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Group Health Insurance Plan

The rising cost of healthcare sector is burning deep holes in everybody’s pocket. With an inflation rate of almost 20%, the healthcare is going far from the reach of common people and wiping out savings of those who can afford. In such drastic situation, a health insurance plan becomes very necessary to avoid hospitalization expenses and to fight inflation. People are following a totally unhealthy lifestyle due to competition, pressure and lack of time. Such type of lifestyle is slowly pushing everybody towards diseases and illness. The current environmental condition is also making people prone to life-threatening diseases. A health insurance policy can help you to cover health issues arising due to the current lifestyle and environmental condition.

Being insured by a health insurance is imperative in todays time to have a peace of mind and be protected against skyrocketing health care costs.Group Health Insurance is one such provision which enables you to get covered yourself against all such things.

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What is a Group Health Insurance Plan?

A group health insurance policy is a type of insurance plan which provides health care insurance coverage to a group of people, who are usually an employee 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 perks, 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 also. Group health insurance policy is a policy issued for one year, which needs to be renewed annually to continue coverage.

What are the coverage benefits under a Group health insurance plan?

A group health insurance policy provides cover for the hospital expenses of the insured in the following forms:-

Inpatient hospitalization

A group health insurance plan provides cover for in-patient hospitalization (minimum 24 hours of hospitalization) costs incurred by the insured due to accident, illness or medical procedure or surgery. The policy covers room rent, medical practitioner fees, nursing expenses, drugs and medicines consumed in the premises, surgical fee, operating theatre, dressing, ordinary splints, plaster casts, anesthetist, anesthesia, etc.


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, medicine expenses, etc.


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, fee for a follow up with the doctor 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 condition for domiciliary treatment varies from company to company.

Day Care Treatment

Due to the advancement in technology, many medical treatments require less than 24 hours of hospitalization and such treatment falls under the category of day care treatment. A group health insurance policy provides cover for such type of day care treatment also. The list of day care treatments covered under a policy is clearly mentioned in the policy details.

Waiver of Waiting Period

There is no any waiting period in a group health insurance policy and the insured person gets cover from day 1 if waiver of preexisting disease has been opted under the group mediclaim policy. 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.

Most of the insurance companies are providing group health insurance plan under their product portfolio, but the inclusions and exclusions of the policies may vary from company to company.

To design a group health insurance, the company’s representative and the insurance company work together to customize the product according to the need of the customer and cost-effectiveness of the product. That’s why a lot of customization is done to design a group health insurance policy.The company seeking group health insurance policy can customize the policy as per its need and budget.

How is the Group Health Insurance Premium Calculated?

The premium for the master policy is calculated basis 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 an important role in premium determination. A favorable the past claim history, lower will be the premium charges. On the other hand, adverse claim experience will attract an additional premium for the group health policy.
  • Location: The location plays an important role too in the premium determination. If the people covered under the policy reside in metro cities , then the premium will on the higher side as the health care costs in metro cities is comparatively higher as compared to non metro locations.
  • Riders: The additional benefits in the policy, attract higher premiums. Rider offers extra and enhanced coverage to the policy holders.

Best Group Health insurance policies

  • Future Generali Group Health Insurance
  • ICICI Lombard Group Health Insurance
  • Bajaj Allianz Group Mediclaim Policy
  • HDFC ERGO Group Medical Insurance, etc.

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 alone. In addition to this, under a group health insurance plan, very limited customization is allowed, related to the limitation of the sum insured, option of riders, expansion of benefits as the employer decides the entire framework of the policy conditions and benefits. On the other hand an individual health insurance policy, one can completely customize the product as per his personal need and requirement. Under a group health insurance policy even if he has some pre-existing disease, he is eligible to be a part of the group mediclaim policy while an application of individual health insurance policy can be rejected on the basis of an existing medical condition.