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Group Health Insurance

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Group Health Insurance

"For small business owners and corporate HR professionals, hiring and retaining skilled professionals is a key concern. Offering valuable employee benefits or perks is one of the best ways to achieve this, and group health insurance stands out as one of the popular choices."

"Group medical insurance helps employers offer extensive healthcare benefits to all employees under one policy. This is more efficient compared to providing health insurance to each employee separately."

"THE PURE POLICY group health insurance offers wider coverage, simple purchase options and a large hospital network, making it easier for you to manage your team while we take care of their health."

What is Group Health Insurance?

Group health insurance, also called corporate health insurance, is an insurance policy that covers the medical expenses of a group of individuals. Many organisations offer group health insurance coverage as part of employee benefits. By offering health insurance coverage, you can promote a healthier, happier and more productive workplace.

Group medical insurance covers a range of medical services and benefits, including hospital stays, daycare treatments, maternity care and surgeries. Additionally, the group health insurance policy can cover your employees’ or group members’ families, including their spouses, dependent children and dependent parents.

Who should buy Group Health Insurance?

Small and Medium Enterprises
Small and Medium Enterprises (SMEs), such as small-scale textile units, logistic firms and regional food processing units.
Start-ups
Start-ups, such as new tech companies, mobile application developers and online service providers.
Large corporations
Large corporations, such as IT service providers, manufacturers and large-scale retail businesses.
Associations or societies
Associations or societies, such as social welfare associations for rural development.
Companies
Companies, such as banks or other financial institutions that want to establish a strong relationship with the customers.

Types of Groups Covered in Group Health Insurance

Let us quickly understand what a group means and what groups are covered under Group Health Insurance policies.

According to IRDAI, a group, under a group health insurance policy, is defined as members coming together to engage in a common economic activity but not merely formed to obtain health insurance coverage benefits. Groups can broadly be classified into two categories:

Employer-Employee Groups
Includes companies and organisations offering health insurance to their employees. It can be small or medium-sized companies or larger corporations and their employees. Employers generally pay the full premium or require a minimal contribution from employees.
Non-Employer-Employee Groups
Includes registered groups like welfare associations or societies offering health insurance coverage to members. It can also include customer groups. For example, banks offer health insurance to their credit card holders. Members usually share the cost of the insurance.

Why Buy Group Health Insurance?

Simple purchase options

Assess your needs, enter details online, choose features and buy the plan easily.

Customer support

Our team is here to guide and assist you at every step.

Cashless network

Get access to over 12000+ hospitals across India to offer cashless treatments.

Wider coverage

Our plans cover in-patient treatment, maternity care, daycare procedures and more.

Customisable add-ons

Enhance coverage with options like pre-and post-natal care and baby day one cover.

Hassle-free claim process

Benefit from a quick and smooth claim settlement process for both cashless and reimbursement claims.

How Does a Group Health Insurance Plan Work?

Policy Purchase

Employers check eligibility and decide the type of coverage required. Then, they share the company details and purchase the policy.

Premium Payment

The employer pays the full premium or divides the cost with the employee based on company policy.

Enrollment

We add the employee details to the system. If the plan includes family members, their details are also added.

Coverage Commencement

The group health insurance policy becomes active, and employees can start using it to cover their medical expenses.

Claim Filing

If an employee needs treatment, they inform the employer and get the required healthcare services.

Claim Settlement

The employer files a cashless or reimbursement claim and gets the bills settled for the employee.

Group Health Insurance Benefits for Employers

To ensure legal compliance
After COVID-19, IRDAI made it mandatory for employers to provide group health insurance in India for employees.
To attract talented applicants to the job
Many skilled professionals prefer companies that offer health insurance coverage while applying for a job role.
To retain employees
Health insurance makes your employees feel valued and encourages them to stay longer. This reduces the need to hire and train new staff.
To support employee well-being
Group medical insurance covers various medical expenses to help your employees stay healthy and stress-free.
To boost productivity
By offering group insurance for employees, you build trust and loyalty within your team. This helps them stay focused at work, boosting their overall performance.
Lower premiums
As the risk is spread across a large group of individuals, the cost is lower compared to reimbursing each employee’s medical expenses separately.
Tax benefit
Employers can claim the premium paid for the policy as a business expense under Section 37(1) of the Income Tax Act.
Enhance reputation
Offering group medical insurance for employees reflects your responsibility as an employer and strengthens your reputation in the market.

Group Medical Insurance Benefits for Employees

Here are some of the most lucrative benefits of group health policies that the employees of an organisation can enjoy:

Coverage at no or less cost
Most employers pay the premium entirely or require only a minimal contribution from employees for health insurance coverage.
Health insurance coverage for dependents
Employees can also cover their family members, including spouses and dependent children, under the policy.
No waiting period
Group health plans cover employees from day one without the waiting period for pre-existing conditions.
Comprehensive coverage
It includes a broad range of medical expenses such as hospitalisation, ambulance costs, surgeries and more.
Easy access to quality healthcare services
Employees can easily access and get treatment for their health conditions in some of the best hospitals across India.
No medical check-up required
Older employees and others with pre-existing conditions can also get health insurance coverage without medical check-ups.
Tax benefit
Employees who contribute to the group health insurance premium can claim a tax deduction under Section 80D of the Income Tax Act.

Key Features of THE PURE POLICY Group Health Insurance Plans

Key Features Details
Policy Group Medicare
Policyholder Employer
Insured Members Employees, and if included, their family members, such as their spouse, dependent children and dependent parents.
Mid-Term Addition of Dependents Post marriage, spouses and newborn children can be added.
Coverage In-patient expenses, pre-and post-hospitalisation, daycare procedures, domiciliary (home) treatment, organ transplant, ambulance cover, maternity cover, family transportation
Add-ons Pre-and post-natal care, baby day one cover
Cashless claims Available in-network and non-network hospitals.
Network of hospitals 12,000+ across India
Pre-medical examination Not required
Waiting period Waiting period No waiting period for initial coverage, specific illnesses, pre-existing health conditions and maternity cover.

What is Covered in Group Health Insurance?

In-Patient Treatment
Hospital stays and treatment expenses, if the employee is admitted for at least 24 hours due to injury, illness, or disease, are covered.
Pre-and Post-Hospitalisation
Expenses for consultations, blood tests, scans, and medicines before being admitted to and after discharge from the hospital are covered. This applies to the number of days mentioned in the policy and for in-patient treatment, daycare procedures, or home treatments.
Day Care Treatment
Expenses for daycare procedures that take less than 24 hours of hospitalisation in a hospital or daycare centre are covered. Refer to common daycare procedures covered under a group health insurance policy.
Domiciliary Treatmentwell-being
Expenses for treatment at home if it continues for more than three days are covered. This does not include enteral feeding (tube feeding) or end-of-life care.
Organ Transplant
Medical and surgical expenses for an organ transplant are covered if the employee is receiving the organ. This is provided if the employee has claimed in-patient treatment
Ambulance Cover
Expenses of moving the insured employee in an ambulance during an emergency or to another hospital for better treatment are covered. This is available for in-patient treatment or daycare procedures.
Maternity Coverage
Maternity expenses for childbirth, termination of pregnancy and newborn medical care are covered. Ectopic pregnancies are not covered under maternity care but can be claimed under in-patient treatment.
Family Transportation Benefit
Transportation expenses for one immediate family member if the insured employee is admitted to a hospital more than 200 km from their home are covered.

Please Note: Inclusions may vary based on individual cases. Please read through your policy document for detailed information.

What is not Covered in Group Health Insurance?

Investigation and Evaluation
Expenses for primary diagnostics and evaluations (blood tests, scans, etc.) not related to the ongoing treatment are not covered.
Rest and Respite Care
Expenses for bed rest and temporary care for insured employees with serious illnesses that cannot be cured are not covered.
Obesity/Weight Control
Expenses related to the surgical treatment of obesity are not covered if it is not recommended by a doctor and supported by standard medical guidelines.
Gender Change Treatment
Medical expenses related to the treatment and surgery for gender change are not covered.
Cosmetic or Plastic Surgery
Expenses for cosmetic or plastic surgery, unless required for accidents, burns, cancer or medically necessary, are not covered. Dental treatments are also excluded in this case.
Addiction
Expenses for treating addiction to alcohol, drug or substance abuse, or any other related condition are not covered.
Unproven Treatments
Medical expenses related to any unproven treatment or medication are not covered.
Miscellaneous
Expenses for refractive error treatment, adventure sports injuries, breach of law, and sterility or infertility treatments are not covered.

Please Note: Exclusions may vary based on individual cases. Please read through your policy document for detailed information.

Things to Consider When Buying Group Health Insurance Plans

Employee needs

Consider the number of employees, their age, health conditions, and any specific requirements they might have.

Policy conditions

Read the policy document to understand the medical expenses included and excluded under the group health insurance policy.

Options for additional coverage (add-ons)

Consider including add-ons like pre-and post-natal care to offer additional coverage.

Premium

Make sure the cost fits your budget while still offering essential healthcare benefits to your employees.

Claim Process

Understand cashless and reimbursement claim processes and the documents required to ensure hassle-free claims.

Eligibility Criteria to Purchase Group Health Insurance

Type of group :

As stated before, the group must qualify as a group as defined by IRDAI. It can be an employer-employee or non-employer-employee group.

How to Apply for Group Health Insurance Policies?

Analyse coverage needs
Determine the number of employees, their age and basic healthcare requirements to determine the coverage necessary.
Enter company details
Use the calculator on this page to enter GSTIN, email address and mobile number.
Determine the policy
Determine the policy and features that suit your company’s requirements and budget.
Review and customise
Check your policy details and premium and make changes to customise your plan. Include add-ons to enhance the coverage if necessary.
Pay the premium
Make the payment online and complete the group health insurance application process to activate your policy.

How to Apply for Group Health Insurance Policies?

Inform Us :

Inform THE PURE POLICY within 24 hours of emergency hospitalisation and at least 48 hours in advance of a planned hospitalisation.

Call us on our customer support number - 9136356555

Use our self-service portal.

Request for Pre-authorisation
Visit any hospital and contact their TPA (Third Party Administrator) to show your Health Card and submit the pre-authorisation form to request cashless treatment with THE PURE POLICY.
Get Hospitalised
If the request gets approved, the employee or the group member can receive the treatment at the hospital.
Get Discharged
Submit the medical reports and bills to the hospital at the time of discharge.
Get Claim Settlement
We will review the medical bills and settle them directly with the hospital.

How to Raise Reimbursement Claims for Group Health Insurance?

Inform Us :

Inform THE PURE POLICY within 24 hours of emergency hospitalisation and at least 48 hours in advance of planned hospitalisation.

Use the Initiate Claim option

Call us on our toll-free number -

Use our self-service portal.

Get Hospitalised
The employee or the group member can get medical treatment at any authorised hospital.
Pay the Medical Bills
Settle the medical bills at the time of discharge and keep all receipts safely for reimbursement.
Submit the Documents
Submit the claim form, medical reports and payment receipts with THE PURE POLICY for reimbursement.
Get Claim Settlement
We will review your documents and reimburse the applicable expenses.

Documents Required for Group Health Insurance Claim

List of Documents for Cashless Claims :

Health Insurance Card / Policy Copy

Copy of Company photo ID

Customer address proof

Duly filled CKYC Form if the claim amount is above ₹1 lakh

Admission notes from a treating doctor

Previous OPD consultation papers with reports, if any

Previous discharge summary or any other medical records, if applicable

Any previously approved / settlement letter from THE PURE POLICY for reference (Optional)

List of Documents for Reimbursement Claims :

Duly filled and signed claim form

Health insurance card or policy copy

Medical Certificate signed by the doctor.

Original discharge summary and original consolidated final bill/p>

Detailed break-up of the submitted final bill

Original cash receipts from hospital, pharmacy, and lab

Bank account details of the payee

Supporting investigation reports

Invoices of any implants used during treatment

MLC (Medico-Legal Case) or FIR (First Information Report), in case of accidents

Nominee’s address and ID proof in case of death claims

Duly filled CKYC form if the claim value is above ₹1 lakh

What is a Health Card in a Group Health Plan?

A health card is the identity card issued to each employee covered under a group health insurance policy. It contains essential information, such as the policyholder's name, policy number, member ID, policy period, age, date of birth and gender.

Employees must carry this health card to the hospital to benefit from cashless treatment. It facilitates easy and efficient access to healthcare services at hospitals associated with the insurance plan.

Group Medical Insurance Add-Ons

Pre-and Post-Natal Care

Covers the expenses for regular health check-ups or follow-up visits, medicines and tests during pregnancy and after delivery.

Baby Day One Cover
Covers the treatment expenses of a newborn baby from the date of birth.

Terminologies You Need to Know Before Buying a Group Health Insurance Policy

Premium

The amount you pay periodically (every month, quarter, or year) to keep the group health insurance active.

Deductible
A fixed amount the employer (or sometimes the employee) needs to pay for every claim before the insurance starts covering medical bills. A higher deductible results in a lower premium.
Copayment (Copay)
A fixed amount the employer (or sometimes the employee) must pay while receiving healthcare services, such as doctor visits or prescription medications. The copayment amount may vary depending on the service.
Network
A group of hospitals that have agreements with the insurance company to provide cashless treatments. While cashless services are available at non-network hospitals, the process is quicker and hassle-free in network hospitals.
Pre-Authorisation
The process of obtaining approval from the insurance company before undergoing certain medical procedures or treatments for cashless claims.
Exclusions
Specific medical services, treatments, or conditions that are not covered under the group health insurance policy.
Waiting Period
The period for which the insured members need to wait for the insurance to start covering certain conditions, like pre-existing illnesses. Waiting periods are not applicable to group health insurance plans.
Renewal
The process of extending the group health insurance policy beyond its initial term. Understanding the renewal terms and conditions, including any changes in coverage or premiums, is crucial.

Eligibility Criteria to Purchase Group Health Insurance

Differentiating factors Group Health Insurance Individual Health Insurance
Who buys the policy? Employers buy and offer it to their employees. Any individual can buy it for themselves or their family.
Who is covered? Who is covered? Employees and their dependents Only the insured person (spouses, children and parents) Only the insured person
Coverage Standard coverage, like in-patient treatment, pre-and post-hospitalisation, maternity care, etc., is common to all employees. Customisable plans with wider coverage, including critical illnesses, AYUSH benefits, modern treatments, etc., specific to individual healthcare needs.
Underwriting (Risk assessment by insurers) Simplified processes with no health check-ups Detailed checks based on age and health condition.
Flexibility Limited flexibility. The employer decides the sum insured and features. Higher flexibility. Individuals decide the type of policy, sum insured and other features.
Add-ons Limited options Wide range of add-on options available
Premium Premium Based on the number of employees, their age, etc. Based on the individual’s age, gender, health condition, etc. Paid by the employer or partly shared by employees. Fully paid by the policyholder. Premium Based on the number of employees, their age, etc. Based on the individual’s age, gender, health condition, etc. Paid by the employer or partly shared by employees. Fully paid by the policyholder.
Waiting period Option to waive off Waiting period Option to waive off Waiting period applies (For example: 30 days for initial coverage and 2-4 years for pre-existing illnesses, maternity care, etc.)
Portability Portability Can be converted to an individual health insurance policy when leaving the job. Remains active and portable regardless of job changes. Portability Can be converted to an individual health insurance policy when leaving the job. Remains active and portable regardless of job changes