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Group Health Insurance

11 Characteristics of Group Health Insurance

By December 17, 2021No Comments

What is Group Health Insurance?

Group health insurance is the health plan that proposes coverage to a group of individuals against various types of risks. These individuals are part of a recognised group such as trade unions, business groups, employer-employee etc. A single policy is delivered in the name of the group and is known as the master policy. All members of the group are insured under the same. 

With the increasing cost of healthcare and medical facilities, it has become mandatory for anyone and everyone to have a health cover. There were times when health insurance was considered as an added benefit. But today, it has become a sheer necessity. Without adequate health cover, an individual is left to suffer financial hardships, in case of medical emergencies. During such critical times, worrying about money is the last thing one would want to do. Thus increased need for health insurance has led the companies to offer health coverage to their employees.

Characteristics of Group Health Insurance

  1. Customized and tailor-made
  2. Purpose
  3. Cashless facility
  4. Covering pre and post hospitalization costs
  5. No waiting period
  6. coverage for pre-existing illness
  7. Coverage for dependents
  8. Pocket friendly premiums
  9. Minimum number of employee
  10. Time duration
  11. Co-payment option

Customized and Tailor Made

One of the key features of the group health insurance policies is that they are customized and tailor-made as per the requirement of an individual group or organization. The policy is formulated on the basis of the number of employees and the benefits an employer wants to extend to its employees. An organization can include or exclude features from the base plan provided by the insurance companies based on its financial budget. It specifically lays down limits for each benefit it wants to cater.

Purpose

Group health insurance policies are available in the market for those groups, who serve their purpose of existence. Without any purpose, the groups are not offered any group health insurance. Also, a group created merely to buy group health insurance will also not be entertained.

Cashless Facility

Group health insurance enables the insured to get cashless claims. To avail the cashless facility, the insured has to get the treatment done in the network hospitals empanelled with the insurance company. The hospital needs to be notified with the details of the insured person during the time of admission. Further, the hospital informs and coordinates with the insurance company and the bill is directly paid to the insurer.

Network hospitals are the hospitals that have a tie-up with the insurance companies.

Medical Identity Card: Medical Identity card falls under cashless services. Some groups or organizations provide a medical card to each of their employees, to shorten the tedious paperwork. They intend to provide a hassle-free, and smooth experience of cashless services to their employees. A single medical identity card covers the employee and the family members in case of need. 

Covering Pre and Post Hospitalization Costs 

Pre-hospitalization expense is referred to as the medical fee incurred by the insured before getting admitted to the hospital. Post-hospitalization expense is referred to as the medical expenses incurred by the insured after getting discharged from the hospital. Expenses incurred up to 30-60 days are covered under pre and post-hospitalization costs.

Pre-hospitalization Expense

These expenses include the cost incurred on various types of tests before getting admitted to the hospital. To accurately diagnose the medical condition of any patient, doctors generally run the patient through various medical tests. The number and kind of medical tests depend on the health and medical condition of the patient. 

These medical tests such as blood tests, urine tests, total blood count, X-rays etc are covered under the pre-hospitalisation expense. It also includes the consultation fees of the doctor.

However, there is a limit to the number of days before which the insured is getting admitted to the hospital. Generally, medical charges borne within or before 30 days before admission in the hospital are covered under pre-hospitalization expenses. Still, it may differ depending on the plan of the health insurance provider.

Post Hospitalization Expenses

These expenses include the expense incurred after getting discharged from the hospital. To accurately confirm that the patient has recovered from the diagnosed illness, various tests could be conducted by the doctor post-hospitalization. These tests are included in post-hospitalization expenses. Generally, charges incurred by the insured from 60 days of the discharge date are included in post-hospitalization expenses. Expenses related to Naturopathy and acupuncture are not provided by the insurance providers.

Employees can claim pre and post hospitalization expenses by submitting the original bills receipt and a copy of the doctor’s prescription or certificate to the employer.

No Waiting Period

One of the key features of group health insurance policy is that some insurance companies skip the waiting duration for the coverage. These plans omit the waiting period requirement which is otherwise mandatory in other plans and policies. The insured can take benefits of such policies and can avail the coverage starting from day one, including any chronic ailments.

However, the insurance policy may differ from employer to employer. Some organizations might not extend this benefit to the employees. It solely depends on the employer as to the features it wants to offer to its employee.

Coverage For Pre-existing Illness

The pre-existing disease is referred to as disclosure of any existing medical condition to the insurance provider as well as the employer at the time of policy purchase. Although insurance companies do not prefer to include any pre-existing disease under their coverage. However, with a group health insurance policy, it can be covered with the time clause.

Under group health insurance, the insurance companies insure any employee with a pre-existing disease from either day one or by adding a waiting period. They offer a time duration in which the employee with an existing medical condition will not be able to raise any claim. Once the waiting period is over, the employee can begin to claim the expenses of pre-existing disease under the insurance cover. Some insurance companies may choose to keep a waiting period of 2 years, some may choose 3. It depends on their discretion.

In case the insured hides the pre-existing disease at the time of policy purchase, the insurance company can reject the claim of the insured.

Coverage For Dependents

Generally, coverage in any policy differs from organization to organization. It basically depends on the health benefits that an employer wants to cater to its employees. Under the group health insurance policy, most of the organizations provide coverage to only employees and their immediate families. 

The immediate family includes parents, spouses and children. It may or may not include parents-in-law. However, if the employee wants the parents-in-law to be included in the cover, it can be done by paying an additional premium. These policies can be customized at the will of the employee.

Pocket Friendly Premiums

Group health insurance policies are some of the most pocket-friendly policies to invest in. These are tailor-made policies and the premium is calculated on the basis of the risk covered. Various factors such as average age, coverage, risk involvement, number of employees to be covered and tenure, affect the calculation of the premium amount. Thus, an organization can choose a policy that suits its pocket and requirements.

Minimum Number of Employees

Group health insurance policies are provided to the organization that suffices its requirement with a minimum number of employees. Generally, an organization needs to have a minimum of 20-25 employees to purchase a group insurance policy. However, the minimum number required may vary from plan to plan.

Time-duration

A group health insurance policy covers the group for the tenure of one year. Every year the policy needs to be renewed to enjoy the benefit cycle. However, it may again differ from policy and the plan purchased by the group.

Co-payment Option

Many times, the employee wants to include add on benefits to the base plan offered by the employer. In such scenarios, the employees have to bear the additional cost of the premium. The employer directly deducts the extra cost of the premium from the salary of the employee. The insurer receives the entire premium in bulk from the employer itself.

Group health insurance plans are some of the most affordable covers that a group can invest in. Their premiums are affordable and pocket-friendly. However, the organization or the employer should review a variety of plans from different insurance providers. They should buy group health insurance that offers maximum benefit at the lowest premiums.

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