Group Health Insurance: What’s covered and what’s not?

A Group Health Insurance Policy includes a definite group of individuals, such as members of a professional association, a society, or employees of a company. A Group is an association of individuals who come together with the objective of performing a common activity and not with the objective of availing of insurance coverage.

A group may be primarily divided into two groups:

Non-employer-employee groups

This includes Resident Welfare Association (RWA) members, credit card holders of a specific bank or company, and business customers, where insurance is provided as an added advantage.

Employer-employee groups

• This consists of staff/ employees of any specific registered organisation.
• Inclusions of Group Health Insurance

Let us check what is included in the Group Health Insurance Policy:

• In-patient Hospitalisation:It includes room rent expenses, ICU charges, doctor's fees, etc., in the event of planned or emergency hospitalisation.
• Pre and Post-hospitalisation:Expenses like consultation fees, diagnostic tests, or medication are included. Time period of pre and post hospitalisation varies from one health insurance policy to another.
• Coverage of Pre-existing Diseases:In case of pre-existing disease, if any, the cost incurred for the treatment will also be covered.
• Advanced Medical Treatment:Advanced medical care along with the coverage for treatments such as robotic surgeries, is also included in a few group insurance plans.
• Maternity Cover:Some insurers also include maternity coverage in group health insurance. The cover for the same might vary from one group policy to another.
• Room Rent:Room rent is also included in a group insurance policy. The room type and expenses covered are as per the policy and insurer only
• New-born Baby Cover: The day your baby is born, he/she gets covered.
• Ambulance Cover:Ambulance charges are covered.
• Corporate Buffer:Corporate Buffer is available as per the employee's requirement.

Exclusions of Group Health Insurance

Following is a list of a few scenarios which might not be included in your Group Health Insurance Policy:

• Self-imposed injuries as a result of suicide or attempted suicide.
• A treatment or hospitalisation due to a contraception procedure.
• Expenses occurring due to alcohol or drug abuse
• Miscarriage, abortion or any consequential treatment cost
• Infertility or IVF-related tests or treatment cost
• Expenses incurred on admissions related to diagnostic and evaluation purposes
• Circumcision, unless mandatorily required for the treatment of disease
• Attempting a breach of law or committing the same with criminal intent

Note: The inclusions and exclusions mentioned above are subject to the policy you opt for and might not apply to all policies.

Conclusion

As we know, employers have to take initiatives to promote a healthy environment that includes mental and physical health. On the other hand, employees are also considered to be invaluable assets for the company. Hence, today's trend demands that health insurance be considered as an employee benefit. Health Insurance recognises and rewards employees, retaining them and obliging them to work with the organisation for a long tenure. Hence, it becomes important to choose a comprehensive health policy which will provide satisfaction to the employees and can be availed at a budgeted cost to employers.

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