Types of Group Health Insurance Policies in India | Niva Bupa

Health insurance plans provide financial coverage for an unforeseen medical emergency. Before buying a health insurance policy, you must know that there are various types of health insurance policies available in India. These comprise individual health insurance plans, health policy for family and group health insurance. Additionally, there are health insurance plans for specific needs, like critical illness insurance, personal accident plan and Corona Kavach. Because of rising hospital expenses, it becomes a must for every individual to avail a health policy as per one’s individual medical requirements. With a large majority of people becoming aware of the benefits of health insurance plans, group insurance policies have come under sharp focus. As compared to individual health insurance plans, group health insurance provides coverage to a group of people, like employees of an organisation or members of a society.

Types of Group Insurance Policies in India -

The two types of group health insurance available in the country are group health insurance for employees and group insurance policies for non-employees.

1. Group Health Insurance for Employees:

Here, an employer purchases a group health insurance for employees of the organisation. It also has the provision to cover immediate family-members of an employee.

Let’s have a look at the coverage of group insurance policies for employees

A. Extended Health Care (EHC)

Professional organisation, who purchase a group health insurance typically provide EHC coverage to its employees. The extent and scope of coverage, as part of EHC, can differ from one organisation to another. EHC includes prescription drug coverage, where the cost of purchasing prescribed drugs is reimbursed to an employee.

It can also provide paramedical coverage, like the expenses incurred in consulting acupuncturists, audiologists, dieticians, naturopaths, chiropodists, occupational therapists, physiotherapists, psychologists, registered massage therapists and speech pathologists.

Extended Health Care can also provide complete or partial coverage for an employee's medical care or hospitalisation-related expenses. Typically, these include expenses, like the costs of medical supplies and equipment, diagnostic services, home care, ambulance, private duty nursing, hearing aids and so on. EHC can also cover emergency medical expenses when an employee is on an official tour/visit. This provides for the expenses incurred in emergency hospitalisation, medical and paramedical costs along with coverage for repatriation and flight/vehicle/train accidents. As part of EHC, many employees also provide vision insurance, which provides coverage for eye examination, corrective laser eye surgery and prescription eyeglasses/contact lenses. 

B. Dental Insurance

This provides coverage for annual dental check-ups, teeth cleaning, orthodontics and other denture services. All major dental procedures, like periodontics, crowns, on lays and bridges are covered under the policy.

C. Life Insurance

It provides financial support to the family-members of an employee, in the case of an unfortunate eventuality.

D. Accidental Death and Dismemberment (AD&D)

It provides financial succour to an employee’s family, in the case of an accidental death. Besides, it also provides additional financial support, if an employee suffers from severe injury to limbs. It also covers loss of sight, hearing or speech.

E. Disability Insurance

It provides coverage, in the case of an employee becoming disabled due to illness, mental health issues or accidental injuries. While short-term disability insurance, typically, provides partial income to an employee for a short time-period - ranging from 15 to 26 weeks, long-term disability insurance replaces lost income, if an employee suffers from an extended disability - lasting for over 16 weeks.

F. Critical Illness Insurance

Here, employers provide financial coverage to an employee, who suffers from a life-threatening medical condition, like stroke, heart attack, cancer etc. 

2. Non-Employer Group Insurance Policies

The second type of group insurance scheme covers members of informal groups, like a particular social organisation, a group of same credit card holders, a group of people who have availed similar loans from a financial institution and so on. Each such informal group will have a group administrator, who will purchase the group health insurance for its members. The coverage of this group health insurance is contingent upon the features of the availed policy. Group members and administrators can opt for either comprehensive or basic coverage.

Advantages of Group Insurance Policies

A key benefit of group health insurance is that it provides coverage to all individuals in the group, irrespective of their existing/past health condition, lifestyle habits and claim records. Remember, in the case of  individual health insurance plans, your existing health condition, lifestyle habits, like tobacco and alcohol consumption along with past records of medical claims will impact the health insurance premiums. You can also be denied coverage if you have certain pre-existing diseases, indulge in unhealthy habits, like drinking and smoking or have made multiple health claims in the past. However, these conditions will not be deterrent in you receiving the coverage from a group insurance plan. Another advantage is that employees share the premium payment amount with the employer and receive comprehensive coverage at minimal payment of health insurance premiums. 

Conclusion

Thus, there are manifold benefits of health insurance plans, and group insurance policies are no exception. Before buying a health insurance policy, you must compare health insurance plans, and select the one that fits your budget and medical requirements.

FAQ's

What is group insurance policy?

A group insurance policy is insurance coverage offered to a group of people under a single master contract. Most commonly, employers provide group insurance to their employees, but other groups like professional associations or societies, can also offer it. The group insurance meaning lies in providing uniform coverage to all members at a lower cost than individual plans. These policies often include life, health, or accident insurance, depending on the types of group insurance policy selected.

What are the key features of group insurance?

The features of group insurance make it a cost-effective and convenient option for both employers and members. Some of the key features include:

• Uniform coverage: All eligible members receive similar benefits under the policy.
• Lower premiums: Premiums are typically lower because the risk is spread across the group.
• No medical underwriting (up to a limit): Many plans offer coverage without requiring medical tests, especially within the free cover limit in group insurance.
• Multiple options: There are different types of group insurance policies, such as group health insurance, group life insurance, and group personal accident insurance.

These features of group insurance make it an attractive employee benefit.

Who is eligible for group insurance?

Eligibility for a group insurance policy typically requires membership in a recognised group. Most commonly, company employees, professional organisation members, or welfare association members can qualify. The group insurance meaning hinges on collective coverage, so the insured members must have a common relationship. Depending on the type of group insurance policy, eligibility criteria may differ slightly; for instance, full-time employment status may be required for certain plans.

What is free cover limit in group insurance?

The free cover limit in group insurance is the maximum insurance coverage a member can receive without undergoing medical screening. It is one of the important features of group insurance, as it simplifies enrollment and ensures faster coverage. The limit is set based on factors like the group size, average age, and sum assured. For coverage beyond this limit, insurers may request medical tests. Most types of group insurance policy include a free cover limit to streamline the onboarding process.