What Is a Stipend for Health Insurance? Benefits and Best Practices
- Author :
- TATA AIG Team
- ●
- Last Updated On :
- 21/02/2025
It is pivotal for employers to invest in the health and well-being of their employees, as they are the building blocks of an organisation. Also, the rising cost of healthcare services in India has made medical treatment an expensive affair for all.
In such a scenario, group health insurance is an effective way for employers to look after the workforce and provide them with adequate health coverage. Let us dwell on the various aspects of GMC policy, including its meaning, benefits, features, etc.
What is Group Mediclaim Policy?
GMC policy means an insurance plan tailored for a group of employees/people, providing them coverage for various medical expenses. It is a single insurance plan that covers a group of people under its umbrella. Such an insurance plan may be offered free of cost by an employer to his employees as a part of the benefits.
Employees also have the option to include their family members, such as spouses, two children and parents, under the same policy. Besides employees, GMC policy is also available to non-employer-employee groups, such as members of an association, society, etc.
Key GMC Policy Features
-Low Premium: One of the most revered features of this policy is that it comes at a lower premium rate than individual health plans.
-No Pre-Medical Test: Buying a GMC policy is easy as it does not involve any medical screening of insured employees.
-Cashless Coverage: Under group insurance, employees can benefit from cashless hospitalisation and get treatments done without spending any money from their pockets.
-Pre- and Post-Hospitalisation Coverage: Expenses incurred 30 days prior to hospitalisation and 60 days post-hospitalisation are covered under this policy. It covers expenses such as medical tests, medicine costs, follow-up charges, etc.
-Sum Insured: A claim made by one employee does not impact the sum insured of the other employees covered under the same plan.
-Claim Settlement: You can either opt for a cashless or reimbursement claim option. However, the cashless method is considered to be hassle-free and convenient.
-Tax Deduction: The premium paid for group health insurance is eligible for deduction under the Income Tax Act.
-Minimum Employees: As per IRDAI regulations, the minimum number of workers required to purchase group insurance is seven. However, the minimum number may vary from one insurance provider to another, provided it is in line with the IRDAI rules.
-Also Read: Individual Health Insurance Vs Group Health Insurance
GMC Policy Coverage
| Coverage | Details |
|---|---|
| Hospitalisation Expenses | It covers all in-patient hospitalisation expenses incurred, such as room rent, ICU charges, doctor fees, surgery charges, etc, |
| Pre and Post-Hospitalisation Charges | It includes all the expenses incurred before hospitalisation and after getting discharged from the hospital. |
| Daycare Expenses | The policy also covers charges for daycare procedures that do not require an overnight stay in the hospital. Examples: cataract surgery, chemotherapy, dialysis, etc. |
| Pre-Existing Diseases | The policy recognises pre-existing diseases. Hence, employees can get a cover for treatment of the same. |
| Ambulance Cover | It includes the ambulance charges incurred for transporting the insured employee. |
| Organ Transplants | The coverage also includes organ surgical and medical expenses related to organ transplant if the insured is the organ recipient. |
Also Read: Types of Group Insurance Plans in India
Exclusions of GMC Policy
It is crucial to be aware of the exclusions of the policy so you know under which circumstances you are not eligible to receive the benefits.
Any disease which is outside the scope of the insurance policy.
Critical illness and maternity benefits are not covered under the base plan. They may be included as an add-on cover.
Cosmetic treatments for look enhancement.
Obesity and weight-related health problems.
Routine dental and optical care is excluded. However, some plans may include coverage for dental and optical treatments.
Any injury or health concern arising out of illegal or hazardous activities.
Medical conditions arising due to substance abuse, alcohol, etc.
Any illness, injury, etc., caused due to war, nuclear radiation, etc.
Diseases such as STDs, AIDS, etc., are excluded.
Any non-medical expenses will be excluded.
Note: The exact coverage may vary from one insurer to another. Hence, one must check with the insurance provider for the specific policy inclusions and exclusions.
Also Read: Who is Eligible for Group Health Insurance?
GMC Policy Benefits for Employees
-Free for Employees: Employees of an organisation can avail of the benefits and coverage of group insurance free of cost. It is provided by the employer as a part of the employment benefits.
-Inclusion of Family Members: Employees can choose to include their immediate family members, such as their spouse, children, and parents. It ensures that the employee’s entire family is protected.
-Fosters Security Among Employees: A group mediclaim policy fosters a feeling of security among the employees and motivates them to contribute to the organisation’s success.
-Immediate Coverage: Unlike individual insurance plans, group insurance provides immediate coverage for the covered diseases without any waiting periods.
-Preventive Healthcare: Some plans also include coverage for preventive healthcare measures such as vaccinations, health check-ups, wellness programs, and so on. Thus ensuring the employee's best health.
-Employee Retention: Group health insurance protects the employees. Hence, it enables employers to achieve higher employee retention as the employees feel valued and protected within the organisation.
-Also Read: What is the Claim Process in Group Health Insurance?
GMC Policy Benefits for Employers
-Tax Benefit: Group medical cover is a tax-saving tool for employers. They can save on taxes by claiming a deduction for the premium paid towards the GMC plan, as these will fall under business expenses.
-Higher Employee Retention: It creates a positive mindset among the employees towards the organisation and employer. Thus, employees continue working with the company and there are fewer resignations. Overall, group medical cover helps to increase the retention ratio of employees as it enhances job satisfaction.
-Improves Company Reputation: A company that invests in ensuring the employee’s health wins the employee's trust. It also builds a positive reputation for the company among the employees and in the industry.
-Also Read: Is It a Right Choice to Buy a Top-up Health Plan with Group Insurance?
Summary
Employees contribute greatly towards a company’s success. Thus, the employer must take all the necessary steps to invest in their well-being. And what’s a better way to do that than providing them with medical security in times of soaring healthcare costs?
TATA AIG lends you a helping hand in taking a step towards employee betterment with SME insurance. Our insurance plans are curated to protect your business and employees against all odds.
Frequently Asked Questions
Can parents-in-law be included in the family under GMC policy?
Some plans may allow including parents-in-law with some restrictions or at an additional cost. The exact coverage depends on the terms and conditions of the policy.
What types of claims can be made under group health insurance plans?
One can make cashless and reimbursement claims under a group health insurance plan, depending on personal preference.
Can employees claim a deduction of group insurance premiums under the Income Tax Act?
If the employee also contributes towards the premium payment of group health insurance, they can claim a deduction of the premium under section 80D of the Income Tax Act.
Disclaimer / TnC
Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.
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