Do Employees Need to Compulsorily Have a Group Health Insurance Policy in India?

Health insurance is a crucial tool for protecting your financial well-being in the face of unexpected medical emergencies. Typically, you have to pay an annual premium to purchase a policy that will cover your hospitalization expenses when you become sick or injured. Often, people avoid buying health insurance because it means they would have to bear an extra cost annually. But there are different kinds of health coverage available for everybody. Believe it or not, there is a way to get health coverage for free. It's called employee group health insurance, and it's a type of insurance that is provided by an employer to its employees at no cost to the employee. Recently, this type of insurance has been made mandatory for employees in India due to the COVID-19 pandemic. In this article, we'll delve into the details of employee group health insurance and explore the benefits it offers to employees.

What is Group Medical insurance?

Group medical insurance is a type of health insurance plan that covers a large number of people, usually firm employees. in this arrangement, the employer often contributes to the premium payments, making it a more cost-effective choice for employees than individual health insurance. This is a type of employer health insurance which provides extensive coverage for medical expenditures, allowing employees to receive required care without facing the entire financial burden themselves. it is a sensible and cost-effective approach for organisations to provide health benefits, ensuring that their employees have access to critical medical services while reducing out-of-pocket expenses.

Is Company Health Insurance Compulsory in India?

Yes, coverage for employees, also known as group health insurance policy, is compulsory in India post COVID-19. Before getting into the details, here’s a quick explanation of the distinction between different Group Mediclaim Policies:

1. When you get coverage for yourself, it is called Individual Health Insurance.
2. When you get coverage for your family, it is called Family Health Cover.
3. When you receive coverage with others as part of a group, it is called a Group Insurance Plan.
4. When you receive health insurance coverage from your employer under a Group Health Insurance Plan, it is called Employee Group Health Insurance. *

Understanding the Basic Coverage

A Group Health Insurance Policy for Employees can be availed free of cost as the policy premium is paid by the employer on behalf of the employee. This policy covers the hospitalisation expenses of the employee (and an employee’s family in some cases) as per the prescribed limit. *

Advantages of Group Medical Cover for Employees

Here are the top benefits of an employer-offered health insurance policy for employees:

Free health coverage

Employees do not have to pay a health insurance premium to receive the benefits of this plan. The premium is paid by the employer as a benefit to the employee for being a part of the company. Your immediate family including your spouse and dependent children are included in the coverage. Moreover, you can add other family members to this cover for a nominal payment. It is a major advantage to have such holistic coverage while healthcare costs skyrocket. *

Top-notch coverage

Even though a Group Medical Cover for Employees is available free of cost, it can be of high quality. Most employee health plans come with the following features:

1. Cover for hospitalisation expenses
2. No waiting period
3. COVID-19 cover
4. Teleconsultations with medical experts
5. Facility to book lab tests*

Preventive Health Care Benefits

Many cashless health insurance providers appreciate when policyholders take steps to avoid major illness or injury. For example, if a policyholder takes regular health check-ups, they are considered favourable. Hence, insurers often promote the practice of preventive health check-ups. They offer these check-ups at affordable prices. Moreover, they can sometimes also include medical tests at reasonable prices through their various associations. *

What is Covered under the Employer's Health insurance?

The coverage details may vary depending on the plan chosen as per the employer health insurance. However, group health insurance plans often cover a wide range of medical expenses, including:

1. Hospitalisation costs (room charges, doctor fees, surgery)
2. Diagnostic tests (X-rays, blood tests)
3. Outpatient care (doctor visits, prescriptions)
4. Maternity care
5. Preventive care services (annual checkups, vaccinations)

What is Not Covered Under the Employer's Health insurance?

Employer-sponsored health insurance plans might not cover everything. Here are some common exclusions:

1. Dental and vision care: Some employers offer separate dental and vision insurance plans.
2. Pre-existing conditions: Some plans might have limitations on coverage for pre-existing medical conditions, especially if you were not previously insured.
3. alternative therapies: Coverage for therapies like acupuncture or massage might be limited or excluded.

How to Submit a Claim Under Group Health insurance?

The claim submission process for group health insurance typically involves:

1. Familiarise Yourself with the Plan: Understand your plan's coverage details and claim procedures.
2. Review the Claim Form: Obtain a claim form from your HR department or insurer.
3. Gather Documentation: Collect medical bills, doctor's reports, and any other required documents.
4. Submit the Claim: Submit the completed claim form and supporting documents to your insurance company.

Is Group Health Insurance enough?

Employee group health insurance is a useful facility for employees, offering free, high-quality coverage for hospitalization expenses, and potentially other benefits such as outpatient treatment and preventive care. However, it's important to note that group health insurance policies are not always the best option for everyone. * While group health insurance can be a great benefit for employees, it is important to consider the limitations of these policies. For example, the coverage of group health insurance policies depends on your employer. You will have to accept whatever coverage they offer you. Additionally, group health insurance policies are paid for by the employer, which means if you leave your job or lose your employer's coverage for any reason, you will also lose your health insurance coverage. * Given these limitations, it may be a good idea for employees to supplement their group health insurance with an individual health insurance policy. Individual health insurance policies allow you to choose your own coverage and customize it to meet your specific needs. They also offer more flexibility in terms of which hospitals and healthcare providers you can use. While individual health insurance policies may require you to pay a premium, they can provide a higher level of protection and peace of mind. * Overall, employee group health insurance can be a safety net for employees, but it is important to remember the limitations of these policies and consider purchasing an individual health insurance policy to provide additional protection. Additionally, you need to be smart with buying an individual policy. You need to buy the right coverage for the right price.  To help you with that, you can use a health insurance premium calculator.

FaQs on Employer-Sponsored Health insurance

How to determine a group health policy’s premium?

Several factors influence group health insurance premiums, including:

1. Number of employees covered: Larger groups typically have lower premiums due to bargaining power.
2. Employee demographics: age, health status, and location of employees can impact premiums.
3. Plan design: The type and extent of coverage offered by the plan affect the premium cost.

Does group health policy offer pre-existing illness coverage?

in india, under the portability regulations of the insurance Regulatory and Development authority of india (iRDai), pre-existing conditions need to be covered after a specific waiting period in portable group health insurance plans. However, coverage details can vary depending on the specific plan offered by your employer.

Since when is Medical insurance made mandatory in india?

There is no mandatory requirement for employers to offer health insurance to their employees in india. However, some government schemes or regulations might mandate health insurance coverage in specific sectors or for certain categories of employees.

What is the minimum employee strength required to apply for employee health insurance?

There is no minimum employee strength requirement mandated by law to apply for group health insurance in india. However, some insurance companies might have minimum group size requirements for offering certain plans.     * Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale. The content on this page is generic and shared only for informational and explanatory purposes. it is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.