Who Is Eligible for Group Health Insurance?

Group health insurance, as the name suggests, is a type of health insurance policy that is purchased for a group instead of an individual.

As mentioned above, it is a part of a corporate/SME insurance plan that an organisation purchases for its employees. It provides each insured individual with medical coverage and benefits such as cashless treatment, extended coverage for family members, and so on.

It is important to note that a group insurance policy is beneficial not only to the employees but also to the organisation or employer. It can help them maximise their tax savings.

Small Businesses and Startups: The primary candidates for group health insurance are the small businesses and organisations that have just been established.

By offering medical coverage, small-scale employers can retain their employees and build long-term relationships with them.

Not only that, having benefits like health insurance can also help them to bring new talents onboard.

Growing/Mid-size Companies: Growing and medium-sized companies are highly recommended to purchase group medical insurance for the well-being of their employees and the betterment of their organisation.

Established Organisations: Employees working in a well-established organisation expect health insurance from their employer. It is a basic necessity that the organisation must fulfil to boost the morale of its employees and keep up with industry standards.

Group medical insurance covers the medical expenses of employees and prevents them from any financial struggle during an unprecedented situation.

Such benefits can lead to the overall development of the organisation by improving the working efficiency and productivity of the workforce.

Any organisation, startup, cultural/social establishment or any other group sharing the same interest can purchase a group health insurance policy.

As per IRDAI, any company or group with at least 20 team members are eligible for buying a group insurance scheme.

Further, small groups or businesses with less than 5 employees/team members can invest in micro-insurance plans.

Following are the detailed requirements of a group health insurance policy in India:

Definition of “Group” in Group Health Insurance

As per IRDAI, a “group” can be either an employer-employee group or a non-employer-employee group.

The former is usually an organisation and its workforce, while the latter is a group of individuals sharing a common interest.

Some examples of a non-employer-employee group are members of the same cultural or social group, a group of the same credit card holders, etc.

Number of Employees

The minimum number of employees or group members to buy a group insurance plan should be at least 20. However, this requirement can vary based on the insurance company and the specific terms and conditions of a policy. It is suggested to consult your insurer to learn about the specific group life insurance eligibility requirements.

Intention for Buying Group Insurance

IRDAI states that you can not form a group with the purpose of availing low-cost insurance. If you negotiate with the insurer before forming a group, then your group will be categorised as a non-legitimate group, and you will not be allowed a group insurance policy.

The primary intention behind purchasing group health insurance in India is to offer medical coverage and benefits to the employees and/or team members.

In-patient Treatment: It refers to the medical expenses incurred when the insured individual is admitted to a hospital or healthcare facility as an in-patient for a minimum duration of 24 hours.

Pre and Post-Hospitalisation Cost: Medical expenses incurred by the insured before and after getting admitted to the hospital or healthcare facility. These can include medical consultations, check-ups, post-recovery sessions, and so on.

Ambulance Cover: Most group health insurance providers also reimburse the cost of transporting the insured to and from the hospital.

Organ Transplant: Some group health insurance plans like Tata AIG also cover expenses arising from an organ transplant of the insured. The expenses majorly include the cost of harvesting the organ from a donor.

Family Transportation Benefit: The transportation cost for a hospital located specified kilometres away from the residence of the insured may also be covered by a group health insurance policy.

Maternity Cover: Group insurance plans from reputed providers can also offer maternity coverage for female employees/group members for childbirth and expenses incurred in miscarriage or medical termination of the pregnancy.

Better Employee Retention: Group health insurance policies can lead to a positive employee retention rate by contributing to the overall benefits program designed for the employees.

By purchasing a group insurance policy, you can instil a sense of loyalty and job satisfaction into your workforce.

Save on Taxes: Another perk of having a group medical insurance policy is that it enables you to reduce your tax liability. You can declare the premium cost of a group insurance policy under “business expenses” and claim tax deductions.

In case your employee has also contributed towards the group insurance plan, then you can also claim deductions on your contribution.

Overall Betterment: Group insurance policy makes sure your employees don’t have to face any financial struggle during health-related emergencies. This benefit keeps them motivated and dedicated towards their work. This, in turn, results in the overall betterment of the organisation.

Group health insurance, as you can see, is a vital initiative introduced for businesses and organisations for the well-being of their workforce. It keeps your employees away from any financial struggle, hence boosting their morale and work efficiency at the same time.

If you haven’t finalised a group insurance policy yet, then it is high time to invest in Tata AIG Group Medical Insurance Policy.

With our group insurance plans, you can enjoy competitive premium rates, efficient claims settlement, cashless treatment, alongside comprehensive coverage.

Besides, you have the option to make your plan even better by opting for various add-ons like critical illness insurance, maternity cover, and so on.

For more information on our group insurance or any other SME insurance, get in touch!

How to buy the best group health insurance plan?

Purchasing the best group health insurance policy requires a close look at the specific requirements. Thus, take into consideration your requirements and factors like your budget, type of coverage, premium cost, etc., to choose the perfect group insurance for your business.

Does group health insurance cover family members?

Whether or not group health insurance covers family members of the insured depends on the specific policy terms and insurance providers. Generally, reputed insurers like Tata AIG offer extended coverage to the dependents (spouse, children, and parents) of the policyholder.

Can employees claim tax deductions for group health insurance?

Generally, the employers are responsible for paying the premiums of a group medical insurance. However, if you have customised your policy and contributed to the add-ons, then you can claim tax deductions under Section 80D of the Income Tax Act of India.