Group Health Insurance Policy

Group health insurance is a health insurance policy that covers a group of people under a single plan, most commonly employees of an organisation. It provides financial protection against medical expenses, offers cashless treatment at network hospitals, and often extends coverage to eligible family members. It is an affordable way for employers to support employee health and well-being.

In Summary

Group health insurance offers medical coverage to employees or members under one policy. It provides benefits such as cashless hospitalisation, comprehensive coverage, lower premiums, and financial protection during medical emergencies. It also helps employers improve employee satisfaction while making quality healthcare more accessible.

Key Takeaways

• Covers a group of people under one policy.
• Commonly offered by employers as an employee benefit.
• May cover pre-existing diseases from day one.
• Provides cashless treatment at network hospitals.
• Can include coverage for eligible family members.
• Offers affordable premiums and comprehensive benefits.
• Helps improve employee retention and satisfaction.

Explore plans that provide comprehensive coverage and wellness benefits to protect your employees and their families.

Group health insurance is a health insurance policy designed to cover a group of individuals who share a common relationship, such as employees of a company, members of an organisation, or customers of a financial institution. The employer or organisation purchases the policy and provides coverage to eligible members.

One of the biggest advantages of group health insurance is that many plans cover pre-existing diseases from the first day without a waiting period. Depending on the policy, it may also include hospitalisation cover, maternity benefits, daycare procedures, wellness programmes, and cashless treatment at network hospitals.

Group health insurance plans are purchased by companies or organizations and offered to their employees or members. These plans cannot be bought by individuals and typically require at least 70% participation from eligible group members for activation.

Once a plan is selected by the organization, employees are given the choice to either opt in or decline coverage. Some group plans offer tiered options—ranging from basic coverage to enhanced plans with additional benefits. The premium is usually shared between the employer and the employees, and coverage can often be extended to immediate family members or dependents for an additional fee.

Group health insurance is generally more affordable than individual plans because the risk is distributed across a larger number of people. This collective participation makes the premiums lower and the coverage more cost-effective.

Here is how group health insurance functions:

Employers and organisations should purchase a group insurance policy to provide health coverage for their employees. This policy benefits companies by enhancing employee satisfaction and retention, while also offering comprehensive medical coverage. Small businesses, startups, and large corporations alike can ensure their workforce is protected against medical expenses, promoting a healthier and more productive work environment.

• Small businesses: Group health insurance helps small businesses attract and retain skilled employees by offering valuable health benefits. It provides affordable coverage, boosts morale, and shows a commitment to employee well-being—without significantly straining limited resources.
• Medium businesses: For growing companies, group insurance supports employee satisfaction and continuity. It helps reduce absenteeism, improves productivity, and positions the business as an employee-centric organization, all while keeping healthcare costs predictable and manageable.
• Large businesses: Large corporations can streamline employee health benefits with group insurance plans that offer broad coverage and customizable options. These plans enhance workforce loyalty, ensure compliance, and support health initiatives at scale for a diverse employee base.

Here are some of the key features of our group health insurance policies:

Here are some key advantages of group health insurance for employers:

Improved employee retention

Offering health insurance shows employees that their well-being is a priority, fostering loyalty and reducing staff turnover.

Tax advantages

Employers may be eligible for tax deductions on their contributions to group health insurance, resulting in financial savings.

Cost-effective coverage

Group mediclaim policies lower overall insurance costs by distributing the risk and premiums across a larger employee base.

Here are some key advantages employees gain through group health insurance:

Hassle-free claims

Group medical insurance simplifies the claims process, offering a smooth and convenient experience for employees.

Family coverage

Depending on the employer’s plan, coverage can be extended to include family members such as a spouse, children, and parents—ensuring broader protection for the household.

Greater job satisfaction

Having access to health insurance as an employee benefit enhances overall job satisfaction and fosters a stronger sense of loyalty towards the organization.

Immediate coverage

Employees are covered from day one without the need for medical tests or waiting periods, ensuring immediate financial protection.

Preventive healthcare benefits

These policies often include wellness programs, routine check-ups, and vaccinations—encouraging early detection and a proactive approach to health.

Note:
Employees who seek treatment at a network hospital can avail of cashless claim settlements. In case of treatment at a non-network hospital, expenses must be paid upfront, but can be reimbursed by submitting a claim within the insurer’s specified timeline.

Tax deductions

A group insurance plan has several health insurance tax benefits for an employer as well as the employees. Therefore, opting for this policy is a win-win situation for both.

Lower premiums

This insurance plan has comparatively lower premiums and several lucrative benefits. One can add various rider covers and customise them as per their preferences and needs.

A group insurance for employees offers the following coverages:

• Coverage for a group of people
• Covers the medical expenses related to diseases, accidents, and illnesses
• Pre- and post-hospitalisation charges that take care of expenses before being hospitalised and after discharge in the recovery phase
• Flexibility to add spouse, up to three children (provided they belong to the age group of three months to 25 years) and other dependents at an extra cost
• Direct settlements of the expenses and cashless facilities are also offered.

The following are a few exclusions in a group medical insurance policy:

• Pre-existing health conditions
• Tests and mandatory medical processes
• No coverage for those who do not belong to the specified age group
• Illness or injury from war
• No coverage for external durable items, such as lenses, wheelchairs, etc.

Group medical insurance for employees can be enhanced with several add-on benefits, including:

Maternity coverage

Provides coverage for childbirth-related expenses, usually with a predefined cap on costs.

Waiver of maternity waiting period

Allows the standard 9-month waiting period for maternity claims to be waived, offering immediate access to benefits.

Newborn baby coverage

Covers medical expenses for newborns from day one, under the maternity coverage limit.

Outpatient (OPD) coverage

Includes expenses for doctor consultations, diagnostics, and minor treatments that do not require hospitalization.

Corporate buffer

Offers additional coverage beyond the base sum insured if it gets exhausted. Employees may need to pay an extra premium to access this benefit.

A company needs a minimum of 7 lives to be eligible for a group health insurance policy.

However, even if a company has fewer than 7 employees, it can still qualify for corporate health insurance by including dependents in the coverage to meet the required count of 7 insured individuals.

Example:
A growing tech startup recently expanded its workforce to five employees. Aiming to offer meaningful employee benefits, the company wanted to purchase a group health insurance policy. However, with only five employees, they didn't meet the minimum eligibility criteria.

To overcome this, some insurers offered a solution—if the company added at least two more individuals, even as employee dependents, they could qualify. The company chose to include the dependents of all five employees, thus reaching the minimum required count. This allowed them to successfully secure comprehensive group coverage for their team and their families.

Group insurance plans on Bajaj Finance Insurance Mall are exclusively available to Bajaj Finance customers. The application process is quick, hassle-free, and requires only basic personal information.

Step 1:
Click here to access the online application form.

Step 2:
Fill in the required details such as name, gender, mobile number, date of birth, and residential PIN code—for yourself or the person you want to insure.

Step 3:
Click on ‘Get Quote’ to continue.

Step 4:
Enter the One Time Password (OTP) sent to your registered mobile number for verification.

Step 5:
Browse through the list of available group health insurance plans, select the one that suits your needs, and click ‘Buy Now’.

Step 6:
Your personal information will be auto-filled based on existing records. Review the details and click ‘Next’.

Step 7:
Provide your address and nominee details.

Step 8:
Answer a few quick questions related to your health and lifestyle by selecting the relevant checkboxes, then click ‘Next’ to move forward.

Step 9:
Double-check all the information entered and click ‘Proceed’ to go to the payment page.

Step 10:
Complete the purchase by making the payment via net banking, UPI, debit card, or credit card.

Your policy will be issued shortly after a successful transaction.

You can reap the benefits of cashless treatment at any of the network hospitals. The procedure to raise a claim is as follows:

Step 1: Search for a network hospital in your city and inform the insurance provider at least within 48 hours of hospitalisation (for emergency situations) or at least three days prior to admission (for planned hospitalisation).

Step 2: Make sure to carry the policy details or the patient’s policy cashless card when you visit the network hospital.

Step 3: Produce a valid ID proof and insurance cashless card at the insurance desk of the hospital.

Step 4: Fill up all the details in the pre-authorisation form and submit it at the hospital.

Step 5: To expedite the procedure, fill up a request form on the official portal and inform your insurer about the same.

Step 6: Your group health insurance provider might take up to two hours to review an application and inform you accordingly via SMS and e-mail.

Step 7: You can even check the status of the claim online.

The insurer will process the claim as per the terms and conditions after the completion of all the formalities.

You can also opt for a reimbursement claim by following these simple steps:

Step 1: In case of emergency situations, you will have to notify the group health insurance provider within two days and pay the expenses to the hospital if you do not have a pre-authorisation.

Step 2: Submit all the necessary documents within fifteen days after the discharge.

Step 3: The insurance provider will accept or reject the claim after reviewing all the documents.

Step 4: Once approved, the insurer will transfer the amount to your registered bank account via NEFT.

Step 5: In case of rejection, you will receive a message regarding the same to your registered e-mail address and phone number.

Here is the list of documents that you need to raise a claim request against your group health insurance policies.

• Claim form (part A and B)
• Cashless card or health card issued by the insurer
• Valid ID proof (PAN, voter ID, passport)
• Original discharge summary
• Original hospital bills and payment receipts
• All doctor consultation papers
• FIR copy or post-mortem report in case of an accident or death

A health card in a group health plan is an identification card provided to members of the plan. It grants access to healthcare services under the group insurance coverage. The card typically includes the member's details, policy number, and insurance provider information, enabling cashless treatment and direct settlements at network hospitals and clinics.

When comparing corporate medical insurance plans, consider the following important points:

• Coverage: Ensure the plan covers a wide range of medical expenses, including hospitalisation, surgeries, and maternity benefits.
• Network hospitals: Check the list of network hospitals for cashless treatments.
• Premium costs: Compare premium rates and the benefits offered.
• Add-on benefits: Look for additional features like wellness programs, preventive care, and critical illness cover.
• Claim process: Evaluate the ease and efficiency of the claim process.

Choosing the right corporate medical insurance ensures comprehensive healthcare for employees.

Health insurance has become quite necessary to care for your and your family's health (check family health insurance), due to changing scenarios. Health-related problems can arise at any point in life and can cause a substantial financial burden and dig into savings for many. This is where group health insurance and group medical insurance come in handy.

For Employers

Cost-effective coverage - Group health insurance allows employers to offer medical coverage to their teams at lower per-person costs compared to individual policies. It helps retain talent, reduce absenteeism, and ensures employees receive timely care—without significantly impacting the company’s financials.

Tax Benefits - Premiums paid towards group health insurance are considered a business expense and are eligible for tax deductions under the Income Tax Act. This helps employers reduce their taxable income while also investing in employee well-being.

For Employees

Extensive coverage - Employees benefit from broad coverage that includes hospitalization, maternity care, specialist consultations, and day-care procedures. Since these plans are designed for large groups, insurers typically offer enhanced features at competitive pricing.

Coverage for family at zero cost - Many employers extend group health insurance benefits to employees’ immediate family members—like spouses, children, and even parents—at no extra cost or minimal contribution, providing financial protection for the entire household.

No waiting period - Unlike individual policies, group health insurance usually covers pre-existing diseases from day one. This instant coverage ensures that employees and their dependents can access medical treatment without worrying about waiting periods or exclusions.

Preventive care services - Group plans often include preventive health checkups, wellness programs, mental health support, and vaccination drives. These services help employees stay healthier, detect issues early, and reduce long-term treatment costs.

Given below are the key points of difference between Group Health and Individual Health Insurance:

Given below are the key points of difference between Group Health and Individual Health Insurance:

Group medical insurance provides coverage for employees at a lower cost, while individual health insurance offers personalised coverage with more customisation options

Bajaj Finance is one of the non-banking institutions with a diversified range of products across commercial, SME, consumer finance, and insurance. With various product offerings and a wide network, makes Bajaj Finance a dependable brand when it comes to your financial needs.

Conclusion 

Group health insurance is an affordable and effective way for organisations to provide quality healthcare benefits to employees. It offers comprehensive medical coverage, cashless treatment, financial protection during medical emergencies, and may also cover eligible family members. Choosing the right group health insurance plan helps promote employee well-being while providing financial security against unexpected healthcare expenses.

Explore plans that provide comprehensive medical coverage and wellness benefits to help protect your employees and their families.