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Group Health Insurance for Employees

Group mediclaim insurance policy for employees

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What is Group Mediclaim Policy and What Does it Entail?

GMC offers health insurance tailored for both employer-employee and non-employer-employee groups, catering to their distinct needs. This product aims to alleviate the financial strain associated with medical expenses arising from sickness, illness, and accidental bodily injury. With comprehensive coverage, it ensures that insured members receive the necessary support during challenging times. Whether it's covering hospital bills, treatment costs, or other healthcare expenses, GMC's health insurance for groups provides peace of mind and financial security, allowing members to focus on their well-being without worrying about the financial implications of medical emergencies.

Why Group Mediclaim Insurance with Bajaj Allianz General Insurance?

A Group Mediclaim Policy (GMC) typically offers a range of features tailored to the needs of a group of individuals, such as employees of a company or members of an organization. Here are some common features:

  • Coverage for Medical Expenses:

    GMC policies provide coverage for various medical expenses incurred by the insured members, including hospitalization expenses, doctor's fees, diagnostic tests, medication costs, and more.

  • In-Patient Hospitalization:

    Coverage for expenses related to in-patient hospitalization, including room rent, nursing charges, ICU charges, operation theater charges, and more.

  • Pre and Post-Hospitalization Coverage:

    GMC policies cover medical expenses incurred before and after hospitalization before and after hospitalization for a certain period, typically ranging from 15 to 120 days for Pre & 15 to 180 days for post

  • Daycare Procedures:

    Coverage for specific medical procedures that do not require overnight hospitalization but are performed in a hospital or daycare center.

  • Pre-Existing Conditions Coverage:

    Provides coverage for pre-existing medical conditions from day 1, subject to policy terms and conditions.

  • Ambulance Charges:

    Reimbursement of ambulance charges incurred for transporting the insured member to the hospital in case of emergency.

  • Maternity Benefits:

    Coverage for maternity expenses, including prenatal and postnatal care, delivery charges, and newborn baby cover, subject to waiting periods and policy limits (if any)

  • Cashless Facility:

    Considering the robust network of empaneled hospitals Cashless facility is available at almost every hospital, allowing insured members to avail medical treatment without making upfront payments (subject to policy terms and conditions).

  • Wellness Benefits:

    Offers wide range of wellness benefits such as annual health check-ups, preventive health screenings, and discounts on health-related services.

  • Customizable Coverage:

    Employers or policyholders can often customize the coverage based on the needs of the group, such as adding or excluding certain benefits, choosing different coverage limits, or opting for additional riders.

  • Cost-Effective:

    GMC policies are usually more cost-effective compared to individual health insurance plans because the risk is spread across a larger pool of individuals.

  • CDC benefit (Claim by Direct Click):

    With CDC, individuals and their families can avoid visiting offices, filling up endless forms, collecting and submitting documents. Simply log in to the Insurance Wallet app from and register the claim from anywhere, at any point in time.

  • Portal Facility:

    Corporate portals and employee portals streamlines the administration of group mediclaim insurance policies, enhance communication between stakeholders, and empower employees to manage their health insurance benefits effectively.

Key Benefits of Portal

✓ Corporate Portal:

  • Policy Administration:

    The corporate portal serves as a centralized platform for employers or HR administrators to manage group health insurance policies. They can handle tasks such as policy enrollment, renewal, and termination, as well as updating employee information.

  • Policy Configuration:

    Employers can configure the policy details, such as coverage limits, deductibles, co-payments, and premium rates, based on the organization's requirements and budget.

  • Employee Enrollment:

    The corporate portal facilitates the enrollment of employees and their dependents into the group health insurance plan. It streamlines the process by allowing employees to submit their information online and tracks enrollment status.

  • Premium Payment:

    Employers can use the corporate portal to manage premium payments, including setting up payment schedules, making payments online, and generating payment reports.

  • Communication:

    The portal serves as a communication channel between the insurance provider and the organization. Employers can receive policy updates, announcements, and alerts regarding changes in coverage or premiums.

✓ Employee Portal:

  • Access to Policy Information:

    The employee portal allows insured individuals to access their policy details, including coverage benefits, co-payments, claim status, and policy documents.

  • Enrollment and Changes:

    Employees can use the portal to enroll in the group health insurance plan during open enrollment periods or make changes to their coverage, such as adding or removing dependents.

  • Claim Submission:

    Employees can submit health insurance claims online through the employee portal. They can upload supporting documents, track the status of their claims, and receive reimbursement directly into their bank accounts.

  • Provider Network:

    The employee portal typically provides information about the network of healthcare providers covered under the insurance plan. Employees can search for participating hospitals, clinics, and healthcare professionals in their area.

Key Features of Bajaj Allianz General Insurance Group Mediclaim Health Insurance Policy

A Group Mediclaim Policy (GMC) typically offers a range of features tailored to the needs of a group of individuals, such as employees of a company or members of an organization. Here are some common features:

  • Coverage from Day One
  • Waiver of Specified Disease & Pre-existing Disease Waiting Period
  • Maternity coverage from day one
  • Assisted Reproduction Expenses
  • Number of Deliveries – coverage upto 3
  • Pre-postal natal coverage both on IPD & OPD
  • Child Coverage – from Day 1 upto the age of 35 years
  • AYUSH Treatment - covered
  • Day care Treatment
  • Domiciliary Hospitalisation
  • Psychiatric Treatment
  • Organ Donor
  • Coverage of Bariatric Surgery
  • Medical Advancement Surgery upto the Sum Insured
  • Coverage towards Road & Air Ambulance
  • International Cover - emergency only
  • Neurodevelopmental Disorder Benefit
  • Vaccination Cover
  • Wellness benefits

Benefits of Group Mediclaim Health Insurance?

Group mediclaim health insurance offers several benefits for both employers and employees. Here are some key advantages:
Comprehensive Coverage

Comprehensive Coverage

Read more

Comprehensive Coverage:

Group health insurance policies typically offer comprehensive coverage for medical expenses, including hospitalization, surgery, doctor's fees, diagnostic tests, medications, and more.

Cost-Effective

Cost-Effective

Group health insurance plans are often more cost-effective compared to individual... Read more

Cost-Effective:

Group health insurance plans are often more cost-effective compared to individual policies because the risk is spread across a larger group of individuals. This can result in lower premiums for both employers and employees.

Employee Retention and Satisfaction

Employee Retention and Satisfaction

Offering health insurance coverage demonstrates that employers care about... Read more

Employee Retention and Satisfaction:

Offering health insurance coverage demonstrates that employers care about their employees' well-being. This can help improve employee morale, loyalty, and job satisfaction, leading to higher retention rates.

Attracting Talent

Attracting Talent

Group health insurance can be a valuable recruitment tool, especially in competitive... Read more

Attracting Talent:

Group health insurance can be a valuable recruitment tool, especially in competitive job markets. It can help employers attract top talent by offering attractive benefits packages, including health insurance coverage.

Tax Benefits

Tax Benefits

Both employers and employees may be eligible for tax benefits on... Read more

Tax Benefits:

Both employers and employees may be eligible for tax benefits on premiums paid towards group health insurance policies under relevant tax laws.

Easy Administration

Easy Administration

Group health insurance policies are easier to administer compared... Read more

Easy Administration:

Group health insurance policies are easier to administer compared to individual policies, as they involve managing a single policy for the entire group rather than multiple policies for individual employees.

 

Coverage for Dependents

Coverage for Dependents:

Group health insurance plans offer coverage for employees' dependents, including spouses, children, and even... Read more

Coverage for Dependents:

Group health insurance plans offer coverage for employees' dependents, including spouses, children, and even dependent parents, providing comprehensive protection for the entire family.

Overall, group mediclaim health insurance is a valuable benefit that offers financial protection, peace of mind, and access to quality healthcare for employees and their families, while also providing several advantages for employers.

Our Trusted partners over the years

  • DELOITTE
  • INTEL TECHNOLOGY
  • PWC
  • CITICORP
  • CIPLA
  • HCL TECHNOLOGIES
  • BOSCH GLOBAL SOFTWARE TECHNOLOGIES
  • LARSEN AND TOUBRO LIMITED
  • JOHNSON CONTROLS INDIA
  • MSN LABORATORIES

  • 1

    Your doctor advises treatment or hospitalization

  • 2

    Intimate the claim on your health insurance

  • 3

    Visit Network hospital (For cashless claim) or Visit a hospital of your choice and pay accordingly (For reimbursement claim)

  • 4

    TPA desk of network hospital contacts BAGIC for cashless treatment (For cashless claim) or Submit original hospitalization related documents to BAGIC -HAT upon discharge (For reimbursement claim)

  • 5

    TPAs with us

List of TPAs associated with us

Life is an unpredictable roller-coaster ride. But amidst all the volatility, you can bank on us for being there by your side, all the time.


Should you want to file your health insurance claim online, click here. Conversely, you can also reach out to us at our Toll Free Number at 1800-209-5858 and we will be glad to help you out.


For Cashless Health Insurance Claim

While we drink to your good health, in case of any untoward incident



  • Approach any of the Bajaj Allianz Network Hospitals for complete cashless facility
  • The hospital will verify your details and send the duly filled pre-authorization form to Bajaj Allianz – Health Administration Team (HAT)

  • We will duly verify the details of the pre-authorization request with the policy benefits and intimate our decision to the healthcare provider within 1 working day


Yay! Your cashless claim is approved



  • We send the First response to your healthcare provider Within 60 mins

  • Your treatment costs at our network hospital will be settled by us and you don’t have to worry about the medical bills


It seems we have a query



  • We will send a letter of query to the healthcare provider, asking for further relevant information that will allow us to initiate the Health Insurance claims processes faster

  • Once we receive the additional information, we will send the authorization letter to your healthcare provider within 7 working days

  • Our network hospital will treat you and you won’t have to worry about the medical bills

We’re sorry, your claim is denied



  • We will send the letter of denial to the healthcare provider

  • The provider will carry out the treatment, as fully payable

  • However, you can certainly file a claim for reimbursement at a later date
For Health Insurance Reimbursement Claim

While we drink to your good health, in case of any untoward incident



  • Collect all hospitalization related documents and submit them, in original, to BAGIC HAT

  • We will carry out a customary verification of the required documents


Oh, we need some more information



  • We will send you a prior intimation of such deficiency so that you have sufficient time to provide further information

  • Upon receiving the requisite documents and some more enquiry, you can bank on us to initiate the insurance claims settlement process and release the payment via ECS within 10 working days (may be subject to terms and conditions)

  • In case you still fail to provide us with the pending paperwork, we will send you three reminders, each 10 days apart, from the date of intimation

  • However, please note that we will be forced to close the claim and send you a letter stating the same if you fail to come up with the pending documents beyond 3 reminders (30 days) from the date of intimation


Yay! Your claim is approved


We initiate a customary verification of the authenticity of the documents and if found permissible within the policy’s purview, we will release the payment via ECS within 7 working days.


However, if your General Insurance claim doesn’t fall within the policy’s purview, we will have to deny the claim and send you a letter stating the same.

Claim Forms
  • Hospitalization Claim Claim form duly filled and signed by the insured
  • Original Discharge summary document
  • Original hospital bill with detailed cost break-up
  • Original paid receipts
  • All Lab and test reports
  • Copy of Invoice/Stickers/barcode in case of implants
  • First consultation letter from doctor
  • KYC form
  • Completely filled and signed NEFT form by Policy Holder/proposer
  • Claim form duly filled and signed by the insured
  • Original Death summary document
  • Original hospital bill with detailed cost break-up
  • Original paid receipts
  • All Lab and test reports
  • Copy of Invoice/Stickers/barcode in case of implants
  • First consultation letter from doctor
  • KYC form
  • Legal heir certificate containing affidavit and indemnity bond
  • Completely filled and signed NEFT form by Policy Holder/proposer.
  • Original paid receipts
  • All Lab and test reports
  • Copy of Invoice/Stickers/barcode in case of implants
  • First consultation letter from doctor
  • KYC form
  • Medical fitness certificate from treating doctor stating the type of disability, disability period.
  • Original hospital bill with detailed cost break-up
  • Original paid receipts
  • All Lab and test reports
  • Copy of Invoice/Stickers/barcode in case of implants
  • First consultation letter from doctor
  • KYC form
  • Medical fitness certificate from treating doctor stating the type of disability, disability period.

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I hereby authorize Bajaj Allianz General Insurance Co. Ltd. to call me on the contact number made available by me on the website with a specific request to call back at a convenient time. I further declare that, irrespective of my contact number being registered on National Customer Preference Register (NCPR) under either Fully or Partially Blocked category, any call made or SMS sent in response to my request shall not be construed as an Unsolicited Commercial Communication even though the content of the call may be for the purposes of explaining various insurance products and services or solicitation and procurement of insurance business. Furthermore, I understand that these calls will be recorded & monitored for quality & training purposes, and may be made available to me if required.

Disclaimer

I hereby authorize Bajaj Allianz General Insurance Co. Ltd. to call me on the contact number made available by me on the website with a specific request to call back at a convenient time. I further declare that, irrespective of my contact number being registered on National Customer Preference Register (NCPR) under either Fully or Partially Blocked category, any call made or SMS sent in response to my request shall not be construed as an Unsolicited Commercial Communication even though the content of the call may be for the purposes of explaining various insurance products and services or solicitation and procurement of insurance business. Furthermore, I understand that these calls will be recorded & monitored for quality & training purposes, and may be made available to me if required.

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