Group Health Insurance Policy

Group Health Insurance plans ensure employees get medical coverage with perks like no waiting period, hassle-free claims and 24/7 doctor access.
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12-March-2025

A Group Health Insurance policy provides health insurance coverage to a group of people with some commonality. For example, employee-employer, bank-customers, and society-members. So, group health insurance policies let organisations, banks, housing societies and companies provide health insurance for their members or staff so that in the event of a medical emergency they have the financial support that is required.

When it comes to group medical insurance plans between employees and the employer, it’s a two-way street that is beneficial for employees as well as employers. Employees can get the benefits of a health insurance policy while employers are able to strengthen their employee retention plan and also avail of tax benefits.

How group health insurance works?

Group health insurance is a type of health coverage purchased by organisations, businesses, or associations to provide medical benefits to their employees or members. It offers a cost-effective solution by distributing risk across a larger group, making premiums more affordable compared to individual health insurance policies.

Here is how group health insurance functions:

1. Eligibility and purchase

  • Only organisations, businesses, or associations can purchase a group health insurance policy; individuals cannot buy these plans.
  • A minimum number of participants, typically 70% of eligible members, is required for the policy to be valid.

2. Enrolment and coverage options

  • Once an organisation selects a policy, employees or members have the option to accept or decline the coverage.
  • Some plans offer tiered coverage, allowing members to choose between basic or comprehensive coverage, including add-ons such as maternity or critical illness cover.
  • Many group plans allow dependants, such as spouses and children, to be added to the policy for an additional premium.

3. Cost-sharing between employers and employees

  • Premiums for group health insurance are typically shared between the employer and employees.
  • Employers may fully or partially cover the premium costs, reducing the financial burden on employees.

4. Lower cost compared to individual plans

  • Since the risk is spread across a larger pool of insured individuals, premiums for group health insurance are lower than those of individual policies.
  • Insurers offer competitive rates due to the bulk purchasing power of organisations.

Group health insurance provides a cost-effective and comprehensive healthcare solution, benefiting both employers and employees by ensuring financial protection during medical emergencies.

Pro Tip

Avail hospitalisation and treatment benefits with health insurance plans starting at just Rs. 15*/day.

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History of group health insurance

The concept of group health insurance has evolved over centuries, from employer-funded care programmes to modern healthcare policies. Below is a timeline of key milestones in its development:

1. Early origins: 1798 – employer-funded healthcare

  • The first recorded instance of group health coverage was established in 1798 when the U.S. Congress introduced the Marine Hospital Service, providing medical care to Navy seamen.
  • Participation was compulsory, with deductions made directly from salaries, laying the foundation for employer-sponsored healthcare.

2. Late 1800s – industry-driven healthcare schemes

  • Industries such as mining, lumber, and railways introduced healthcare services for their workers.
  • These initiatives recognised the importance of employee health for productivity and business continuity.

3. The first formal group health insurance policy: 1910

  • Montgomery Ward, a U.S. department store, launched the first official group health insurance plan.
  • Instead of reimbursing medical expenses, the policy provided cash payments equal to half of workers’ wages if they were ill or injured.

4. Early 1900s – national health insurance proposals

  • Progressive political movements advocated for compulsory national health insurance.
  • However, strong opposition from doctors, labour unions, and insurance companies prevented its implementation.

5. Expansion during World War II: 1940s

  • Wage controls during World War II prevented employers from increasing salaries, but health insurance benefits were exempt.
  • Employers used health insurance to attract workers, leading to a sharp rise in employer-sponsored insurance.

6. Introduction of Medicare and Medicaid: 1965

  • Despite employer-sponsored plans, many retirees and unemployed individuals remained uninsured.
  • The Social Security Amendments of 1965 introduced:
    • Medicare for senior citizens.
    • Medicaid for low-income individuals.

Over time, group health insurance has evolved into an essential employee benefit, ensuring financial security and access to quality healthcare.

A group can be majorly divided into two

Group health insurance policies categorise groups into two primary types based on their structure and purpose:

1. Employer-employee groups (formal groups)

These groups consist of businesses, organisations, or companies that provide health insurance to their employees as part of their benefits package. The employer acts as the policyholder, and employees, along with their dependants in some cases, are covered under the plan.

Key features:

  • Offered by companies, businesses, or startups to their employees.
  • Employers may fully or partially cover the premiums.
  • Helps attract and retain talent while boosting employee satisfaction.

2. Non-employer-employee groups (informal groups)

These groups include associations, cooperative societies, banks, and other non-employer entities that provide health insurance to their members. Unlike formal groups, these members are not linked through employment but share a common affiliation.

Key features:

  • Includes professional associations, housing societies, and cooperative banks.
  • Members typically share common interests or professions.
  • Offers cost-effective healthcare solutions by pooling risk among members.

Both types of groups benefit from cost savings, broader coverage options, and financial security in medical emergencies. Group health insurance ensures accessible healthcare, whether for employees in a corporate setting or members of an association.

Key features of group health insurance policies

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

Features

Specifications

Cashless claim settlement

Across 8,000+ network hospitals

Expenses coverage

Up to Rs. 50 lakh

Ambulance charges

Included

Tax benefit

Included

Daycare procedures

Covered

Domiciliary treatment

Covered

Pre- and post-hospitalisation

Covered


Key benefits of group health insurance

Here are the key benefits of a group health insurance policy:

Comprehensive coverage

A group medical insurance policy provides comprehensive coverage for medical expenses, and includes the cost of ambulances, medicines, specialists, and more.

Comprehensive medical benefits

Group health insurance plans offer comprehensive coverage against medical expenses caused due to several health conditions, including hospitalisation (for accidents) and regular hospital benefits.

Cashless claims

Insurers have tie-ups with hospitals to create a network where one can get the advantage of cashless mediclaim. To avail of cashless treatment, you need to get hospitalised with a network hospital and you have access to the best healthcare without any out-of-pocket expenses. The insurer settles the bills with the hospital directly.

Flexible terms

Group health insurance plans allow the owner of the group to choose the policy term as per the group size and needs.

Added benefits

Exhaustive rider options with group health insurance provide maternity coverage along with coverage for several pre-existing health conditions with a rider plan.

Why is group health insurance essential for you?

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.

Here are some of the reasons group health insurance is important:

  • Provides health coverage to a group of employees under one policy
  • Offers more affordable premiums due to the larger risk pool
  • Enables employers to attract and retain talent
  • Helps promote a healthy workforce and reduce absenteeism
  • Covers pre-existing conditions for employees
  • Provides financial protection for unexpected medical expenses
  • Offers a variety of coverage options to fit the needs of the group.

Group insurance plans provide comprehensive coverage to ensure employees and their families are protected against unforeseen medical expenses. Overall, it is crucial for businesses and their employees to ensure access to quality healthcare and financial stability.

What makes group health insurance policy popular

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.

Key inclusions of a group health insurance policy

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

Key exclusions of a group health insurance policy

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.

How to apply for group health insurance policies

Group insurance policies available on Bajaj Finance Insurance Mall are exclusively available for Bajaj Finance customers. The application process is fast and simple and only requires a few basic information.

Step 1
Click here to open the online application form.

Step 2
Fill in the application form with basic details such as name, gender, mobile number, date of birth, and residential PIN code for you or the person you want to insure.

Step 3
Now click on ‘Get Quote’ to proceed.

Step 4
Enter the One Time Password (OTP) received on your registered mobile number for verification.

Step 5
Choose your preferred group health insurance policy from the list of health insurance policies and click on ‘Buy Now’.

Step 6
Your personal details, based on our records, will be pre-filled. All you need to do is check if the details are correct and click ‘Next’.

Step 7
Enter your address and nominee details.

Step 8
Answer a few questions about your health and lifestyle by clicking the relevant checkboxes. Click on the ‘Next’ button to proceed.

Step 9
Verify if the previously filled details are correct and click on the ‘Proceed’ button to visit the payment page.

Step 10
Make the payment through net banking, UPI, debit or credit card to buy the policy.

How to raise cashless claims for group health insurance

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.

Also, read: Senior Citizen Health Insurance

How to raise reimbursement claims for group health insurance

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.

Documents required for making a claim

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

What is a health card in a Group Health Plan?

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.

Who should purchase Group Health Insurance?

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.

Important points to keep in mind while comparing Group Health Insurance

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.

How is Group Health Insurance different from Individual Health Insurance?

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

Feature

Group Medical Insurance

Individual Health Insurance

Coverage

Covers a group of people, typically employees of a company

Covers a single individual or family

Cost

Generally lower premium rates due to bulk purchase

Higher premium rates based on individual risk factors

Eligibility

Provided by employer; employees and sometimes their dependents are eligible

Available to anyone willing to purchase a policy

Customisation

Limited customisation as it is designed to meet general needs of the group

Highly customisable to suit individual needs

Claim process

Often simpler with direct settlements and cashless options at network hospitals

Individual must file claims and manage reimbursements

Policy tenure

Active as long as the individual is employed with the company

Chosen by the policyholder, typically ranging from 1 to 3 years

Benefits

May include additional wellness programs and preventive care

Varies based on the chosen plan, often including more comprehensive coverage


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

Health Insurance from Bajaj Finance: What makes it a good decision

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.

Related article

Senior Citizen Health Insurance

Private Health Insurance

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Frequently asked questions

What are the different types of group insurance policies?

In India, there are different types of group insurance plans available to provide coverage to a group of individuals. Some of the most common types of group insurance plans in India are:

1. Group Health Insurance: This type of plan provides health coverage to a group of people under one policy, such as employees of a company or members of an organization.

2. Group Term Life Insurance: This plan provides life insurance coverage to a group of people for a specific period of time, usually one year. This coverage can be renewed each year.

3. Group Personal Accident Insurance: This type of insurance provides coverage for accidental death, disability, or dismemberment that occurs due to an accident.

4. Group Credit Life Insurance: This plan provides coverage for loans taken by the members of a group to cover the repayment of the outstanding loan amount in case of the borrower's death.

5. Group Travel Insurance: This policy provides travel-related coverage to a group of people travelling together for business or leisure.

Each type of group insurance plan in India has its own specific features, benefits, and eligibility criteria. It is important to carefully consider the needs of the group before choosing a plan.

Can husband and wife have separate group health insurance?

Yes, husband and wife can have separate group health insurance policies if they are both eligible for coverage. However, if both policies cover the same individual, the benefits of the policies may be coordinated to prevent duplication of coverage.

Who is eligible for group insurance coverage?

The eligibility for group insurance coverage varies according to the policy and the group offering the policy. Typically, group policies are offered to employees of a company or members of a group or association. Eligibility may also depend on certain employment criteria, such as minimum hours worked or length of employment.

Are group insurance plans better than individual plans?

Group insurance plans can often provide better coverage and more affordable pricing than individual health insurance plans due to the larger risk pool. Additionally, group plans may offer a wider range of coverage options and be easier to access. However, individual plans may be a better choice for those who are self-employed or do not have access to a group plan.

What is covered in group health insurance?

Group health insurance covers medical expenses for employees, including hospitalisation, surgeries, pre- and post-hospitalisation care, maternity benefits, and sometimes outpatient treatments. It may also offer cashless treatment and direct settlement options.

What is a group policy in insurance?

A group policy in insurance is a single policy that provides coverage to a specific group of people, typically employees of a company, offering uniform benefits under one contract managed by the employer.

What is group insurance and its benefits?

Group insurance provides collective coverage to a group, such as employees. Benefits include lower premiums, comprehensive coverage, cashless treatments, direct settlements, and enhanced employee satisfaction and retention.

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*T&C Apply - Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Allianz Life Insurance Company Limited, HDFC Life Insurance Company Limited, Future Generali Life Insurance Company Limited, Bajaj Allianz General Insurance Company Limited, SBI General Insurance Company Limited, ACKO General Insurance Limited, ICICI Lombard General Insurance Company Limited, HDFC ERGO General Insurance Company Limited, Tata AIG General Insurance Company Limited, The New India Assurance Company Limited, Cholamandalam MS General Insurance Company Limited, Niva Bupa Health Insurance Company Limited , Aditya Birla Health Insurance Company Limited, Manipal Cigna Health Insurance Company Limited and Care Health Insurance Company Limited under the IRDAI composite CA registration number CA0101. Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. Please refer insurer's website for Policy Wordings. For more details on risk factors, terms and conditions and exclusions please read the product sales brochure carefully before concluding a sale. Tax benefits applicable if any, will be as per the prevailing tax laws. Tax laws are subject to change. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product. Visitors are hereby informed that their information submitted on the website may also be shared with insurers. BFL is also a distributor of other third party products from Assistance Services providers such as CPP Assistance Services Pvt. Ltd., Bajaj Finserv Health Ltd. etc. All product information such as premium, benefits, exclusions, sum insured, value added services, etc. are authentic and solely based on the information received from the respective insurance company or the respective Assistance service provider company.

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