A group health insurance plan provides health insurance coverage to a group of people, who are usually the employees of a common company, professionals in a common group or members of a cooperative society. For most of the salaried people, group health insurance comes as one of the most beneficial benefits, which is offered by an employer. The group health insurance policy helps a company to mitigate the risk faced by their employees and increases employee satisfaction as well. This category of health insurance is issued with a one-year policy term, which needs to be renewed annually to continue the coverage.
What are the coverage benefits under a Group health insurance plan?
A group health insurance policy provides cover for the insured, as specified below.
Inpatient hospitalization
A group health insurance plan provides cover for in-patient hospitalization (minimum 24 hours of hospitalization) cost incurred by the insured due to accident, illness or medical procedure/surgery. This policy covers room rent, medical practitioner fees, nursing expenses, drugs and medicines consumed in the premises, surgical fee, operating theatre, ordinary splints, plaster casts, anesthetist, anesthesia, etc.
Pre-Hospitalization
The medical costs that are incurred 30 days (varies from company to company) before the hospitalization, are covered in a group health insurance policy under its pre-hospitalization cover. The expenses under pre-hospitalization may include doctor visit, laboratory expenses, cost of medicines, etc.
Post-Hospitalization
The medical costs that are incurred 60 days (varies from company to company) after discharge from the hospital, are covered in a group health insurance policy under its post-hospitalization cover. The expenses under post-hospitalization may include diagnostic test, the fee for a doctor’s visit after being discharged from the hospital, etc.
Cashless Treatment
The insured person under a group health insurance plan can avail cashless medical treatment at the network hospitals of the insurance company. The list of network hospitals is available in the policy details of the health insurance plan.
Domiciliary Treatment
A group health insurance company provides cover for treatment taken at home on the advice of a medical practitioner, due to unavailability of bed or inability of the patient to visit the hospital. The terms and conditions for domiciliary treatment vary from company to company.
Day Care Treatment
Due to the advancement in technology, several medical treatments require less than 24 hours of hospitalization and such treatments fall under the category of daycare treatment. A group health insurance policy provides cover for daycare treatment. The list of daycare treatments covered under a policy is clearly mentioned in the policy details.
Waiver of Waiting Period
There is no waiting period in a group health insurance policy and the insured person gets covered from day 1 if the waiver of pre-existing illness has opted under the group health plan. Even pre-existing diseases are covered from day 1 of the policy. So, even if you are suffering from a disease, you still can get a group health insurance policy without any waiting period.
Note: Group Health Insurance Plan is a complete tailor-made and customized policy. The entity taking insurance can customize the policy and add or delete the benefits as per their specific requirement and budget. The premium will vary accordingly.
How does a Group Health Insurance Plan work?
A master policy is issued in a group health insurance plan, which provides health care coverage for each and every individual of the group for which the policy has been bought. All the terms and conditions of a group health insurance policy, including the exclusions and inclusions, are mostly same for every member of the group.
A group health insurance is designed to meet the need of the customer and cost-effectiveness of the product. The company or any corporate entity seeking group health insurance policy can customize the policy as per its need and budget.
Most of the insurance companies are providing the group health insurance plans under their product portfolio, but the inclusions and exclusions of the policies may vary from company to company.
How is the Group Health Insurance Premium Calculated?
The premium for the master policy is calculated on the basis of the following parameters:
- Demographic: The details of the members of the group in terms of age, income, medical condition, size of the group, etc. are analyzed by the insurance company and a specific premium rate is assigned considering demographic factors.
- Coverage Benefits: As per the policy coverage benefits opted by the employer opting for the group health insurance policy, the premium amount will vary accordingly. Higher the benefits, higher will be the premium charged.
- Past Claim Experience: Past claim experience plays a vital role in premium determination. A favorable past claim history makes a low premium charge. On the other hand, adverse claim experience will attract an additional premium for the group health policy.
- Location: The location plays an important role in determining the premium. If the people covered under the policy reside in metro cities, then the premium will increase as the health care costs in metro cities are comparatively higher as compared to other locations.
- Riders: The additional benefits in the policy, attract higher premiums. Rider offers extra and enhanced coverage to the policyholders.
How Group Health Insurance is different from an Individual Health Insurance?
A group health insurance plan offers coverage to a group of people while an individual health insurance policy offers coverage to an individual. Under a group health insurance policy even if he has some pre-existing disease, he is eligible to be a part of the group health policy while an application of individual health insurance policy can be rejected on the basis of an adverse medical condition.
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