GROUP HEALTH INSURANCE POLICIES
Which is Better PERSONAL POLICY OR GROUP POLCY ?
WHAT IS GROUP HEALTH INSURANCE POLICY ?
As the name suggests , it is the Health Insurance policy taken by a sponsor organization for the benefit of a group of people . The group of people may be employees , customers , associates or any other group associated with them .
As per IRDAI , Groups can be employer-employee groups or non employer-employee groups . (Examples are holders of the same credit card, savings bank account holders of a bank or members of the same social or cultural association and so on.)
For example , A bank may sponsor a common health insurance policy covering all its staff or ex-staff or all its deposit customers or beneficiaries of its loan schemes or credit cards . The bank will come to an agreement with the insurance company with regards to benefits of the policy as well as terms & conditions for the issue of the policy including premium payment . The benefits may vary to different sections of the group . The payment will be arranged by the sponsor bank . Premium may either be borne by the sponsors themselves or collected from the actual beneficiaries . The agreed terms & conditions as well as benefits between the sponsors and the insurance company will bind all the beneficiaries of the policy .
The sponsor organization may take a ready made corporate policy offered by the insurance company or can get tailor made by the insurance company depending up on the size of the group . Minimum number of Beneficiaries expected is seven .
Some of the examples of the group health insurance policies are :
1 . Group Health Insurance policy taken by the Indian Bankers Association on behalf of the employees & Family members of the staff of various Public Sector Banks and also ex-staff .
2. Acko Insurance Company's Corporate Health Insurance plan for the employees which will be tailored by the insurance company as per needs of the corporations . Such policies are available with many of the Health insurance Companies .
3. PNB oriental Royal Mediclaim Policy for PNB Account holders . The customers have to bear the insurance premium . Normally such policies may not come free to the customers of the bank .
Normally banks arrange the health insurance for their customers through an accredited insurance company . Though premium is collected by the banks , cover is provided by individual insurance company associated with the policy .
The sponsor organizations may take a group health policy either directly from an Insurance company or through an insurance broker company / Corporate agents who would negotiate with various insurance companies on behalf of their clients .
PREAMBLE : Most of the employees of organized sector , either private or public or other middle class citizens would have taken Health insurance policies . The employees would have got their mediclaims mostly arranged by their employees as a Group insurance policy and the premiums would be to the account of employers . Some would have taken through their bankers again arranged by the bankers as a Group insurance for their customers and would have paid their bankers . Some would have taken the individual policy directly from the insurance companies .
In this article , we explore the benefits and negatives of the Group policy along with the IRDAI guidelines on the subject .
Benefits of Group health Insurance plans
What a Group Insurance Policy covers ?
Normally a Group Health Insurance policy covers :
1. Pre & Post hospitalization expenses along with Hospitalization bills
2. Maternity expenses
3. Pre & Post Natal expenses
4. Ambulance charges
5. Day care expenses
The additional benefits available while taking up a Group Health Insurance Policy are
1. No medical test Required at the time of taking the policy
2. Pre-existing conditions are normally covered in the policies .
3. No waiting period either for pre-existing diseases or otherwise .
4. No copayment
5. Sponsors can negotiate both for customized policy and premiums which will be beneficial to the members of the group , if members have to bear the cost fully or partially .
6. Insurance companies normally provide dedicated customer service staff for early processing of claims from the group insurance members
ONE OF THE INTERESTING FEATURES OF A GROUP INSURANCE POLICY IS IT COVERS ALL MEMBERS IRRESPECTIVE OF THEIR AGE AND EXISTING MEDICAL CONDITIONS .
All the benefits may not be available in all Group policies . Hence please check whether the above features are available when taking up a particular group policy
NEGATIVES OF GROUP INSURANCE POLICY :
1. The benefits , terms & conditions of the policy is finalized by the sponsor of the policy . Hence a member of the group has to follow the policy conditions . Member of the group policy scheme have to be satisfied with whatever cover available in the policy . An individual may not get all the needed special covers in a group policy . Further sponsor organizations offer the policy till the members are associated with them . Once they sever the relationship , even on retirement , policy cover may not be available . At a late age . they may find it difficult to have a new policy .
2. Normally an employer bears the cost of insurance taken for their employees and families . But organizations / banks which sponsor group policies for the customers require the customers to bear the cost . Further the premiums fixed in a group policy depend on the average age of the members . Hence a member who is hale and healthy and without medical history and of young age may find a similar individual policy at a much lesser premium than the premium charged in the group , But a very senior member with serious medical probabilities may find the premium very attractive .
3. In comparison , an individual can find a health policy convenient to him / her and carry his personal or family policy life long without a break .
How to Buy Group Health Insurance policy ?
An organization which wants to buy group health insurance family for the employees and and their families can approach insurance companies who offer group insurance or approach a Insurance broker who may be able to get a better terms . If your organization is small or medium , you may have to take a ready made group policy from an insurance company and you may not be able to bargain for a better terms and premium . Then you may try a trusted insurance broker or a corporate agent , compare the offers and decide up on . If your organization is very large , you may even call for a tender from insurance companies and brokers giving out the expected coverage from the policy .
However comparing quotes from various insurers and brokers , you may be able to get better terms & competitive premiums .
Insurance Companies offering Group Health Insurance :
Most of the Health insurance companies and many General insurance companies offer Group Health Insurance policies .
Some of the Group Health Insurance policies are
1. STAR health group Insurance Policy for Bank Customers .
2. GODIGIT Group Health Insurance policy for Employees
3. ICICILOMBARD group health insurance policy
4. RELIANCE GENERAL group Mediclaim policy
5. SBI GENERAL Group Health insurance policy
6. ACKO Group Health policy for Employees
7. BAJAJ ALLIANZ Group Health policy for Employees
Most of the Health insurance companies will have group health insurance as one of their products .
For the list of Health Insurance companies in India , CLICK HERE
INSURANCE BROKERS OFFERING GROUP INSURANCE SERVICE :
The sponsor organizations for a group policy can approach insurance companies . But they also have an another option of seeking services Insurance broking services or Corporate Agents . Their service may be more helpful to small and medium companies. But even big organizations can try their services .
The broking companies and Corporate Agents are authorized by IRDAI . There ae more than 500 insurance brokers who are authorized to carry on their business .( For the list , CLICK HERE ) and more than 750 Corporate Agents ( For the list , CLICK HERE )
Though there are more than 500 accredited brokers and 750 Corporate Agents , only some are active in Group health insurance and have their own tailored mediclaim packages . We give below some examples :
1.Loop Health: One-Stop Solution For Group Health Insurance promoted by Phoenix General Insurance Brokers Private Limited
2. Plum group Health Insurance promoted by Plum Benefits Private Limited , Corporate Agents
3. Bajaj Finserve Group Health Insurance promoted by Bajaj Finance Limited , Corporate Agents
4. ANVITI Employer Health Benefits , promoted by by Anviti Insurance Brokers Limited
5 . PLAN COVER Group Health promoted by HII Insurance Broking Services Pvt. Ltd
6 ETHIKA Group Insurance promoted by Ethika Insurance Broking Pvt. Ltd
IRDAI GUIDELINES ON GROUP HEALTH INSURANCE :
IRDAI ON GROUP HEALTH INSURANCE :
A group insurance policy gives you advantages of standardised coverage and very competitive premium rates. You can avail of group insurance policies that a group you belong to takes.
Groups – for this purpose - can be employer-employee groups or non employer-employee groups as defined by IRDA’s group insurance guidelines. (Examples are holders of the same credit card, savings bank account holders of a bank or members of the same social or cultural association and so on.)
Here are some things to be careful about when you participate in a group policy:
Only one master policy will be issued to the Manager of the group and will be in the name of the group (eg: the association)
You are entitled to get a certificate of insurance if you participate in a non employer-employee group policy for your records.
This certificate should contain
the schedule of benefits
premium charged and
terms and conditions of the cover
Your cover could cease if you leave the group
When you leave the group the insurer should offer you continued coverage under an individual policy
The Manager of the group should disclose the premium rate and terms of the policy including the premium discounts offered to the group and should pass on the discounts to all members
The manager of the group has to disclose any administrative or other charges he is collecting from members over and above the premium charged by the insurance company.
For the complete IRDAI Guidelines , CLICK HERE
IRDAI' s Model Group health policy document
Draft guidelines on Group Health Insurance by IRDAI :
INSURANCE COMPANIES TO ISSUE CERTIFICATE OF INSURANCE , WITH COMPLETE DEAILS OF THE GROUP POLICY .
Dated 29.04.2022 : Chances are that Employees or members of a group insurance may not be aware of the details of insurance now as detailed information may not have been furnished to them either by the employer or the insurers . In case of emergencies , they would be groping in dark about the procedure they have to adopt for admitting in to an hospital , their insurance eligibility and whether particular surgery is eligible for insurance or not . Now to help insured persons from such a situation , IRDAI has come out with a draft for fresh set of Guidelines to be issued to Insurance companies for protecting the interests of insuring public .
As per the new draft guidelines , the insurer shall ensure issuance of certificate of insurance (CIS) to the members of the group, who are insured. The certificate of insurance shall include the schedule of benefits, period of cover, the premium paid, the frequency and
premium payment term. It should have important terms and conditions including . waiting periods, sub limits, deductibles, co-pay and exclusions. It shall also detail the procedure to be followed to register a claim with the insurer including complete details of the insurer where the claim should be registered.
Where an employer buys a group insurance policy for its employees, the employer may be treated as the master policyholder with the employees being treated as the beneficiaries. In such cases, the employer shall issue confirmation of insurance protection to individual employees with clear reference to the group insurance policy. The reimbursement claims of individual persons insured thereunder may be paid through the employer. In non-employer-employee cases, the individual group member would be treated as the insured beneficiary and the master policyholder will only be the holder of the policy .
Other significant guidelines :
1. Migration : Master Policyholder and General / Heath Insurer concerned shall facilitate the migration/portability as per the group scheme rules .
2. Pricing : Insurers must justify the rates and terms offered to any group to the Authority, if called upon to do so. All discounts should be based on valid underwriting considerations, taking into account the loss experience of the group, the expenses including commission that may be incurred / payable. Discounts and Loadings offered shall be based on objective criteria with appropriate justifications
3. ID Card : All group health insurance policies having named beneficiaries should have ID cards issued to the beneficiaries to enable them obtain cashless service, wherever applicable.
4. As the primary purpose of any health cover is to meet the treatment costs or to manage the life style on diagnosis of a critical illness, no Insurer is permitted to offer any indemnity or benefit based credit linked group health products, except for coverage of accidental death and disability in respect of policies issued under Personal Accident.
you may read the complete draft guidelines by CLICKING HERE . One can forward their comments/suggestions on the within referred exposure draft by 13th May 2022 in the attached format to the email id k.srinivas@irdai.gov.in