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Group health insurance is a type of a health insurance policy taken by an employer or organization to cover their employees under a single master health insurance policy. Group health insurance policy is usually decided by the HR or Admin of an organization as it forms a part of employee benefits given to the employees by the employer. 

Below are the things that are to be considered by the HR/Admin of the organization before finalizing on the group health insurance policy:- 

  • Selection of Insurance broker: Insurance broker is a type of intermediary who can source insurance business on behalf of an insurance company. There are many types of intermediaries who are authorized to source the insurance business such as Individual Agent, Insurance broker, Banks etc. Out of these only the insurance brokers are legally liable to the decisions taken and can be penalized by the authority for deficiency in services whereas the other intermediaries are legally not liable for any deficiencies. 
  • Coverage under the policy : The coverage under the group health insurance policy should also be taken into consideration before purchasing the policy. Group health insurance policy is a tailor made health insurance policy and there is no one size fits all concept in group health insurance business. The group health insurance policy can be customized by the clients as per their needs and requirements. 
  • Network hospitals: Network hospitals are the hospitals which are tied up with the insurance companies to provide cashless claim settlement facility to their customers. The more the number of network hospitals the more comfortable for the employee to choose from the existing options. Every insurance company ties up with the hospitals to provide cashless service to its customers and these hospitals are known as network hospitals. 
  • Corporate Login portal: Group health insurance policy customers would be provided with a corporate login portal where the organization can download the health cards as well as make additions or deletions of members in the policy. The organization needs to maintain a sum in their CD account which could be utilized to make additions of members in the group health insurance policy. 
  • Waiting periods: There are certain waiting periods in the group health insurance policy which can be deleted or added as per the requirements of the customers. The waiting periods if included in the group health insurance policy can reduce the premium to be paid by the customers but the main benefit of group health insurance policy is that the waiting periods can be deleted and the claims can be made without waiting. 
  • Maternity Cover: Maternity cover in group health insurance covers the hospitalization costs of members in case of delivery and other related treatments. Maternity cover can be availed in a group health insurance policy by customizing the policy. The sum insured or the coverage under the maternity section would be in addition to the base sum insured available under the group health insurance policy. 
  • Day care procedures: Day care procedures are those in which the treatments are done within a day and usually don’t require for the patient to be admitted as inpatient. The advancement in the technology has resulted in the operations and treatments to be done and patient discharge happens on the same day, these treatments are known as daycare procedures. Each insurance company has a list of daycare procedures that are covered under the group health insurance policy. 
  • Disease wise sub limits: Group insurance policies have a clause or condition known as disease wise sub limits under which the sum insured coverage available for few diseases would be limited. It means that some diseases would be covered only up to a certain percentage of the sum insured and not the complete sum insured. Exercising this option in a group health insurance policy can reduce the premium to be paid by the customer. 
  • Claim settlement: The visibility of a group health insurance policy comes at the time of claim settlement. Claim settlement can be done on Cashless or Reimbursement basis depending on the option exercised by the insured. The best claim settlement can be experienced by taking the group health insurance policy with an insurance broker. Insurance brokers are legally liable if there is any deficiency in the services provided by them to their customers. 
  • Co-pay: Co-pay or co-payment is the amount of claim that has to be borne by the insured customer at time of hospitalization. Co-pay option can be opted in a group health insurance policy to reduce the premium but the members should pay some amount from their pockets at the time of claim settlement. The co-pay can range from 10% to 50% depending on the option chosen by the customer. Once the co-pay option is chosen, it cannot be altered during the course of the policy. Hence, it is very important for the HR/Admin of an organization to be mindful at the time of taking a group health insurance policy. 
  •  Wellness Benefits: Group health insurance policies come with certain wellness benefits for the employees of an organization such as health check-up, doctor on call, second opinion, apps for tracking activities etc. The wellness benefits are free of cost to all the members of the group health insurance policy and can be utilized at any point of time. There are certain wellness benefits such as health check-up once during the policy period for the members covered under the group health insurance policy. The health check-up may consist of basic check-ups such as heartbeat, bp, sugar etc., which would be beneficial to both the customers as well as the insurance companies. If the vitals of a member are not in sync then he/she could be advised to visit a doctor immediately thereby preventing a sudden circumstance which can impact both the member as well as the insurance company. 

Exclusions:

Group health insurance policy is a tailor made policy which has the tailor made coverage as well as the tailor made exclusions. It is important for the HR/Admins of an organization to understand the exclusions mentioned in the group health insurance quotations submitted by the insurance companies. For example there might be an exclusion of knee replacement in the quote which means that the members cannot avail knee replacement surgery during the policy period.

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