Group Health Insurance

TiE Suraksha Group Health Insurance

By November 16, 2020 November 20th, 2020 No Comments

tie suraksha group health insurance

A business is nothing without the people who work behind the scenes. While the entrepreneur may have big dreams, it is ultimately the team, with whose help he/she can realize the goals. It is the team that plays a key role in understanding and executing the founder’s vision. Fast-paced startups are becoming a preferred workplace for individuals entering the job market. With so much new talent raring to join them and their vision, startup founders have their pick of talent. Because the allocation of a limited budget is often a big priority for startups, and because most startups don’t have large HR teams, not-so immediate priorities like healthcare often get thrown on the backburner. While many startups put wellness as a priority in their company culture, founders should take care to pay attention to employee health insurance.

Health insurance for startups is a great way to reduce operating costs. Generally, it costs more for an individual to purchase their own health insurance plans, be it for themselves or for their families. Company-provided health insurance, sponsored by employers is more desirable for employees (as it covers nearly everything with no waiting periods) and can be a big motivating factor that gets candidates to choose your startup. Another big benefit is that healthy team is a more productive team – period. So it should come as no surprise that healthy employees have been found to be three times more productive than sick ones.

Now that you know why you should prioritize your team’s health insurance, it’s time to see the steps you need to take to choose the right health insurance for your startup. TiE Delhi-NCR in partnership with Plancover Insurance is coming out for the very first time in India a Group Health Insurance Cover titled “TiE Suraksha” to empower member startups and it’s employees. This health insurance has been carefully and very specially designed keeping in mind our members to ensure maximum coverage and benefits at the lowest of the cost ever possible from the insurance industry. Some of the salient features of this policy are –

Scope of Coverage: Plan – 1  Plan – 2 Plan – 3
Family Definition Self only Self + Spouse + 2 Children up to the age of 25 years Self + Spouse + 2 Children up to the age of 25 years + Dependent Parents/in-laws
Sum Insured
2 lac 3 lac 5 lac
Rs 1,245 Rs 1,310 Rs 1,730
2 lac 3 lac 5 lac
Rs 4,410 Rs 5,355 Rs 7,565
2 lac 3 lac 5 lac
Rs 23,470 Rs 28,770 Rs 39,450
Premium to be paid (excludes applicable GST)
Sum Insured Type Individual Family Floater Family Floater
Age Limit 18 years to 55 years 1 Day to 55 years 1 Day to 80 Years
Pre Existing Diseases/condition Not Covered Covered Covered for Employee Spouse and children. For parents covered after 1 year
First 30 days waiting period Applicable Waived off Waived off
1yr / 2 yr / 4 year exclusion Applicable Waived off Waived off
Maternity Limit Not covered 50,000 INR for the first 2 children 50,000 INR for the first 2 children
Maternity waiting period Not covered 9 months 9 months
New born Baby Coverage Covered from Day 1 Covered from Day 1 Covered from Day 1
Pre & Post Hospitalisation 30 day – 60 days 30 day – 60 days 30 day – 60 days
Disease wise capping Default No capping No capping
Room Rent 1% of SI for Normal and 2% of SI for ICU. Proportionate deduction applicable Single standard AC room for normal and no capping for ICU. Proportionate deduction applicable Single standard AC room for normal and no capping for ICU. Proportionate deduction applicable
Ambulance charges Not Covered Not Covered Covered up to INR 1,000 per claim

Who can avail the benefits?

This Group health policy is exclusively available only for Members of TiE Delhi-NCR. Founders who are current members and have an organisation (registered & incorporated) with full time employees can enrol. Their employees don’t have to take additional membership to avail the benefit. The policy will be in force for the time period you are a renewed and a paid member.health policy

FREQUENTLY ASKED QUESTIONS  

This plan is specifically crafted for members of TiE - existing and new ( click here to 
become a new member of TiE - Delhi NCR ). You need to be a member to avail the 
advantages under this plan.
This plan comes with the following benefits to you : 
        ■ No Medical tests, typical forms to be filled  or declarations to be made to become a part 
            of this policy   
        ■ This plan Does Not have any waiting periods for you to avail of the benefits in most 
            plant-types. You are covered from the moment you make a payment and fulfill the 
            eligibility criteria 
        ■ Parents Coverage - Unlike the challenges you face in getting parents cover in the retail 
            market, this plan offers coverage for your parents without any questions 
        ■ Affordable costs - entire family coverage with uncomparable benefits versus retail 
           products and at negotiated rates. A startup or a smaller organization will get the 
           advantages of large group discounts without any underwriting checks which are typical 
           for a smaller company.  
         ■ Access to the best hospitals across the country on a Cashless basis 

Construct of the policy - Organisations with less than 7 employees will become a part of the 
TiE Master policy. Those with more than 7 employees will be given a policy directly in the name 
of the company directly by the insurer at the same rates.
What constitutes a company eligible under this plan -  
          ○ Any entity with a GST certificate mentioning the nature of the entity as a Private Limited, 
             Public Limited, or Proprietorship will be eligible. Individuals at this time will not be covered 
             until the roll-out of the 2nd phase of this plan. 
          ○ If the GST number is recently changed from individual to proprietorship, private limited, or 
             public limited, you will be eligible for availing membership benefits under this plan.
Active members -  This program is available for all active members of TiE. This list has been 
provided to the plan administrator and will be updated on a monthly basis.  In case a member
has taken a plan and does not renew the TiE membership, the insurance coverage will be 
canceled for that member. This is a legal requirement as per policy construct and guidelines.  
Principle of Equal Benefits  - this means that as an organization you will have a choice of 
opting for any one of the 3 plan types. Whichever plan you choose, will be applicable to all 
members and will remain constant through the tenure of the policy. To keep the administration 
simple and due to construct of this cover, different plans for different employees will not be 
possible in the same organization. At least not at this point in time.
Plan 3 which covers parents, is available to any organization where the total number of lives ( 
including employees, spouses, children, and parents, exceeds 150 ). In case you are yet not 
meeting these criteria, kindly get in touch with us separately using this Link

There are multiple insurers we have worked with for launching this plan. The participating 
insurers are amongst the top brands in the country.

There is no minimum requirement of the number of employees required for enrolment in 
the policy.

All health insurance policies will pay for expenses incurred towards the treatment of any 
specific illness/sickness which requires hospitalization. Admission in a hospital for a 
minimum period of 24 hrs is mandatory for any claim from the policy. However, this 
condition is waived under certain procedures which are called Daycare procedures” where 
the expenses are paid even if there is no hospitalization. 

Yes. Medical expenses incurred for covid-19 treatments get covered in this insurance. 
Hospitalization in a hospital is mandatory. Home containment expenses for covid-19 does 
not get covered under this plan.  

The typical waiting periods include-
      ■30 days waiting period  -  except for accidents,  in a standard policy, no coverage is 
         available for the first 30 days. This  is not applicable for Plan 2 and Plan 3 
      ■1st  Year / 2nd Year waiting period - certain designated treatment or ailments are not 
         covered for this period viz Cataract, Hernia, Hysterectomy, Fistula, Piles and Stone 
         removal - this waiting period is waived off for Plan 2 and Plan 3  - for this everything will 
         be covered from  day 1 
      ■Pre Existing Disease / Conditions waiting period - Typically applicable for 3 years or 4 
         years. this waiting period is waived off for Plan 2 and Plan 3  - for these everything will 
         be covered from day 1. In Plan 3, for parents, there is a waiting period of 1 year for 
         pre-existing diseases.
  
Plan 1 - Waiting periods are applicable. 
Plan 2 - All waiting periods are waived off, except for maternity which has a waiting period 
of 9 months. This means if a covered person gets pregnant on or after taking the policy, 
with the gestation periods of  9  months, the claim will be paid. Hence, anyone pregnant as 
on the date of taking the cover, will not be eligible for the maternity benefits.  
Plan 3 - No standard waiting periods, except for Pre-existing diseases and conditions for 
dependent parents which are covered after a waiting period of 12 months.  

Plan 1 -  Maternity expenses are not covered. 
Plan 2 -  Maternity expenses are covered up to INR 50,000/-  
Plan 3 - Maternity expenses are covered up to INR 50,000/- 

There are three plans that you can select from: 
Plan 1 - Available only for employees.  
Plan 2 - Covers for the employee, spouse, and up to 2 children.  
Plan 3 - You can cover your entire family members including dependent parents only.  

No. The policy is annually renewable and valid only for a maximum period of 12 months.

The insurance plans cover expenses for both cashless and reimbursement claims. 
Cashless claims are paid directly to the hospital by the insurer. Reimbursement claims are 
paid to the employee directly through an electronic transfer. In the event of the death of the 
employee, then the claim will be paid to the beneficiary/legal heir of the employee. 

There is no co-payment on claims in any of the plans. However, Plan 1 has sub-limits for 
specific diseases and room rent. Other plans allow you unrestricted access to a Single 
standard AC room.

To keep the administration of the policy simple, the premiums have been normalized across all types of 
family composition. In case you are to get married during the tenure of the policy, you will not 
be charged an additional premium. The same goes in case a married couple has a child during 
the policy tenure. Just upon intimation, they will  get added to the policy

In this case, you will be eligible for  Plan 3. 

As mentioned above, these premiums have been normalized across various combinations of parents - hence you will need to opt for the standardized plan 3  

TiE Delhi-NCR has provided a list of all active members. Only those members will be eligible for coverage 

Enrollment is the process of getting your employees and their dependents to sign up for the 
insurance. You have a window period of 45 days from the plan launch date to get enrolled 
in any of the plans under this program.  
We will provide you with the online link for uploading the employee’s database which then 
will let you know the premium. You can then remit the premiums online. You will also 
provide the GST details to confirm that the company is either a proprietorship, private 
limited, or public limited.  
Your coverage will start from the date you provide the employee details and make the 
premium payment or any other designated date.  
You and your employees will be provided with individual login Ids 

Yes.  However, these additions during the midterm will be restricted to natural additions ( 
newlywed spouse, or newborn baby). You cannot add dependent parents midterm of the 
policy. 

Both cashless and reimbursement claims are paid under this insurance. The insurer has a 
wide network of hospitals across India for cashless settlement of claims. Reimbursement 
claims will be paid within 30 days of submission of all documents.

Every individual member who is enrolled in the insurance will get an electronic card 
(cashless health card) that can be used at hospitals for availing cashless treatments. 
However, cashless treatments are possible only in a network of hospitals. If you take 
treatment in a non-network hospital, you can only take reimbursement of the claim.

In case you have more than one policy, either a personal cover or coverage through a 
spouse insurance plan, you can always claim under both policies. This claim typically takes 
care of unpaid bill amounts due to capping in some policies. Such amounts will be either 
unpaid due to room rent capping, treatment capping for example in Maternity claims. In any
event, the amount claimed from all polices cannot exceed your overall cost of the hospital 
bill

In case of hospitalization under the policy, all Outpatient expenses - 30 days before the 
date of admission and 60 days after the date of discharge, related to the main 
hospitalization will be paid. Stand-alone OPD charges are not covered in these highly cost 
effective plans. 

In case the premiums are being recovered from the employee’s salary, you 
will need to mention that on Form 16. In which case, individually the employees can take 
advantage of tax benefit under section 80D 

 

Disclaimers:-
The details mentioned above are for representational purposes only.  TiE Delhi-NCR takes no express or implied responsibility for anything mentioned above. Insurance is the subject matter of solicitation. The purchase of Insurance products by TiE Delhi NCR members is purely voluntary and not linked to availing of any other services from the organization. Insurance will be underwritten by an IRDAI licensed insurance company. The policy will be issued to you by the insurer and would be subject to the terms and conditions governing such a policy. The contract of insurance would be between the insurer and the insured only, and not between TiE Delhi-NCR and the insured.

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