires you to switch your investments in a way that are better suited for a family. You will now want to include your spouse to your financial world by adding them as a nominee in your banking accounts and other investment assets. Amidst all these personal and financial changes, do not forget to add your spouse to your health insurance plan. Adding spouse to health insurance after marriage is quite easy and can be done in three ways.
Buying a new family floater plan
If you do not have an existing health insurance plan, now would be a great time to invest your money in a family floater health insurance plan. Health insurance plans for family members cover your spouse, parents, and dependent children. The family floater plan allows you to pay a single premium to cover all named family members for medical expenses.
When buying a family floater plan, do ensure that it offers adequate coverage for you and your family. It is also important to keep in mind that the coverage amount is directly proportional to the health insurance premium you need to pay. This means that a family health insurance plan that offers a sum insured of Rs 10 lakh will require you to pay lower premium as compared to a family health insurance plan that offers coverage of Rs 20 lakh. However, it is advisable to opt for a higher sum insured if you have senior members in the plan.
Adding spouse to insurance after marriage
If you already have an existing health insurance policy, you can extend the cover to your spouse by adding their name to the policy after marriage. Upon adding you spouse, the individual health insurance plan will be transformed into a family floater plan. Since the coverage amount will increase, the premium of the policy will be recalculated. You can also add your spouse to your existing health insurance policy at the time of its renewal. You will need an application form and a few KYC documents like identity proof, residence proof, marriage certificate and photographs, to get this process started. You can easily get the application form from the insurer’s website.
Adding your spouse to the health insurance plan offered by your employer
There are many companies that offer health plans to their employees. These plans usually extend the coverage to the immediate family of the employee. However, this condition varies from one insurer to the other. Hence, it is better to check with your insurance company if they allow you to add your spouse to the existing health insurance plan that is issued by your employer. Here, it is important to remember that the health insurance policies offered by employers are group insurance plans and may, therefore, have certain limitations to coverage. Still, these plans offer a great option for coverage in case you don’t have health insurance of your own.
It is quite important to avail the health insurance cover for your spouse after marriage. This can help the both of you to securely plan your financial future.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
Health Insurance
Steps of adding spouse to health insurance after marriage
Marriage is a huge step in everybody’s life. And personal finance has a big role to play for a successful married life. Therefore, it is important to update the financial records, including the health insurance plan, post-marriage.
In case you did not have an individual health insurance policy before the wedding, you can invest in a family floater plan for yourself and your spouse. In case you already have an individual health insurance policy at the time of wedlock, then you do not need to buy another one for your partner. Instead, you can add your spouse to the plan and convert it into a single policy. It is a feasible and simple way of ensuring that you and your partner are adequately covered.
Porting health insurance after marriage is also important. When one of the partners already owns a plan, you simply need to add another partner to the current policy as the spouse. There is no specific rule which specifies who can add the partner. The process of adding the spouse to health insurance after marriage is simple. The one who owns the policy can start this process with the submission of KYC documents such as identity proof, proof of age, photographs and marriage certificate.
The change will come into effect in the next policy renewal by just submitting the additional form and paperwork. Once you do this, the premium will be calculated and pro-rated. It will become a family floater insurance policy that covers all the members of the family for a single premium. You will not have to worry about paying separate premiums for each member of the family. It will cover the entire family at the lowest premium based on the age of the members in the family. Let us take a look at the benefits of a family floater plan.
A major perk of the floater plan is that you can cover yourself and your entire family in one policy. The policy is easier to handle and you do not have to worry about handling separate individual plans
You enjoy additional benefits like a newborn cover, maternity benefits, etc. It will be highly effective for young married couples who are on the road to starting a family. You must ensure that you choose a plan that covers yourself and the spouse and invest in one right after marriage
You must also get maternity cover at the earliest. It has a waiting period between 0 to 4 years and if you buy the cover on time, you will be able to enjoy the maximum benefits
With a family floater plan, you enjoy the same tax benefits under Section 80D as you do on individual health insurance
Many plans come with a reinstatement feature where you enjoy the reinstatement of the entire coverage after it is exhausted in the policy period. This is only applicable to unrelated claims but it is very useful.
If you do not have a policy and are looking to buy one, consider a joint life policy. It will work on the same lines and will provide coverage to your children in future if anything unfortunate happens to the parents. The main reasons couples should think of joint life insurance are premium reduction and waiver benefits. In this case, if one partner dies due to an unfortunate event, the spouse will not only be entitled to enjoy the full sum assured on the cover but will also be absolved of the responsibility of the payment of premium. Alternatively, the spouse may have to pay premiums only applicable for their own cover for the remaining period of the policy.
After your marriage, it is your responsibility to ensure the safety and adequate coverage of your spouse. You must include your spouse in the decision and speak to them about the coverage you wish to buy. Only then proceed with the decision. The right health insurance plan will offer acomplete protection and peace for the future.
Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.
Health Insurance
Advantages of Group Health Insurance
As the name suggests, group health insurance is aimed to offer health insurance cover to a group of people, usually employees, and if offered by an employer. It can also be offered to members of a professional association or a society. As compared to individual insurance, group insurance has many benefits for the employee as well as the employer who offers the insurance.
Comprehensive cover: Group health insurance plans offer wide coverage and can be customised by the employer. It comes with many benefits like cashless healthcare services at network hospitals. There is no waiting period which means the employee is covered from day one. Besides personal accident cover, some group health insurance plans offer cover to family members of the employee.
Guaranteed cover: All employees and in some cases their dependants are covered, even if they have existing medical conditions. A group insurance policy doesn't require a separate medical check-up. As long as an employee is working for the organisation offering group health insurance, he or she shall remain covered under the plan.
Low premium: As group health insurance plans are bought for a larger group of people, they offer comprehensive cover at affordable rates. The costs are much lower than individual health insurance plans. Group health insurance plans can be customised as per the employer’s budget and requirements.
Tax incentive for the employer: Besides safeguarding employees from health issues, group health insurance plans also provide tax benefits to the employer. Under Section 80D of the Income Tax Act, tax relief is offered to businesses that give their employees the benefit of group health insurance.
Happy employees: When companies offer health insurance plans to their employees, they help retain and attract good talent. A Group Health Insurance plan is a significant part of the employees’ total compensation. A group health insurance plan provides employees with financial security against accident and illness.
Rider options: With a nominal extra payment, employees can take advantage of other additional benefits. The employee can also opt for a corporate plan along with the base plan offered by the employer. The riders may differ from one organisation to another.
Provide your employees SBI General Group Health Insurance
Group health insurance is a very important benefit that makes employees feel like a valued part of an organisation. It helps companies retain as well as attract talent. SBI General Group Health Insurance plans offer multiple coverages: Individual, family floater. It offers wide coverage from Rs 1 lakh to Rs 7.5 lakh. The group health insurance plans offer pre- and post-hospitalisation expenses. With SBI General group health insurance plans keep your employees happy.
Disclaimer: SBI General Insurance Company Limited I Corporate & Registered Office: 'Natraj', 301, Junction of Western Express Highway & Andheri - Kurla Road, Andheri (East), Mumbai - 400 069. | The information in the advertisement is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale. * ‘Tax benefits are subject to changes in tax laws’ I 'For SBI General Insurance Company Limited IRDAI Reg. No. 144 dated 15/12/2009 | CIN: U66000MH2009PLC190546 | SBI Logo displayed belongs to State Bank of India and used by SBI General Insurance Co. Ltd. under license. | Website : www.sbigeneral.in,Tollfree 18001021111 | UIN: SBIHLGP21330V022021 | ADDIG/20-21/AUG/652
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