GMC and GPA (In Medical Insurance): What is the Difference?

Employee satisfaction is among the most important factors influencing an organisation's productivity. It has a significant impact on how a company thrives and stays competitive. Employers provide various benefits, such as privileged leaves and insurance, to keep employees happy and engaged.

Employers cover their employees through various insurance policies, the two most common of which are Group Medical Coverage (GMC) and Group Personal Accident Policy (GPA). These policies assist employers in covering the costs that must be incurred due to unfortunate workplace incidents. In addition, these policies cover employees' medical and financial needs and ensure their well-being.

This article elucidates the main features and differences between these two standard employee benefit plans.

Understanding Group Medical Coverage (GMC)

Group health insurance or group medical coverage in health insurance is a medical benefit that covers all medical expenses in case of hospitalisation and other health expenses (only under certain conditions agreed upon by the two parties)

Scope

Medical emergencies faced by employees that would require hospitalisation and expensive treatment. A GMC medical insurance covers pre-and post-hospitalisation charges, as well as daycare charges.

Coverage Type

An employee's medical expenses will be covered under GMC medical policy as long as the expenses are equal to or less than the sum insured limit. For example, if the sum insured is 4 lakhs and the expenses amount to 2 lakhs, all the expenses will be covered under GMC medical insurance. This means that most GMC coverages are based on an indemnity basis.

People Covered

Although this depends on the agreement between the insurer and the employer, GMC medical policies cover the whole family (including spouse, parents, and children) along with the individual. 

Coverage Range

Wide coverage range. GPA can be included in GMC medical insurance as an add-on, widening the range.

Customisation

GMC in health insurance can be customised by the employer.  In certain circumstances, the employee using the services can additionally customise the GMC to meet his or her own needs.

Inclusion

GMC medical policies are a boon when faced with hospitalisation cases. Here is a list of expenses they cover:

• Hospitalisation costs
• Pre- and post-hospitalisation expenses
• Daycare expenses
• OPD or Outpatient Department expenses (only as an add-on)
• Maternity cover

Exclusion

We have tried to jot down common exclusions from GMC medical insurance. For a detailed overview, you must consult the Policy Wordings. Here are some common exclusions from GMC insurance. For a detailed overview, you must consult the policy prospectus.

• Drug and alcohol abuse
• Self-inflicted injuries
• Treatments not specified under the policy
• Mental illnesses

Ideal For

GMC medical insurance is ideal for almost every employee-employer set-up, irrespective of industry.

Understanding Group Personal Accident Policy (GPA)

It is an employee benefit plan that covers all expenses of an employee in the face of injuries or accidents that might cause deformities or even death. GPA in health insurance is also called a 24-hour worldwide accident policy, as it comes with international coverage.

Scope

All expenses related to accidents or injuries that require serious treatment are covered under GPA insurance coverage. A GPA insurance coverage may cover on-duty and off-duty expenses per the terms and conditions. Although GPA benefits can be extended to employees in any industry, GPA insurance coverage suits employees in high-risk industries such as oil and gas, construction, and travel.

Coverage Type

The coverage type differs from GMC medical policy. The coverage type of GPA in medical insurance is based on benefits. The person insured will be given a lump sum amount depending on the nature of the injury. For example, if the sum insured of a GPA is 50 lakhs but the accident results in total disability, then all expenses will be borne by the insurer.

People Covered

A GPA is extended to cover family expenses. It is usually limited to the individual.

Coverage Range

Only accidents and serious injuries will be covered under GPA insurance coverage. Thus, a GPA has a narrow range of coverage. 

Customisation

Generally, customisation is not applicable with a GPA benefit.

Inclusion

The exact inclusions under GPA vary according to the terms and conditions. However, here are some inclusions that feature under GPA:

• Death due to accident
• The dismemberment of any body part
• Permanent disability (total and partial)
• Education of children
• Some add-on benefits like medical expenses incurred due to accidents and a daily allowance for hospitalisation

Exclusion

GPA health insurance does not extend its benefit in certain cases. If the injury has been caused by self-inflicted harm or involvement in adventure sports or illegal activities. 

Comparing GMC and GPA

The main difference between GMC and GPA in medical insurance is the range of services they provide. GMC stands for Group Medical Coverage, which is a type of health insurance plan typically offered by employers to their employees. The employer pays a part of the premiums, and the employees pay the remainder. This plan covers various medical expenses, including doctor's visits, hospitalisation and prescription drugs.

GPA stands for Group Personal Accident policy, a type of health insurance that provides a set level of coverage in case of an accidental emergency. This plan offers a fixed premium, and the insurer pays the full cost in the case of total or partial physical disability. This plan provides more comprehensive coverage than GMC but is more expensive and may only be available in some areas.

Overall, GMC and GPA in medical insurance offer different types of coverage. GMC provides a more affordable option to employees, while GPA offers a more comprehensive coverage option. Therefore, it is essential to research and compare both options to determine the best fit for your needs.

Now that you know your employee benefits well, it will be easier for you to plan for your health emergencies better. While enjoying the benefits of an employee welfare plan is excellent, investing in personal health insurance for yourself and your family is also wise. Visit the Niva Bupa website for details on a list of health insurance plans designed to suit every need.