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Group Health Insurance

What is the Group Mediclaim Floater Policy? Pros and cons. Everything You Need To Know.

Group Mediclaim policy 

Group Mediclaim policy is one of the most preferred benefits offered to the employees. Any recognized group in existence, such as employer-employee, trade unions, associations etc can purchase a group mediclaim policy for its employees. The features of any health policy depend on the organization’s financial capability and its philosophy.

Features of Group Mediclaim Policy

  • Customized and tailor-made
  • Purpose
  • Cashless facility
  • Covering pre and post-hospitalization costs
  • No waiting period
  • Coverage for pre-existing illness
  • Coverage for dependents
  • Pocket friendly premiums
  • Minimum number of employee
  • Time duration
  • Partial or co-payment option

What is a family floater?

A family floater is a health mediclaim plan where the coverage is extended to the entire family. In simple words, a floater brings all the family members under an umbrella cover. Being covered under the floater policy, the members of the family can enjoy the medical benefits under a larger common pool.

From the perspective of a married man with two kids, it is simpler and wiser to get one family floater health insurance plan of sum assured of 5 lakhs rather than buying 4 individual health insurance plans separately.

How does the Family Floater work?

Mr. Malhotra purchased a family floater policy with an assured sum of 5 lakhs. The policy includes Mr. Malhotra, his spouse and two children. He pays an annual premium of Rs. 9500. Let’s consider two possible scenarios:

Scenario 1: Mr. Malhotra’s spouse had gallbladder surgery and she had to be hospitalized. The total cost of the surgery was Rs. 3,75,000. Because of the family floater policy, the cost of the surgery was settled by the insurance provider and Mr. Malhotra didn’t have to pay any money.

Scenario 2: Mr. Malhotra’s entire family is infected with Coronavirus. Out of four, three of the members were seriously ill and were admitted to the hospital. The total cost of the treatment in the hospital for three members is Rs.7,50,000. The family was covered with the sum assured of Rs. 5,00,000, out of which Rs. 3,75,000 have already been utilized. The additional amount of Rs. 2,50,000 will be borne by Mr. Malhotra himself.

Though the chances of the entire sum assured being utilized at once are slim. Because the probability of the whole family getting hospitalized is rare.

Group Mediclaim Floater Policy

Under group mediclaim floater policy, the company not only extends the group health insurance benefits to the employees, but it also includes the families of the employees under the same sum assured coverage. 

However, this floater is not extended by every organization. Some employers offer it to their employees to hire and retain them.

Features of Group Mediclaim Floater policy

  • The floater provides coverage to the employees and their families under the single cover.
  • There are group insurance policies that cover the employee and their family members who are above the age of 65, however there are one’s that provide cover till lifetime. It entirely depends on the financial philosophy of the organization.
  • The sum insured provided to the employee remains the same, however the chance of being the entire sum utilized by the entire family at once is rare.
  • It provides cashless claim settlements to the employees if the treatment has been availed through the network hospital.
  • It provides hassle free claim settlement.
  • It additionally provides coverage against critical illness if the organization is maintaining a corporate buffer.

Advantages of Group Mediclaim Floater policy

  • It shelters the health of all the family members.
  • All the employees and their family members are covered in a single policy irrespective of their age.
  • The insurance companies and the organization provide the facility to add a family member to the existing policy, at a point of time.
  • The employee does not have to deal with individual health policies of the family.
  • In case the employee wants to enhance the benefits of the mediclaim policy, add-on benefits can be added by the employee. But the additional cost of the premium will be borne by the employee.
  • Coverage is provided to the entire family with less cost of premium. 
  • It saves the money of the employee. As the employee does not have to buy many policies for each family member.

Disadvantages of Group Mediclaim Floater policy

  • Extending the coverage of the family members does not imply that the sum insured has been extended too.
  • The insurance policy covers the employees and their family members only upto the sum insured provided by the employer.
  • The sum insured will reduce with the usage. It implies that if any family member uses the sum insured, the insurer will reduce the sum insured up to that extent.
  • If a family member exhausts the entire sum insured at once, then the rest of the family will have no cover.

How does the Group Mediclaim Floater policy work?

Mr. Malhotra works with a software company and lives in Delhi with his wife and two children. The software company where Mr. Malhotra is an employee, offers its employees the sum insured of Rs. 5,00,000 under group mediclaim floater policy.

Scenario 1: Mr. Malhotra’s wife had a bypass surgery and she had to be hospitalized. The cost of the treatment including surgery charges, hospitalization, medicines etc. came out to be Rs.5,50,000. Because no network hospital was nearby to their residence, Mr. Malhotra admitted his wife to a non-network hospital. When Mr. Malhotra filed the claim under a group health insurance policy; his employer asked him to settle the claim first. 

The claim of Rs. 5,00,000 was reimbursed later by the employer as it was the sum insured amount provided under the group mediclaim floater policy. However the amount of Rs. 50,000 was borne by Mr. Malhotra himself.

Scenario 2: Some days later, Mr. Malhotra meets with an accident. Passengers nearby took him to the hospital and he was treated by the doctor. The cost of treatment came out to be Rs. 1,50,000. When Mr. Malhotra reached out to his employer to settle the claim under group mediclaim policy, but they refused. They explained to him that his sum insured was already exhausted during the surgery of his wife. 

To Conclude, family floaters have their own set of advantages. The same being extended by an employer is surely an effective way to attract and retain employees.

Employees definitely prefer this sort of comprehensive coverage. However, whether the final investment is made in a family floater or a group health insurance policy, the ultimate aim of the employer is to cover the employees against medical uncertainties. And it creates a sense of loyalty among employees if the same health benefits are extended to their families.

Employers in search of a reliable group healthcare plan for the CA professionals working under them can connect to PlanCover. PlanCover is a well-known insurance-broker company that offers the leading policies from IRDAI-approved companies in India. You can connect to their team even if the employee strength is low. Find the best group healthcare policy that suits the needs of a CA professional with dedicated support from PlanCover. 

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