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Group Health Insurance Plans & Policies

Group health insurance is a collective health insurance policy offered to a group of individuals. This plan allows companies, organisations, banks, and even housing societies to procure health insurance for their staff or members. The employer pays the premium of this policy while all employees and their families can avail the benefits. A group health insurance plan is beneficial for both employers and employees. While the employees get health coverage benefits, the employers get an increased chance of an employee staying in the company. In addition, the employer also gets tax benefits for providing such policies to employees.

Features of group health insurance policy

Here are the key features and benefits of Group Health Insurance Policy:

  • Comprehensive coverage

    The policy provides comprehensive coverage for medical expenses, including the cost of specialists, ambulances, medicines, and more.

  • Medical benefits

    The policy offers comprehensive coverage against medical expenses incurred due to a wide range of health problems, including hospitalisation in the case of an accident and daily hospital benefits.

  • Coverage for dependents

    A group/ employee health insurance policy offers an option of covering the employee’s spouse and children under the plan at a reasonable additional cost.

  • Save time and money

    Group health insurance plans are perfect for saving time and money. It is one of the best options for employees working in the same organisation. The insured group also gets discounts and waivers in this kind of insurance.

  • Cashless claims

    Avail cashless claims facility for medical treatments at all network hospitals.

  • Flexible terms

    With group health insurance policies, you can choose the policy term according to your needs and group size.

  • Education loan scheme

    Apply online

    You can apply for the group/ employee health insurance online in a few easy steps.

  • Extended benefits

    Get a medical cover for pre-existing diseases or maternity expenses with an add-on cover.

Benefits of Group Health Insurance Policy

Tax Exclusions

Companies that offer group health insurance book a tax rebate for themselves and their employees.

Higher Benefits In Lower Costs

Employers can derive better cost propositions by negotiating premiums on group insurance plans that cover many employees. Employees also benefit from better plan features compared to retail health insurance plans.

Better Talent Retention For Employees

Group health insurance policies can be a motivator for better employee engagement and building a better employer brand.

Risk-Free Work Culture

Group health insurance refers to the health insurance plan covering a group of people working under the same organisation. One of the biggest advantages of group health insurance is that the employer bears the premium.

Under this insurance plan, you can get coverage against medical expenses related to illnesses, diseases, and accidents. Additionally, it also covers pre-and post-hospitalisation charges. The policy provides cashless facilities and direct settlement of expenses with the hospital. Under certain circumstances, the policy can also be extended to the employee's family members. You can add the member's spouse and up to three children aged between three months to 25 years or other dependents for an extra cost.

Apart from this, offering group health insurance also indicates an employer's emphasis on employee well-being. The plan provides assistance and safeguards members from bearing financial expenses that may occur uninvited.

Group health insurance plans offered by Bajaj Finance

Insurance provider Waiting period (pre-existing diseases) Claim ratio Renewability Network hospitals
Aditya Birla Group Activ Health (ABCD) 2 years 94% - 8000+
Aditya Birla Super Top-up NA 94% - 8000+
Bajaj Allianz Global Personal Guard Policy NA 98% - 6500+
ManipalCigna Pro-health Group 2 years 91% - 6500+
ManipalCigna Pro-health Group 4 years 96% - 7000

What is covered in Group Health Insurance?

A group health insurance covers the following things:

  • Group health insurance covers a group of members under the policy.
  • It covers medical expenses related to illnesses, diseases, and accidents. Additionally, it also covers pre-and post-hospitalisation charges.
  • Group health insurance policy can also add a member's spouse and up to three children, aged between three months to 25 years, or other dependents for an extra cost.
  • The policy provides cashless facilities and direct settlement of expenses with the hospital.
  • Domiciliary expenses can also be availed.
  • The pricing of employee health insurance or corporate health insurance plans differs from company to company as every company has a different employee strength.

Why is group health insurance required?

With the constantly changing scenarios worldwide, it has become crucial to take care of one’s health and build a plan to secure the financial requirement that could arise due to health-related concerns. This shift has made group health insurance more relevant to companies.

Tax deductions: Group health insurance policy comes with tax deductions for both the employees and employers. Hence, investing in a health insurance policy is a win-win for the employer and the employee.

Lower premiums, great benefits: Health insurance is a great tool to keep yourself insured against medical expenses. A group medical insurance has a relatively lower premium and better benefits. You can also add some covers and customise them per your needs and preferences.

What isn't covered in Group Health Insurance?

Here are the exclusions under the group health insurance policy:

  • Pre-existing illnesses are not covered under group health insurance policies.
  • Mandatory medical procedures or tests are not included.
  • Age groups except those mentioned above are not included in employer health insurance or corporate health insurance plans.
  • Injury or illness from war is also not considered.
  • Company health insurance policies do not include external durable items like a wheelchair, lenses, etc., even if doctors recommend it.
  • Dental and pregnancy-related treatments are also not included.

Why choose group health insurance from Bajaj Finance

Bajaj Finance is the most diversified non-banking institute in the country, with multiple product lines across consumer, commercial and SME finance, making it one of the most profitable companies in the category.

How to raise a claim?

While raising a claim under top-up health insurance, one must keep all receipts and bills arranged chronologically. Here are a few steps to raise a claim with your insurer:

Cashless claim

You can benefit from cashless treatment at partner network hospitals anywhere in the country. The procedure to file a claim is as follows:
  • First, search for a partner network hospital (E.g., Aditya Birla network hospital) in the city where you want to get cashless treatment.
  • Intimate the insurer within 48 hours of hospitalisation (in case of emergency hospitalisation) and 3 days before admission (in case of planned hospitalisation).
  • While visiting the hospital, carry the patient’s insurance cashless card or the policy details.
  • Show the health insurance cashless card and valid ID proof at the hospital’s insurance desk.
  • Fill in the pre-authorisation request form available at the hospital correctly and submit it to the hospital..
  • For quicker action, fill in the request form on the official website and intimate the insurer.
  • Wait for the decision as your request will be reviewed.
  • The insurer may take up to 2 hours after receiving the request and inform you about the decision via e-mail and SMS.
  • You can also check the status online. The claim will be processed per the terms and conditions of the policy after all the formalities are completed.

Reimbursement claims

  • In case of an emergency admission, you need to notify the insurer within 48 hours and pay the charges to the hospital directly unless the insurer has issued a pre-authorisation.
  • Collect and submit the list of the documents mentioned below within 15 days of discharge from the hospital.
  • After reviewing the documents, the insurer will approve or reject the same per the terms and conditions of the policy.
  • The insurer will send the reimbursement amount via NEFT to your registered bank account if the request is approved.
  • If the request is rejected, the same will be communicated to your registered contact phone number and e-mail address.

How to apply for group health insurance?

Here are the steps you can follow to easily apply for the top-up health insurance plan with us:

Step1: Click the ‘Apply Now button at the top.

Step2:Fill in the online application form with your personal and click on the ‘Submit’ button.

Step3:A Bajaj Finance representative will contact you to discuss the available policies and receive the necessary documents.

Steps4:Receive your group health insurance within a few hours.

Frequently asked questions (FAQs) about group health insurance

1. What is group health insurance?

Group health insurance is offered by organisations, banks, business groups, housing societies, and employers to their employees, and the organisation itself bears the cost of the premium. It is also known as a corporate health insurance policy. When the employer provides the group health insurance policy, both the employer and employee are the beneficiary. The premium will vary from one insurance policy to the other. Similarly, insurance coverage, payment, and premiums will also be different for every employee.

2. What are the benefits of group health insurance?

The main benefit of group health insurance is that the premiums paid towards these insurances are cost-effective. Plus, the policyholder gets access to the best medical facilities and quality healthcare at times of emergency.

Group Health Insurance acts as an incentive that employers can offer to their team. Employees are guaranteed financial aid in the event of an unfortunate hospitalisation. It also helps in tax deductions under the income tax act if you have corporate health insurance.

3. Why is group health insurance important?

Group health insurance is important as it provides safety and security to the employees and their dependents. The security of group insurance results in better productivity and creativity.

Moreover, by offering coverage to the employees, the employers get tax deductions under the Income Tax Act. A group insurance policy is beneficial for both the employer and employees.

4. Are group health insurance premiums tax-deductible?

Yes, the premium paid towards group health insurance is eligible for tax exemption under Section 80D of the Income Tax Act. Employers can claim a tax deduction. Employees are only entitled to the benefits offered under the group health insurance policy. Employees cannot claim the tax benefit if their employer pays the premium amount of the group health insurance policy. However, if the premium amount is deducted from the employee’s salary, then the employee can claim a tax rebate.

5. What is group health insurance coverage?

Group Health Insurance is insurance coverage for the health of a group of individuals. It is designed for companies to cover all employees under a stable plan to cushion the risk of any medical expenses. Group health insurance is cost-effective with better coverage, benefits, and customisation options.

6. Can individuals buy group health insurance?

A group of individuals can buy a group health insurance, whereas an individual cannot. Various group health insurance policies come with different coverage plans, inclusions, and exclusions. Some group health insurance policies cover 7 to 10 people, whereas others cover up to 50 people. You can explore and find the kind of coverage that best suits your needs.

7. What is the difference between group health insurance and individual health insurance?

Individual health insurance covers the policyholder, whereas group health insurance is a cover extended by an employer and may also cover your family. Both health insurances have variations in coverage and other benefits.

8. Can husband and wife have group health insurance?

Husband and wife can be a part of a group health insurance policy if they work for the same organisation. They can also be a part of the same policy if that particular policy availed by the employer covers your family as well.

9. Is group health insurance mandatory?

Yes, all employers must cover their employees under group health insurance. The current health scenario has changed the government’s perspective, making it mandatory for all organisations to cover their employees.

10. Does group insurance cover pregnancy?

Group insurance is an umbrella to secure all employees against any medical emergency. Generally, pregnancy is not covered under a group health insurance policy but can be taken up as an added cover.

11. Is COVID-19 also covered under the Group Health Insurance?

Yes, treatment for COVID-19 is covered under the group health insurance plan. It provides benefits like cashless hospitalisation, ambulance expenses, and financial assistance with medicines, drugs and diagnostics. You can choose a group health insurance plan covering only COVID-19 or other diseases, including coronavirus infection.

12. What is the meaning of Advance Cash benefit?

When the insurer covers 50% of the estimated cost of treatment in cash during the treatment, and the remaining estimated cost is reimbursed post the treatment is over. It is known as Advance Cash benefit. The insured need not worry about the medical expenses during the treatment and get financial assistance for the medical expenses.

13. What are the terms and conditions of health group insurance?

A group health insurance policy covers a group of people working in the same organisation or under the same employer. The general terms and conditions of the policy include:
• The plan is valid as long as the employee works in the organisation.
• Only the employer can cancel the policy.
• The policy's benefits can be availed at network hospitals across the country.
• There is a facility for the cashless and direct settlement of expenses with the hospital.
• No pre-existing illness or disease is covered under this plan.
However, you must go through the detailed terms and conditions before buying the policy to avoid paying for any hidden charges.

14.What type of life insurance plan is most commonly offered under group plans?

Most group life insurance plans are term insurance plans. Group life insurance plans are often offered under the employee benefit package by the employer or an organisation. These plans are usually offered on yearly renewal basis. The employer or employee whoever pays the premium against this plan is eligible to benefit from the tax deduction under section 80C of the Income Tax Act.

15.What is the waiting period for group health insurance?

The usual waiting period in availing of the benefits under group health insurance plans is between 30 and 90 days. However, the duration may vary from insurer to insurer. Also, since you are registered under a group plan, there maybe a chance that the waiting period maybe waived off. You must once check with your employer or the insurance provider on the terms and conditions if applicable before availing of the benefits.

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