Group Medical Coverage (GMC), Group Personal Accident Insurance (GPA), Group Term Life (GTL), and Frequently Asked Questions (FAQ)
Group Medical Coverage (GMC): The Group Medical policy covers expenses by the insured persons on account of hospitalisation due to sickness or accident. The policy covers expenses incurred on room rent, medicines, surgery, etc. Expenses for hospitalisation are payable only if a 24-hour hospitalisation has been taken. (Except for named day-care procedures, which do not require a 24-hour hospitalisation). Under such schemes, the typical expense heads covered are; room/boarding expenses as provided by the hospital, nursing expenses, surgeon’s fee, anaesthetist’s fee, medical practitioner fee, consultant fee, specialist fees, anaesthesia, blood, oxygen, operation theatre charges, surgical appliance, medicines, and drugs, diagnostic material and x-ray, dialysis, chemotherapy, radiotherapy, cost of the pacemaker, artificial limbs, and similar admissible expenses. These policies are tailormade to the individual requirements of the company. The major factors taken into account while building the policy structure are the employee experience, market benchmarking, long term strategic alignment with company philosophy and pricing considerations.
Hassle-free claim management: Fast, fair, and transparent claim procedure, third-party administration for claims processing, with largest network strength for seamless cashless support hospitals in the network list, and customer support services.
Group Personal Accident Insurance (GPA): A personal accident cover the employee against any financial loss caused by an accident which may results in loss of life and / or partial or permanent disability. The policy covers injury that is caused due to an accident that immediately or eventually results in accidental death, total disability, permanent partial disability, and total disability or weekly indemnity. These policies are tailormade to the individual requirements of the company.
Group Term Life (GTL): Group Term life -. This Insurance cover provides financial security to the dependents of the employee in case of an unfortunate death due to any reason. This provides the employee a hassle-free financial security while it benefits the employer as a strong retention tool and a loyalty-building measure.
Frequently asked questions (FAQ)
What is group health insurance?
A group's medical needs are covered through a group health insurance plan. Because employers are responsible for paying the group medical insurance plan's premiums, it is typically acquired by businesses or organisations to offer additional medical coverage to their employees as a benefit.
Why is group health insurance required?
Organisations today are focused on their employee wellbeing more so than ever. They provide employees with health insurance policies. Group health insurance programs are advantageous for both employers and employees for a variety of reasons, including the following:
- Broad coverage and better benefits: Most group health insurance plans offer their employees broad coverage and extensive benefits.
- The ability to have customised coverage is available with group and corporate health insurance policies. An employer might select a plan that offers OPD or maternity coverage, for instance.
- Reasonably priced premiums: When comparing group health insurance with individual health insurance, the group plans are more reasonably priced. This is because group health plans always have greater rates of coverage one receives.
- Since group health insurance plans are tailor-made, they can extend day 1 coverage for pre-existing diseases, and waive off all other ailment-specific waiting periods.
- It acts as a financial support to employees and their dependents in case of medical needs as well acts as a retention tool for employees.
What are the advantages of group health insurance?
Benefits of group health insurance for employers:
- Broad coverage and better benefits: Most group health insurance plans offer their employees broad coverage and extensive benefits.
- Supports in employee retention: Retaining employees has become challenging in the present era due to the job market demands. However, the chances are high that employee stays with the company in if they are offered advantages like health insurance coverage to themselves as well as their families.
- Tax benefits: Because both the employer and the employees are entitled to gains under a group health insurance plan, as was already indicated, the employer benefits financially by offering such policies to its staff.
- Motivated employees: Having a business health insurance plan today, when medical costs are at their highest, inspires employees.
- Better benefits at low cost: Employee health insurance offers better benefits at a comparably lower cost.
What are the key features of group health insurance?
There are numerous group health insurance plans and company health insurance options on the market. The following are some elements that all employee health insurance plans have in common.
- Employer-sponsored health insurance often provides medical coverage for the insured (themselves), spouse, children, and parents who are dependent on them.
- Provision to cover maternity related expenses and pre-existing conditions.
- At network hospitals, employee health insurance provides cashless hospitalisation.
- Additional expenses like ambulance costs may also be covered by group health insurance.
- Some health insurance plans for employees reimburse specialists' and other medical professionals' fees for subsequent examinations.
- The group health plan does not need any prior medical examinations.
- Group health insurance is more affordable when compared to standalone health insurance plans. It assists in lowering the risk and liability associated with employee claims for the business.
- There are provisions to introduce voluntary solutions for coverage enhancement or parental enrolment with flexible age bands going all the way up to 100 years.
- D&I based benefits can also be included, which extends to same-sex partner, live-in partner, infertility, adopted child, surrogacy, dependent sibling, mental health counselling etc.
- Provision to cover outpatient (OPD) related expenses which involve routine consultation with a general practitioner or a specialist, pharmacy expenses for disease management, and diagnostics.
How to claim group health insurance?
To submit a cashless claim for group health insurance, follow these steps.
- Complete the pre-authorisation paperwork at the hospital's TPA desk.
- A pre-approval is disclosed to the insurer by the TPA.
- The insurer provides approval along with an initial sum.
- Following the completion of treatment, the final pay-out is made by the terms and conditions of the insurance plan.
For a reimbursement claim under the group health insurance plan, follow the procedures below.
- After being hospitalised, notify your insurance company right away.
- Send in the claim form and any other paperwork within stipulated time of being discharged.
- Gather each original copy of each bill, document, and summary of discharge.
- After reviewing the policy's terms and circumstances, the insurer will handle the claim.
- Submit a voided check to transfer the funds.
- After receiving all the information, the insurer will transfer the money within 15 days.
Note: It is advised that the policyholder keep a copy of all relevant paperwork and claim forms on hand. Some insurers support paperless processing of claims.
What Is group personal accident insurance?
Group Personal Accident Insurance protects its members against mishaps that result in death or injury. It is frequently offered as corporate group insurance for staff members, business owners, and board members. Accidents can result in both permanent or temporary physical disability as well as a financial catastrophe for the victim and his or her family. We are all susceptible to accidents in our daily lives, and if the accident involves the family's primary provider, things might get complicated. Therefore, it is crucial to choose an insurance policy that offers compensation in the event of an accident that results in disablement or death Group accidental insurance policies are a solution introduced to meet these needs of the enterprises. These policies provide all-inclusive protection for the group against unavoidable disability and death, subject to chosen policy T&C.
How to claim for group personal accident insurance?
To submit a claim for group personal accident insurance, follow the steps listed below:
Claim assurance:
- Notify the HR of the company who would then liaison with the insurer/ advisor to inform them of the accident.
- The insurance company records the claim after receiving the notification.
- Once the claim is filed, the insurance provider provides the insured with the claim form along with a list of all the needed paperwork.
- Surveyor may be arranged and after completion of necessary due diligence the claim is then approved and processed further.
- The claim is processed by the merits of the policy after receiving the necessary documentation.
Claim Settlement:
- The claim is processed, and a check is created and issued to the applicable insured after all pertinent documentation and a properly completed claim form have been received.
- The claim settlement team notifies the insured, the point of contact in question, the beneficiary, and the organisation's HR when the claim is denied in a refusal letter.
How to claim group health insurance?
To submit a cashless claim for group health insurance, follow these steps.
- Complete the pre-authorisation paperwork at the hospital's TPA desk.
- A pre-approval is disclosed to the insurer by the TPA.
- The insurer provides approval along with an initial sum.
- Motivated employees: Having a business health insurance plan today, when medical costs are at their highest, inspires employees.
- Following the completion of treatment, the final pay-out is made by the terms and conditions of the insurance plan.
What is a group term life insurance?
An employer provides group term life insurance to support an employee's family in the tragic event of the employee's passing. It is designed to help the insured's family to sustain any immediate expenses and stabilise while they cope-up with loss.
What is the difference between individual life insurance and group term life insurance?
An organisation's whole workforce is meant to be covered by a single plan under a group insurance policy. The employer completes all the paperwork required to buy this insurance. Individual life insurance, however, as its name implies, only protects a single person (you and in some cases, your spouse). Unlike group term insurance, which is often an annual plan, these must be purchased by the individual, and the premiums must be paid for a certain period (normally more than 3 years). Another significant distinction is that group insurance premiums can be negotiated depending on group size and claim history, but individual-term insurance rates are set.