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group mediclaim insurance
Group Mediclaim Plans

Group Mediclaim

A Group Mediclaim policy is purchased by an employer from the insurance company for the well-being of the employees. In order to offer this policy, either the employer pays the applicable insurance premium or a specific amount is deducted from the employees’ CTCs (Cost to Company) for paying the premium cost. The primary objective of the plan is to insure a company’s employees against various health risks in accordance with the policy’s terms and conditions. 

When it comes to the group health insurance portfolio, there are a multitude of schemes available, for example, plans for critical illness, plans for individuals, family floater health insurance, etc. On an ideal basis, at least one type of health insurance scheme must be a part of a company or an organization. This provides a kind of financial backup in the time of a health scare. 

As a Group Mediclaim policy is purchased in bulk for a group of people, they are relatively cheaper than individual medicare plans. Moreover, the policy not only covers the employees but also their immediate family members, thereby providing extensive support to various professionals.

What are the Advantages of Group Mediclaim Policy?

Purchasing a Group Mediclaim policy is profitable for both the employees and the employers in a multitude of ways.

How The Policy is Beneficial For Employees?

  • Protects Your Dear Family Members Too!
    Whether or not a Group Mediclaim policy also covers your family members, it all differs from one policy to another. However, such plans often provide additional coverage to the family members (usually up to 5 members) or the dependents of the employees. If an employee wishes to opt for such additional protections, such as coverage for the parents, the plan gives them immediate coverage without charging any additional premium payment.
  • Medical Screening? – No Need for It!
    In order to buy an individual health insurance plan, medical screening is done to determine the health status of the person. Based on the test results, the premium amount of the policy is decided by the insurance company, which may be lower or sufficient accordingly. However, in a Group Mediclaim policy, no employee is required to go for medical tests that can substantially affect the premiums. Regardless of the health status of all the employees, the plan brings them all under the same benefits and coverage.
  • Settling Claims Becomes a Cakewalk
    One of the major benefits a Group Mediclaim policy provides to the employees is its faster query redressal as well as claim settlement process. Rather than rummaging here and there in the health insurance company for settling the claim, the employees just need to present relevant bills in front of the employer, and the rest of the process is carried out by the company itself.
  • Why WAIT When Group Mediclaim is Here?
    Most health insurance policies have a waiting period when it comes to claiming maternity benefits, pre-existing diseases, etc. Usually, the waiting period is for a few years, under which the insured person cannot raise a claim. Nevertheless, such waiting limitations are reduced under a Group Mediclaim policy. Be it the employee or his/her parents and kids, a corporate health insurance plan starts covering right from the first day of the plan.
  • Easily Accessible
    In an individual health insurance plan, it becomes difficult to extend the policy to the employee’s parents, spouse, children, etc. Besides facing the hassles of purchasing a separate family floater insurance, the plan usually becomes an expensive affair for many employees. Thus, a Group Mediclaim policy offers easy access to family health benefits, such as parental coverage and maternity coverage, which would otherwise be difficult due to the age as well as the health status of the dependents.
  • Is There Any Pre-Existing Disease? – Cover It from Day 1!
    The moment an employee joins the company or an organization, a Group Mediclaim policy starts covering his/her pre-existing diseases. Thus, there is no need for any employee to go through the waiting period for any pre-existing medical condition.
  • Bliss for Going-To-Be Mothers
    One of the greatest advantages a Group Mediclaim provides is wider maternity coverage. Majority of corporate health insurance plan provides coverage for normal deliveries as well as for C-section deliveries. Besides, unlike the standard 90-days cover, a Group Mediclaim covers newborn babies as well.
  • Save On money as 
    a Group Mediclaim policy is bought by the employer and disseminated among the employees, it costs much lower. The premium amount of the policy is equally contributed by all the employees, making it affordable for each employee.
  • No Limitation on Diseases
    Whether it is a pre-existing medical condition or the one that arose later, a Group Mediclaim policy does not have any kind of limitations on the diseases.

How The Policy is Beneficial For Employers?

  • Doesn’t Break Your Bank
    Considering the cost factor, a Group Mediclaim policy is always cheaper than an individual or family floater health plan. As the policy is purchased in totality for the employees, it is usually inexpensive for the company owner. Moreover, the employees can be asked to partake in paying the premium amount, thus reducing the burden on the employer for paying premiums all alone.
  • Doesn’t Allow IRS to Get Hands on Your Money
    In case the employer pays the entire premium amount on behalf of his/her employees, the employer can leverage tax benefits for providing such financial support.
    As per the Income Tax Act, 1961, any amount paid by an employer for providing the beneficiaries to his/her employees will be treated as a management expense or ‘profit in lieu of salary’. Thus, the whole premium amount can be claimed as a management expense in the company’s Profit & Loss account.
  • Scared of Losing Your Employees? – Make Them Stay Longer!
    In an era where there is a plentitude of good jobs, holding employees to the company becomes a laborious task. When a company provides various healthcare benefits to its employees, they are then less likely to quit your company. Hence, there is no denying the fact that offering a Group Mediclaim policy means better retention rates and a successful company.
  • It sounds to be a good place to work at’ – Hear This More Often!
    Not only a Group Mediclaim policy helps in employee retention, but also in attracting good talents. People often love companies that provide them some valuable benefits. Health benefits are something that a potential employee cannot ignore in a company. Many individuals refuse to work with organizations when they find that such benefits are missing in the company. Thus, a strong Group Mediclaim policy fascinates potential employees and helps to create a positive outlook for your company.
  • Get Easy Premium Payment Options
    When the employer decides to pay for the premium of a Group Mediclaim policy, he/she may pay it monthly, quarterly, or yearly. The payment mediums totally depend on the convenience of the employer.
  • Be Stress-Free While Managing Claims
    Nowadays, tech-supported insurance companies allow employers to manage insurance-related processes in a convenient manner. With the rapid digitization penetrating deeply into the system, insurance companies are using digital technologies to make policy purchases, claim settlement processes, and customer services more simple and handy.
  • Bliss for Going-To-Be Mothers
    One of the greatest advantages a Group Mediclaim provides is wider maternity coverage. Majority of corporate health insurance plan provides coverage for normal deliveries as well as for C-section deliveries.
    Besides, unlike the standard 90-days cover, a Group Mediclaim covers newborn babies as well.

What is the Need for Group Mediclaim Policy?

In the current scenario, companies and organizations are becoming more employee-centric. Hence, they are offering various health benefits to their employees while keeping in mind the beneficial aspects of the plan.

Some of the reasons why a Group Mediclaim policy is important are as follows:

To Survive Well in the World of Uncertainty

A medical emergency can arise anywhere and anytime, leading to a financial emergency. This can subsequently cause a lot of burden and anxiety to an employee as well as his/her family members. Years of savings can wipe out the employee’s bank within a few minutes, and he/she may end up paying expensive medical bills, which could otherwise be paid by the insurance company.

For instance, Mr. X met with a car accident and ends up on the hospital bed. He has been earning Rs. 30,000 per month for two years in a reputed company. There is a need for immediate surgical treatment costing around Rs. 5,00,000. The company in which Mr. X works does not have any Group Mediclaim or group health insurance plan. As per his salary structure, he only has around Rs. 7,20,000. This simply means that Mr. X’s 24-months struggle will be drained out in covering his medical expenses from hospitalization and surgery to medications and other follow-up treatments.

In such a challenging situation, a Group Mediclaim policy acts as a ‘friend in need’. By allowing the insurance companies to pay for the medical expenses, employees are set free from any financial burden or medical debt. Such kind of financial security to the employees protects them as well as their family members from the uncertainties of life.

Happy Employees is Equal to Better Performances

Owing to the worrisome lives of people in today’s scenario, maintaining good health has become the topmost priority among individuals. With health topics becoming the next talk of the nation, companies are also leaving no stone unturned to provide a comprehensive health plan to their employees.

Although a Group Mediclaim policy cannot avoid unfortunate things from occurring, it can certainly act as a ‘need of the hour’ for the employees. When a company provides an effective healthcare support system to its employees in terms of benefits and facilities, they feel more valued and satisfied. It is because they develop a sense of financial security that if something unexpected happens, the insurance company will help them out.

Not only does the plan protects the employees and their family members against unfortunate events, but it also leads to better productivity and enhanced performances. After all, employees are the backbone of a corporate organization. When they feel happier and satisfied, they tend to work harder in order to deliver their best. 

Sky-High Prices? – Get Away from Them!

Besides providing help at the time of need, a Group Mediclaim policy allows the employees not to pay premium from their own pockets. In this context, two major types of Group Mediclaim policies are given as options to the employees: Contributory Plan and Non-Contributory Plan.

In a contributory plan, the employees can contribute to paying premiums to the insurance company. Only a nominal amount of money is deducted from the CTC of the employees and the rest of the payment is done by the employer itself.

In a non-contributory plan, the whole premium is paid by the employer itself. Thus, in case an employee does not wish to pay for the premium, he/she can do so without any hesitation.

Besides, a Group Mediclaim policy is relatively cheaper than buying individual health insurance or a separate family floater plan. The major reason behind this is the fact that the employer purchases the plan in bulk and disseminates it equally among the employees.

Do You Wish to Create a Positive Company’s Image? – Group Mediclaim is the Key!

The companies which value their employees get valued back. The employees will become more loyal towards the company or an organization because of the health benefits and facilities. This, in turn, will create goodwill for the employer as well as the company.

The retention and employees’ acquisition rates will also improve because no one wishes to avoid the comfort and support that the company is providing in terms of an extensive health insurance plan. All such aspects will certainly create a positive company’s image among the people.

Go Beyond the Basic Coverage

Most of the Group Mediclaim provides comprehensive health benefits to make sure that the employees get the care they need the most.

Some of the common coverages under a Group Mediclaim policy are as follows:

  • Health Checkups
  • Critical Illness Coverage
  • Doctor Consultations
  • Mental Well-Being
  • Oral Care
  • Disability Coverage
  • Accidental Death Coverage
  • Coverage to Family Members

Get Bigger Than Before!

One of the main reasons why a Group Mediclaim policy is important for the company is to gain assistance in growing as well as expanding the organization. While tying a knot with a top-notch health ecosystem partners, a company can nurture its existing employees, look for new and good talents, refine its approaches, offer great customer services, increase its productivity, enhance its brand positioning, and create a confident firm – all of which consequently leads to the quality growth and expansion of an organization.

What’s Included and What’s Not?

Group Mediclaim Inclusions

  • Pre-Existing Illness: Any illness before joining the company or organization will be covered.
  • Pre- & Post-Hospitalization: All the expenses that occurred due to pre and post-hospitalization processes, such as diagnosis, treatment, medications, surgery, etc. will be covered.
  • Daycare Treatments: Covers all the expenses of daycare treatments, such as cataract surgery, dialysis, chemotherapy, etc.
  • Maternity Coverage: Provides coverage for the medical expenses associated with the maternity treatments, such as deliveries, medications, follow-up treatments, newborn child benefits, etc.
  • Family Coverage: Covers immediate family members of the employee, such as parents, spouse, children, etc.
  • Chronic Illness Coverage: Covers all the expenses related to chronic illnesses, such as diabetes, arthritis, etc.
  • Cashless Hospitalization: During medical emergencies, the employees can avail cashless treatment in the registered hospital. He/she does not need to carry cash in bulk to commence with the treatment.
  • Additional Coverage: The plan also provides coverage for ICU charges, ambulance charges, organ donors, etc.

Group Mediclaim Exclusions

  • Self-Imposed Injury: No coverage for suicide, suicide attempts, etc.
  • Injuries Arising Due to Narcotic Substances: Any expense arising due to consumption of alcohol or drugs will not be covered.
  • Cosmetic Surgery: Plastic surgery, artificial implants, and various other cosmetic treatments are not included.
  • Congenital Diseases: Any disease or disability occurring due to a birth defect will not be covered. Treatment of AIDS, as well as other related diseases, will also not be covered.
  • Non-Allopathic Treatments: Any non-allopathic treatment, such as ayurvedic treatment, will not be covered.

What is the Claim Process?

In order to file a claim, one can go through the following common steps:

  1. Contacting the Insurance Provider: Firstly, you need to call the insurance company to make it aware of the event. 

  2. Attaining Guidance: A customer care representative will guide you to start the process and fill necessary documents. 

  3. Filling the Form: A claim form will be provided by the insurance company either online or offline. The claim form needs to be duly filled and signed by the insured person.

  4. Attaching Documents: All the necessary documents must be attached to the form.

  5. Sending Claim: Once the document work is done, send the claim (along with documents) to the respective insurance company.  

  6. Assessment and Verification of Documents: Once the claim form and documents reach the insurance provider, it is thoroughly assessed and verified to carry out further processes.

  7. Settling the Claim: Once the verification and assessment are done, the insurance company will settle the claim within a short period of time.

Documents Required

  • Duly filled claim form with the sign of recognized doctor or hospital
  • Medical reports
  • Final medical bills
  • Cash memos
  • Police report (in accident cases)
  • Investigation report
  • Prescriptions from a recognized doctor
  • Discharge summary

FAQs

It differs from one insurance company to the other. Some insurance providers are providing coverage for COVID-19 treatments, while others are not. Thus, always check the coverage extent before buying the policy.

No. On a general basis, a Group Mediclaim policy does not require you to wait for a set period of time.

Most of the companies stop providing you the coverage the moment you leave or quit the job. Therefore, you need to take a separate individual plan to protect yourself against unexpected misfortunes.
The premium amount of a Group Mediclaim policy is calculated on the basis of the age of employees, number of employees, their location, and number of their dependents. After analyzing the nature and composition of a group, the insurance company determines the premium amount to be paid by the policyholder.

Any individual:

  • who is above 18 years and below 70 years.
  • who belongs to an employer-employee group.
  • who is dependent on the employee, such as children, spouse, and parents.

The amount of maternity coverage differs in normal and C-section deliveries. For normal deliveries, the sum assured is around Rs. 25,000; while for C-section deliveries, the sum assured is around Rs. 35,000. Although there are companies that extend the coverage till Rs. 50,000, some companies provide coverage as high as Rs. 1 lakh as a maternity benefit. Moreover, some companies provide coverage for a newborn baby without any waiting period of 90 days (which is considered as a standard waiting period for claiming the benefits).

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