Group medical insurance policies provide organizations and groups with a cost-effective, comprehensive healthcare solution. Whether you are a small business, a cultural association, or a group with a common interest, you may be eligible to apply for a group medical insurance policy.
In this article, we will explore the eligibility criteria for group health insurance, who is not eligible for it, and the benefits it offers to employers and members alike.
What are the eligibility criteria for group health insurance plans?
Organizations and groups must meet certain criteria to qualify for group insurance plans. These criteria are set up by the regulatory authority for insurance in India, the IRDAI; however, there might be additional requirements depending on the insurer and the specific policy.
A group is a set of individuals having common interests. They can be divided into formal and informal groups. A professional organization falls under formal, while groups from cultural or social associations, credit card holders, or bank account holders of a specific bank form informal groups.
A group must typically have at least 20 employees to avail of group policies. However, certain insurers offer group plans for less than five members, depending on certain circumstances.
Who is not eligible for group health insurance?
The requirements to opt for a group plan might be open to interpretation. Thus leading formal and informal organisations and groups to look for an insurance provider, who could help them with their specific case for eligibility.
However, it might be more clear as to who is not eligible for a group plan:
● Students
Students are typically not eligible for group health plan due to IRDAI rules and regulations; however, they can be included in a parent’s group plan if the student is under 25.
● Solo entrepreneurs or self-employed individuals
A solo entrepreneur or self-employed individual is not eligible for group plans as they do not meet the minimum eligibility requirements to opt for a group plan.
● Family business
As a family business looking for a group health insurance plan, the spouse is not considered an employee and does not qualify for group coverage.
● If the group is formed to avail insurance at a preferable rate
If a group is created primarily to avail insurance at a preferable rate, they may be deemed ineligible for the plan.
What are the benefits of opting for a group plan?
Group medical insurance policies offer numerous benefits for both employers and members. Let’s explore some of the critical advantages of opting for a group health insurance plan:
● Comprehensive coverages
Group plans offer comprehensive coverage to all group members and are highly customisable, allowing organizations to tailor policies according to their needs.
● Pre-existing disease coverage
Several insurers like Niva Bupa offer pre-existing disease coverage, allowing employees of various ages and medical conditions to avail of proper medical care.
● Coverages for dependents
Several insurers offer plans that cover dependents of the employees, including children and parents.
● Tax benefits
Providing group plans to your employees offers tax benefits for the premium paid.
● Cost-effective
Group plans are significantly more cost-effective than purchasing individual policies for all employees.
● Talent attraction and employee retention
Providing health insurance is a deciding factor for many employees to join or remain in an organization as the fear of health risks and rising treatment costs enter the picture.
● Cashless treatment at network hospitals
Cashless claims offer a hassle-free experience, making it an excellent benefit for covered members.
● No pre-policy check-up
Several insurers require no pre-policy checkup from covered individuals, making the purchase process much more convenient and beneficial.
Conclusion
Group medical insurance policies offer organizations and groups a valuable and comprehensive healthcare solution. Whether you are an employer seeking healthcare benefits for your employees or an association of members looking for complete coverage, group health insurance plans can meet your specific needs.
By understanding the eligibility criteria and exploring the different types of coverage available, you can make an informed decision and ensure the well-being of your employees or group members.
