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Group Health Insurance

What is Covered & not covered in Group Health Insurance for Startups?

What is Covered not covered in Group Health Insurance for Startups 1

Group health insurance policies are not just for the large companies in the business. Small to medium-sized companies can also get access to the many advantages of insurance policies. Startups can also avail of the benefits and help provide the employees with steady medical expense support for their well-being. There are multiple insurance policies that offer similar benefits under their group insurance plans. 

Startups and group health insurance policies

Startups can opt for the employee group health insurance policies because of the diverse coverage offerings. The coverage features vary depending on the selected policy and associated insurance company, but as a whole, it is a great option. Knowing about the different coverage and non-coverage areas will help gain a clear picture before opting for any employee group health policy

  • Covers medical expenses for existing diseases

With a group health insurance policy, the employees can get the expenses to treat any pre-existing disease. Most of the leading insurance companies offer medical expense coverage for any prolonged illness. It also includes diagnostic tests, treatment expenses, doctor fees, and other surgery costs. It truly helps the employees of the startup by offering them undeniable insurance support. 

  • Covers maternity expenses

Maternity medical expenses fall under the policy coverage areas in most group health insurance for startup companies. The female employees or the spouse of the male employee can avail of this benefit. The maternity coverage for normal deliveries and C-sections may vary depending on the regulations of the insurance policy. With most of the leading insurance providers, there is also coverage for the newborn for ninety days. 

  • Covers accidental hospitalization

A group health insurance also covers the expenses for hospitalization due to an accident. It is a part of the policy norms in almost every insurance company. This insurance coverage aspect helps the employees to stay worry-free even during medical emergencies caused due to accidents. They can either get a cashless service at the selected hospital or reimbursement of the total expense of treatment. 

  • Covers medical expenses for the family and dependents

The group health insurance is useful for the employees of the associated startup and their families. The employee’s family members and dependents can also avail of the insurance advantages on getting hospitalized for a valid reason. However, the regulations related to this point may vary depending on the selected insurance provider. 

  • Get cashless service in hospitals

Cashless coverage for hospitalization and medical treatment falls under the coverage sphere in group health insurance. Under this benefit, the employee or dependent family member can produce the insurance card and get admitted to the hospital under acceptable policy terms. The reason for hospitalization has to be a valid one, and the hospital must fall under the list of the cashless facilitated centers of the opted insurance policy

  • Covers the charges for medical accessories and ambulance

While treating a disease or getting surgery, there are several other expenses apart from the bed charge and doctor fees. The expenses may include accessory costs for ambulance charges, nursing charges, and much more. Group health insurance covers it all for the employee and their family member, subject to the terms and conditions purchased by the startup in their purchase of a group policy

Areas that do not fall under insurance coverage

Until now, all the discussed points fall under the coverage sphere of the leading group health insurance providers for startups. But you must also know about the non-coverage aspects for gaining a clear idea of the associated policy regulations. 

Coverage rules vary depending on the selected insurance company

Under the IRDAI authority, group health policies of different insurance companies have diverse policy rules that affect the coverage and non-coverage domains. You can get a complete list of expenses that are not payable, which are non-medical in nature.  These are standardized across all insurance policies in India. ** 

  • No coverage for Treatment of Obesity and any weight control program

The policies do not cover any treatment expense for obesity control or weight control program. Even if the treatment is prescribed by a registered physician, it does not qualify for plan coverage. 

  • No coverage for medical treatment under homeopathy or Ayurveda

The insurance policies do not support the expenses of medical treatment that fall under different wings of medical practice other than allopathy. The majority of the insurance companies only offer cashless or reimbursement of expenses if you undergo treatment at a hospital that practices modern medicine. There are no insurance coverage provisions with alternative healing treatments like homeopathy, acupuncture, Ayurveda, etc. 

Of late due to the advancement in medical field including Ayurveda and homeopathy, some insurance plans provide coverage for treatment taken in government registered hospitals for ayurvedic and homeopathic treatments. 

  • No coverage for unproven treatment and diagnosis procedure

Any expenses incurred towards experimental, investigational or unproven treatment  primarily  for  diagnostic,  X-ray  or  laboratory  examinations  or  other  diagnostic studies  which  are not  consistent  with  or incidental  to the diagnosis  and  treatment  of the positive existence of an ailment or presence of any Illness. 

  • No coverage for ailments created due to drug abuse

There are no insurance benefits for treatment to combat excessive drug abuse or drug consumption-related ailments. You can only get the expense reimbursed or avail of cashless service with treatment that generates due to physical disorders and accidents. In many insurance policies, there is no financial support for psychiatric diseases. 

  • No coverage of medical expenses for extended family

In most of the leading group health insurance policies for startups, only the direct dependents of the employee fall under the list of beneficiaries. There is no policy support for extended family members like in-laws and relatives. An employee may get coverage for their spouse, children, and parents. 

  • No coverage for regular checkup expenses

If the employee gets admitted for a regular health checkup without a valid prescription from a physician, the insurance policy will not cover the expense. For availing of the benefits of reimbursement or cashless treatment, there must be a valid physical illness or disease that needs immediate medical attention. 

  • No coverage for vaccination and preventive care

There is no coverage for ​​preventive  care,  vaccination  including  inoculation  and immunizations  (except  in case  of post-bite treatment) unless certified as essential by the attending Medical Practitioner as part of the ongoing treatment as a direct consequence of an otherwise covered claim. 

  • No coverage for additional medication expenses and services

The insurance plan does not offer coverage for hospital charges for admission, discharge, administration,  registration, documentation and filing.  Even charges for access to telephone and telephone calls  internet,  foods  (except the one served for the patient that is included in the overall charges),  cosmetics,  hygiene articles, body care products vitamins and tonics unless vitamins and tonics required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim. These are standard non-payable items under your health insurance plans. 

Get a ready service from the professionals

PlanCover a top-rated insurance broker, has been offering  diverse range of options to provide group health insurance for startups and small to midsize companies. You have the choice of the insurer with PlanCover providing you access to the health insurance marketplace. Get several policy benefits that will help your employees lead a stress-free life and grow loyal to your startup company. Connect to the ever-responsive team of PlanCover, and they will help you out with all the doubts you have in mind regarding the coverage and non-coverage aspects of the leading insurance policies. 

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