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Group Health Insurance
Group Health Insurance is a comprehensive Health Insurance policy that covers a specific group of people, usually employees of a company. A Group Health Insurance plan can be extended to provide coverage also to the family of the insured employees including spouse, dependent children and at times dependent parents. It is also known as Corporate Health insurance, Employee Benefit plan or Group Mediclaim Insurance.
Group Health Insurance is beneficial not only for the employees but also for the employers. It provides financial security to the employee during a medical emergency.
At Tata AIG, we offer an all-encompassing Group Health Insurance policy for your employees to cover them against accidents, illnesses, and other medical emergencies.
Why Buy Group Health Insurance?
Employees are the invaluable assets for any organization. Their welfare and care are of utmost importance for the organization. With changing lifestyle, rising medical cost & the recent pandemic has demonstrated us how important it is to have an insurance for employees.
The Covid induced lockdowns had a great impact on the work of the Small and Medium Enterprises. To come in terms with the new reality and emerge from this downturn, SMEs have to find new ways to meet these challenges and pave the way for growth.
One of the ways is to invest in the Employees and their well-being by means of Group Health Insurance which goes a long way in making sure that Employees appreciate the health and financial security provided through Insurance coverage, now, more than ever.
As more and more people nowadays look for work-life balance and a fair set of benefits from their organisation, hiring and retaining good employees is no longer an easy task.
As an employer, a Group Health Insurance plan equips you to work towards employee wellness in several ways.
Better employee retention
A group health coverage from the employer gives a sense of security to the employees and their families. Moreover, it creates a feeling of belongingness and employees feel cared for. This inclusiveness goes a long way in gaining loyalty, trust, and sincerity from the employees.
The rising cost of medical treatment is often a cause of worry for many. Securing your employees with group health insurance frees them from the mental stress of unplanned medical expenses. A Group Health Insurance plan frees your employees from the mental burden of high treatment costs and results in better mental health for them.
Happy employees are motivated employees. The value and care your employees feel with Group Health Insurance boosts their motivation and contributes to a supportive and healthy workplace culture.
Advantages of Group Health Insurance Policy
Employees covered under a group health insurance plan can enjoy comprehensive coverage without pre-medical examination. This coverage can also extend to providing them with maternity covers, regular doctor consultations and much more, depending on policy terms. Moreover, unlike individual plans, where policyholders must undergo medical tests, group plans do not require any pre-purchase medical tests.
Covers Employees And Their Families
A group health insurance policy offers employees and their families coverage against unforeseen and emergency medical expenses during hospitalisations. Depending on policy terms, the employee can choose to include some or all of their family members as dependents under their group plan.
Pre-Existing Disease Coverage from Day 1
Since group health insurance plans are generalised plans, the organisation / employer can opt to cover the pre-existing diseases from day 1.
Group plans are a far more affordable option when compared to other plans. This is because the insurer's risk is spread across a large number of employees, thereby lowering the overall cost of insurance on an individual basis.
Boosts Employee Morale
Group plans can help boost employee morale at organisations and increase a business' employee retention rate. This is because people value jobs and work environments where they feel appreciated and cared for. As an added benefit, it can also help enhance their mental well-being and increase productivity as employees are less likely to be burdened with any financial stress relating to their medical expenses.
Group health insurance plans can be customised by the employer to fit the group's size and needs.
Key Features of Tata AIG Group Health Insurance
Since group insurances are tailor made health plans, these features are indicative and can differ based on customisation by the employer when deciding on their desired scope of coverage.
Option to Coverage from Day 1
Employees only or Employees + Family Members as Dependents (Optional): Legal spouse, children, dependent parents
Mid-Term Addition of Dependents
New borns and spouses in case of marriage for a requisite premium.
Covered up to the Sum Insured and the Sub-Limit applicable per claim.
Pre & Post -Hospitalisation Expenses
Covered up to the number of days as specified in the policy schedule/ insurance certificate.
Day Care Procedures
Covered up to the number of days as specified in the policy schedule/ insurance certificate.
Covered if opted for as per policy schedule
Covered if opted for as per policy schedule
Baby Day One Cover
Covered if opted for as per policy schedule
Covered if opted for as per policy schedule
Covered if opted for as per policy schedule
Available for Network Hospitals.
Covered if opted for as per policy schedule
8000+ hospitals across India.
Family Transportation Benefit
Covered if opted for as per policy schedule
Who Should Buy Group Health Insurance?
- Startups and Small Businesses: New startups and small agencies stand to benefit the most from including group health insurance as one of their employee benefits. It can increase employee retention and attract new talent to the organisation. So if you have just started your company, offering a group plan will inspire trust and goodwill from your employees and help save on taxes in the long run.
- Growing Startups, Mid-Size Companies and Agencies: In the case of growing startups and agencies, offering our Group MediCare Policy to your employees as an added benefit can boost employee morale. This is because a group health plan can reduce any stress or financial burden your employees may feel, as we will take care of most of their medical expenses This can increase productivity, giving you a competitive edge over other businesses.
- Established Organisations and Large Corporations: If you operate a large or established organisation, then a group health policy is an expected benefit for all your employees. It can also help sustain your organisation's brand name and help potential hires view your company more favourably. Offering our Group MediCare Policy to your employees and, by extension, their family members can also help strengthen employee-employer relationships in the long run by inspiring a sense of trust and security when working for your organisation.
What is not Covered in Group Health Insurance for Employees?
Any claim made during the policy waiting period, the waiting period for specific diseases and pre-existing diseases will not be covered. However, there are exclusions available for these.
Investigation and Evaluation
Expenses related only to primary diagnostics and evaluation purposes. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.
Rest and Respite Care
Expenses related to enforced bed rest and respite services for terminally ill people.
Expenses related to the surgical treatment of obesity that does not fulfill all the below conditions:
- Surgery to be conducted is upon the advice of the Doctor.
- The surgery/procedure conducted should be supported by clinical protocols.
- The member has to be 18 years of age or older.
- Body Mass Index (BMI) of the patient is greater than or equal to 40 or greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
- Obesity - related cardiomyopathy
- Coronary heart disease
- Severe Sleep Apnea
- Uncontrolled Type2 Diabetes
Gender Change Treatment
Expenses related to treatment and surgery for gender change.
Cosmetic or Plastic Surgery
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following accidents, burns, or cancer or as part of medically necessary treatment.
Expenses for treatment for alcoholism, drug or substance abuse, or any addictive condition and their consequences.
Expenses related to any unproven treatment, services and supplies for or in connection with any treatment.
Expenses for some cases of refractive error treatment, injury due to adventure sports, breach of law, and sterility and infertility treatment.
Documents required for Group Heath Insurance Claim
List of documents needed to avail cashless facility
- Insurance Card / Policy Copy
- Copy of Company photo ID.
- Customer Address Proof.
- Duly Filled CKYC Form if Claimed amount is above Rs 1L.
- Admission notes from treating doctor.
- Previous OPD consultation papers with reports if any.
- Previous discharge summary or any other medical records available with you.
- Any previously approved / settlement letter from Tata AIG for reference. (Optional)
List of documents needed to avail Reimbursement
- Duly ﬁlled and signed Claim form
- Insurance Card or Policy Copy
- Medical Certiﬁcate signed by the doctor
- Original discharge summary & Original consolidated ﬁnal bill.
- Break ups required for the submitted ﬁnal bill.
- Cash paid receipts of hospital/pharmacy/lab.
- Bank details of payee name with printed.
- Supportive investigation reports.
- In case of implants used, invoices are required.
- In case of Accidental injuries, MLC/ FIR is required.
- In case of death of main member, details of nominee (as per policy schedule), along with address & ID proof of nominee.
- In case claim value above Rs 1 lakh, CKYC form with mandatory columns ﬁlled, with photograph of main member and cross signed on it.
What is Covered in Group Health Insurance?
Indemnification of medical expenses incurred due to disease/ illness/ injury during the policy period that requires the insured person’s admission to a hospital as an in-patient for a minimum period of 24 consecutive hours.
Expenses for consultations, investigations, and medicines incurred up to the number of days as specified in the policy schedule prior to admission in the Hospital. The coverage can be claimed under In-patient Treatment/Day Care Procedures/Domiciliary Treatments
Expenses for consultations, investigations and medicines incurred up to the number of days, as specified in the policy schedule post discharge from the Hospital Like pre-hospitalisation expenses, this benefit can be claimed under In-patient Treatment/Day Care Procedures/Domiciliary treatments.
Day Care Procedures
Coverage for expenses for listed Day Care treatment due to disease/ illness/ injury during the policy period taken at a hospital or a Day Care Centre. For more information, you check our blog on common day care procedures covered by health insurance.
Coverage for expenses related to at-home or domiciliary treatments of the insured person if the treatment exceeds beyond three days for management of an illness. It does not include coverage for enteral feedings or end-of-life care.
Note: Domiciliary hospitalization means medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances:
- the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or
- the patient takes treatment at home on account of non-availability of room in a hospital
Coverage for medical and surgical expenses of the organ donor for harvesting the organ where an insured person is the recipient. These expenses will be covered if the organ donation is in accordance and compliant with The Transplantation of Human Organs Act (Amended), 1994. The insured person must also have submitted an in-patient hospitalisation claim under the in-patient hospitalisation treatment cover to be eligible for this cover.
Coverage for expenses incurred on transportation of the insured person in a registered ambulance to the hospital in the case of an emergency or transfer from one hospital to another for better treatment. The claim must be admissible under this policy's in-patient treatment or day care procedures to be eligible for this cover.
Coverage for maternity expenses for childbirth and/or maternity expenses like the medical and lawful termination of pregnancy and the medical resuscitation of the newborn baby as per the sublimit specified in the policy schedule. In the case of ectopic pregnancies, while they aren't included under our maternity cover, they can still be claimed under the in-patient treatment clause of our Group MediCare policy.
Family Transportation Benefit
The transport cost of one immediate family member, like the insured person's legal spouse, child, parent, etc., is reimbursed if the insured person is admitted to a hospital at least 200 km away from their residence.
Benefits of Group Health Insurance for Employers
Insured employees are happy employees. While health insurance can't prevent disease, and it can be difficult maintaining a healthy lifestyle in today's world, offering health insurance to your employees can boost goodwill among employees. This is because looking after your employee's health and wellness results in happier individuals which can, in turn, contribute to a better work environment. This can make or break an organisation as companies only perform as well as their employees.
Increases Employee Retention and Attracts New Talent
Expanding on the previous point, one of the first things new employees look into before considering working for an organisation are CTC, company culture and employee benefits. Offering health insurance as a benefit to your existing and potential hires can be the deciding factor in tilting their decision to pursue or continue working for your organisation.
What is a Health Card in a Group Health Plan?
A Health Card is a vital component of a Group Health Plan that serves as an identification and access card for individuals enrolled in the plan. It typically contains essential information about the member ID, policy period, age, date of birth and gender.
The primary purpose of a Health Card is to facilitate easy and efficient access to healthcare services within the network of providers associated with the insurance plan.
A Health Card typically includes information such as the policyholder's name, policy number, and other relevant identification details. It may also feature the contact information of the insurance company and a helpline number for policy-related queries.
Group Health Insurance Claim Procedure
Raising cashless claims
In case of hospitalization in our network hospitals, you don’t need to pay anything to hospital for the covered expenses; Tata AIG will directly pay to the hospital on your behalf.
Steps to follow to avail Cashless facility
- Approach Insurance / TPA help desk in our network hospital with required documents.
- Insurance desk will send us the duly ﬁlled pre-authorization form along with supportive medical records.
- On receipt of preauthorization request from hospital, we will check payable/admissible amount and approve cashless facility as per policy terms and conditions.
- After discharge you can avail pre and post hospitalization medical expenses through Reimbursement process as mentioned below.
In case the Insured gets admitted in a Non-Network Hospital and pays hospitalization expenses directly, TATA AIG will later reimburse the Insured for the medical bills.
Steps to follow to avail reimbursement facility
Make sure you collect all paid bills with their break up details dully signed and stamped by hospital authority. Also collect a copy of treatment records like indoor case papers / treatment charts / vitals charts etc…
Submit / Courier speciﬁed documents to the below address for reimbursement.
Corporate Health claims Tata AIG General Insurance Company Limited, H.No 7-1-6-617/A, 5th and 6th Floor, Imperial Towers, Door No 615,616, Ameerpet, Hyderabad 500016, Telangana.
- Within 30 days from discharge date above mentioned documents to be submitted at respective TPA as mentioned in policy schedule
- In case submitted documents fulﬁll the need of processing the claim, the settlement of claimed amount will be credited to your account within 15 days on the receipt of last document received.
In case of any deﬁciency, a letter will be sent to your registered e-mail ID, and if you fail to submit the same within the given period of time, the claim will be closed and read as NO CLAIM.
Things to Consider When You Are Comparing Group Health Insurance
Base Coverage and Exclusions
The most important part of a group health insurance plan is its coverage and exclusions. This will set the precedent of what is covered under the policy on its purchase.
A policy with poor coverage can cause your employees to suffer later. When comparing multiple policies, the coverage should be able to cover most of your employees' medical requirements while still maintaining a reasonable premium amount.
Moreover, exclusions are just as important to consider as the benefits when comparing plans. This gives you a rough idea of the policy's terms and can be deciding factor on whether you choose to purchase the plan depending on your employees' requirements.
Why Choose Tata AIG?
Being an online insurance provider allows us to deliver group health insurance plans with extensive coverage at affordable rates. Plus, our online facilities allow you to compare multiple health policies on our site.
Oftentimes, a marginal increase in policy premium transforms a good policy into a great one by opting for required add-ons insurers offer under each plan.
When comparing group policies, check the add-ons offered under each plan to ensure that any outstanding necessities from employees with chronic conditions are covered here.
As stated, most employees do not use their group policy benefits. This can be due to many factors, one of which can be because of tedious processes that discourage employees from filing claims outside hospitalisations.
Why Choose Tata AIG?
Our online infrastructure allows us to streamline our services and be a one-stop solution for all your policy requirements.
Claims Settlement Ratio
A claims settlement ratio (CSR) can be an important factor when comparing group health plans, as it indicates the insurer's annual claim approval rate.
However, an insurer's CSR can decrease due to factors like fraudulent claims, claims against exclusions, or claims raised during waiting/grace periods. So while CSR is an important factor, it should not be the sole deciding factor on purchase.
At Tata AIG, we held a CSR of 96.43% for FY 2021-22. We also offer online, paperless transaction services to help streamline your claims processes and claims tracking facilities to ensure transparency.
Having a wide range of network hospitals and clinics covered under your group health insurance plan ensures that all your employees have access to high-quality medical care no matter where they are. We have 8000+ network hospitals across India, where employees covered under our Group MediCare Policy can claim cashless facilities.
How is a Group Health Insurance Different from Individual Health Insurance?
Group health insurance and individual health insurance are two distinct types of health coverage that vary in terms of their eligibility, cost structure, and coverage options.
Group health insurance refers to a policy provided by an employer or an organization to cover a group of individuals, such as employees or members of an association.
In contrast, individual health insurance is purchased directly by an individual for themselves and their dependents. Here are some of the key differences between the two:
|Differentiating Factors||Group Health Insurance||Individual Health Insurance|
It is primarily offered by employers to their employees as part of employee benefits. It covers all eligible employees and, in some cases, their dependents.
Individual health insurance is available to any individual, including self-employed individuals, unemployed individuals, or those not covered under group policies.
It generally provides standard coverage options determined by the employer. These plans often include basic hospitalisation, pre- and post-hospitalisation expenses, and some additional benefits.
Such plans offer a wider range of coverage options, including comprehensive coverage for hospitalization, outpatient care, maternity benefits, critical illness coverage, and more. Individual policies can be customised to suit the specific needs of the insured.
These plans usually have lower premium costs compared to individual policies because the employer often subsidises a portion of the premium. The premium is shared between the employer and employees, making it a cost-effective option.
The premiums are solely the responsibility of the insured person and are based on factors such as age, medical history, and chosen coverage options.
These plans are typically tied to the employer. When an employee leaves the organisation, the coverage may be lost unless they opt for portability or an individual policy.
Such plans are portable, allowing individuals to maintain coverage.
These plans in India generally have simplified underwriting processes, with no or minimal medical underwriting requirements.
Here, the insurers may conduct more extensive underwriting, considering an individual's medical history, pre-existing conditions, and overall health to determine eligibility and premium rates.
Terminologies You Need to Know Before Buying a Group Health Insurance Policy
Before purchasing a group health insurance policy, it is essential to familiarize yourself with key terminologies to make an informed decision.
Here are important terms you should know:
The amount you pay periodically (monthly, quarterly, or annually) to the insurance company to maintain the group health insurance coverage.
The predetermined amount that the insured individual or the group must pay out-of-pocket before the insurance coverage kicks in. Higher deductibles generally result in lower premium costs.
A fixed amount that the insured person must pay at the time of receiving healthcare services, such as doctor visits or prescription medications. The co-payment amount varies depending on the service and is often a set percentage or a fixed sum.
A group of healthcare providers, hospitals that have agreements with the insurance company to provide services at negotiated rates. It is important to understand the network's size and the availability of preferred healthcare providers.
The process of obtaining approval from the insurance company before undergoing certain medical procedures or treatments.
Specific medical services, treatments, or conditions that are not covered under the group health insurance policy. It is crucial to review the list of exclusions to understand what is not covered by the policy.
The duration during which certain benefits, such as coverage for pre-existing conditions or maternity benefits, may not be available. It is important to know the waiting period associated with different benefits.
The process of extending the group health insurance policy beyond its initial term. Understanding the renewal terms and conditions, including any changes in coverage or premiums, is crucial.
Benefits of Group Health Insurance for Employees
No Waiting Period For Pre-Existing Diseases
One defining feature of group health policies is that employees can expect coverage for their pre-existing conditions from day one of being insured. In contrast, most health insurance plans usually have a waiting period for pre-existing disease coverage.
No Medical Check-Ups Required
Most group plans do not require employees to undergo a medical check-up before getting insured.
Coverage For Family Members
As previously stated, group plans allow employees to include their immediate family members under their plan. Most health plans allow employees to include up to 5 dependents.
Quick Claims Process
A key benefit of group health insurance plans for employees is that claims are handled on a priority basis. This means that the employee does not have to face much hassle during the claims process since it is mostly handled by the employer and the insurance company.
How to Choose the Best Group Health Insurance Policy in India?
The Group Plan Must Cater to All Employee Types: The best group health insurance policies are ones that cater to all types of employees in an organisation. This is because not all insured employees will claim their health benefits or use their policies. In short, group plans must cater to a wide array of employees regardless of their current health condition.
Easy Accessibility to Network Hospitals: Network hospitals that are within reach are essential for employees to make cashless claims and other benefits. Having them close by will also help start treatments and procedures faster for insured employees in case of medical emergencies. At Tata AIG, we have over 8000+ network hospitals pan-India. You can use our hospital locator tool to check the location of our network hospitals in your city.
Quick and Hassle-Free Service from The Insurer: The post-sales service of the insurer must be up to the mark. This is essential as employees are more likely to use their group plan during a medical emergency if the ensuing processes have been simplified and streamlined.
Affordable While Still Being Feature-Rich: Group health plans are favoured by companies for their affordability and flexibility. One way to ensure you get the best value for money is to compare plans and check features, add-ons and quotes from multiple providers. Aggregator sites are a convenient way of doing this. As always, make sure to check that all possible insurers are IRDAI-approved to avoid fraudulent purchases.
Insurers Must Offer Paperless Processes: Most insurers today offer their services online through their official website. This includes us at Tata AIG, where we have digitised all of our processes for paperless transactions. This is a crucial factor when deciding on insurance providers. It could mean the difference between paying multiple visits to the insurance company involving cumbersome paperwork and tedious processes, which could take hours off your day, as opposed to completing all of your processes and transactions online within a few minutes.
Employees Must Have Access to the Insurer In Case of Queries: The insurer must offer services like 24/7 customer support, quick claims processing, etc. This ensures a smooth and stress-free settlement process for the employee without multiple follow-ups.
Option to Track Claims: Claims processes and settlements are a key part of insurance plans. To ensure transparency, insurers that offer a claims tracking option on their website should be preferred. This can help employees understand the status of the claim, the documents required for further processing, and an estimated time frame for the claims settlement.
Adding/Removing Insured Members Must Be Easy: For mid-term policy additions and exclusions, insurers must provide an easy interface to update changes. This can be beneficial in the event of death, childbirth or the addition of a legal spouse.
Why Choose Tata AIG Group Health Insurance Plan for Employees?
Coverage From Day One
Most health insurance plans often have a waiting period before they can claim coverage. However, with our Group MediCare plan, employees can enjoy insurance coverage from day one. This applies to pre-existing disease coverage as well.
Less Cost, More Benefits
Our group health insurance plans are a more affordable alternative for employees when compared to most other health plans.
Employees also get access to high-quality medical care for chronic conditions, coverage for daycare procedures, and access to wellness initiatives. They can also include their family members under their policy as dependents to cover their medical expenses.
Wide Network Of Hospitals
With our network of 8000+ hospitals across India, employees can file for cashless treatment without waiting for reimbursement costs. This can benefit employees as they do not need to worry about arranging treatment funds in case of a medical emergency. We, at Tata AIG, prioritise all claims and settle them as soon as possible as per the eligibility and policy condition.
At Tata AIG, we offer a fully online application process which is supported by our online infrastructure. In other words, when you apply for our Group MediCare health insurance plan, the application process can be done fully online within a matter of minutes. Similarly, to raise a claim, employees need to upload their documents onto our portal. They can also track their claims by logging in to the portal.
Frequently Asked Question
How to purchase Group Health Insurance from Tata AIG?
To purchase Group Health Insurance from Tata AIG, follow these basic steps:
- Assessment: Assess the healthcare needs of your group, including the number of employees and their specific requirements. This will help you determine the coverage amount and type of plan suitable for your organisation.
- Reach out to us: Contact us, and our representatives will guide you through the process, answer your queries, and provide expert advice on the available options.
- Buy online: You can visit the Group MediCare Policy page to buy the policy online.
Who needs to have Group Health Insurance?
Group Health Insurance benefits organisations of all sizes, including small businesses, startups, and large corporations. Any organisation that values the well-being of its employees should consider having a Group Health Insurance policy. It provides comprehensive healthcare coverage to all eligible group members, including employees and their dependents.
Group Health policies ensure financial protection against medical expenses but also help attract and retain talented employees, boost employee morale, and create a healthy and productive work environment.
By proactively investing in the health and welfare of your workforce, you demonstrate your commitment to their well-being, making such health plans a valuable asset for your business.
What are the possible inclusions and exclusions under the Group Health Insurance from Tata AIG?
Tata AIG offers several inclusions and exclusions. It's important to review the policy document for a detailed understanding of the coverage and exclusions.
- Inclusions: Tata AIG's Group Health Insurance plan covers a wide range of healthcare benefits, including coverage for in-patient treatment, which includes pre and post-hospitalisation expenses, day-care procedures, organ donor cover, ambulance cover, maternity cover, baby day one cover, and family transportation benefits (Pls refer to your policy schedule for detailed T&C).
- Exclusions: The plan, however, has certain exclusions. These include expenses related to investigation and evaluation, treatments for obesity, cosmetic or plastic surgery, gender change treatments, unproven treatments, sterility and infertility treatments, and dental treatments.
Is medical diagnosis and evaluation also covered under Tata AIG Group Health Insurance?
Medical diagnosis and evaluation are not covered under Tata AIG Group Health Insurance.
Is the migration of policies available under Tata AIG Group Health Insurance benefits?
Yes, migration of policies is available under Tata AIG Group Health Insurance benefits. Tata AIG offers a seamless policy migration option, which allows groups to transfer their existing group health insurance policies from another insurance provider to Tata AIG.
This migration process ensures a smooth transition without losing continuity or coverage for the insured members. It allows groups to avail themselves of the comprehensive benefits and services offered by Tata AIG's Group Health Insurance plans.
The migration process and eligibility criteria may vary, so it is recommended to contact our policy experts for further information and assistance regarding policy migration.
What is the claim settlement process for the Tata AIG Group Health Insurance plan?
The claim settlement process for Tata AIG Group Health Insurance plan typically involves the following steps:
- Intimation: In the event of a claim, it is important to notify Tata AIG as per predefined TAT. Contact the dedicated claims helpline or customer service to initiate the claim process. Provide relevant details such as policy number, insured person's information, nature of the claim, and incident details. You can reach Tata AIG 24/7 on our toll-free number 1800-267-7123.
- Documentation: Submit the necessary documentation to support the claim. This may include claim forms, medical reports, bills, prescriptions, discharge summaries, investigation reports, and any other relevant documents as requested by Tata AIG.
- Verification: Tata AIG will review the submitted documents and assess the claim for validity and coverage under the policy. The claim may be subject to verification, including medical examination if required.
- Claim Settlement: Tata AIG will process the settlement once the claim is approved. The payment will be made directly to the insured or the healthcare provider, depending on the circumstances and policy terms.
- Reimbursement or Cashless: The claim settlement can be either reimbursement or cashless, depending on the chosen option. In the case of a cashless facility, Tata AIG may directly settle the medical bills with the network hospital, subject to policy terms and conditions.
How to pick the right Group Health Insurance for employees?
To pick the right Group Health Insurance for employees, you need to keep in mind the following aspect:
- Consider their healthcare needs, including pre-existing conditions and age demographics.
- Evaluate coverage options such as in-patient and outpatient benefits, maternity cover, and pre/post-hospitalisation expenses.
- Check the network of hospitals and the customisation options available. Assess the claim settlement process, premiums, and cost-sharing mechanisms.
- Research the insurance provider's reputation, customer service, and additional services like wellness programs.
- Seek expert advice and compare multiple options to make an informed decision that provides comprehensive coverage, value for money, and promotes the well-being of your employees.
What is the premium calculation procedure under the Group Health Insurance plans?
The premium calculation procedure under Group Health Insurance plans typically considers factors such as the number of employees, their age, the sum insured, coverage benefits, and any additional risk factors specific to the group to determine the premium amount.
Who can be covered under a Group Health Insurance plan?
A Group Health Insurance plan can cover various individuals, including employees, dependents (spouses and children), and sometimes dependent parents. The exact eligibility criteria may vary depending on the specific plan and the terms set by the insurance provider. Contact us to learn more about Tata AIG Group Health Insurance plan benefits.
What is the waiting period for Tata AIG Group Health Insurance Policy?
The waiting period varies depending on the policy and may typically apply to pre-existing conditions, certain illnesses, or specific treatments.
There is no waiting period for Tata AIG Group Health Policy and the coverage starts from day 1 as per the plan opted for.
Can I purchase Group Health Insurance for the employees of my small business?
Yes, you can purchase Group Health Insurance for your small business employees. Group Health Insurance is available for businesses of all sizes, including small businesses. It offers healthcare coverage to employees, providing financial protection and access to medical services. To qualify for group health insurance, employer typically need a minimum of 10 employees.
What are the disadvantages of a Group Medical Insurance Policy?
While Group Medical Insurance Policies offer numerous benefits, they also have some potential disadvantages. Here are a few disadvantages to consider:
- Dependency on Employer: Group policies are typically tied to the employer, meaning if an employee leaves the organisation, they may lose their coverage and have to seek alternative insurance options.
- Limited Control: As an individual covered under a group policy, you may have limited control over coverage or specific benefits. The decision-making lies primarily with the employer or the insurance provider.
When is the right time to purchase Group Health Insurance?
The right time to purchase a Group Health Insurance is typically when an organisation is established or when employers need to provide comprehensive healthcare coverage. It is advisable to purchase it early to ensure employees can access healthcare benefits from the start.
Additionally, purchasing before any major health issues arise is beneficial, as pre-existing conditions may be subject to waiting periods. The timely purchase allows for better financial planning, employee retention, and a healthy work environment.
Is COVID-19 covered under Group Health Insurance Plans?
No, not all group health insurance plans in India must cover COVID-19. However, considering the unprecedented nature of the pandemic, most insurance providers have extended coverage for COVID-19 under their group health insurance plans.
The coverage for COVID-19 under group health insurance plans may vary depending on the insurance provider and the specific terms and conditions of the policy. Typically, the coverage includes hospitalisation expenses, such as room charges, doctor's fees, nursing expenses, diagnostic tests, medications, and other necessary medical treatments related to COVID-19.
At Tata AIG, COVID-19 cases are covered If treatment is taken on in patient basis at govt. recognised hospitals.
What does "room rent capping" refer to in group health insurance?
Room rent capping" in group health insurance refers to a policy provision that sets a limit or cap on the amount the insurance company will reimburse for room charges during hospitalisation. If the room rent exceeds the specified cap, the policyholder may have to bear the additional expenses out of pocket.
For example, if the policy has a room rent capping of ₹5,000 per day and the room charges are ₹6,000 per day, the policyholder will pay the remaining ₹1,000. Room rent capping helps insurance companies control costs and prevent excessive billing for higher-category rooms.
Is it possible to customise the room rent under group health insurance?
Customising the room rent under group health insurance can be done by the policy holder only. Group health insurance plans often come with predefined room rent limits or capping, which cannot be individually adjusted or customised.
The insurance provider predetermines the room rent limits typically based on the sum insured or the policy's terms and conditions. Policyholders should carefully review the policy documents to understand the specific room rent limits applicable to their group health insurance plan.
With Tata AIG, the room rent options under the Group Health Insurance policy are stated below:
- For in-patient treatments, the maximum allowable Room Rent will be restricted to the specified amount/percentage of the Sum Insured or the designated room category mentioned in the Policy Schedule/Certificate of Insurance.
- For associated medical expenses, if the Insured Person is admitted to a room with higher Room Rent expenses than the specified limit in the Policy Schedule/Certificate of Insurance, they will be responsible for a proportionate share of the total Associated Medical Expenses (excluding pharmacy charges, diagnostic costs, costs of implants & medical devices, and consumables expenses). The proportionate share is determined by the difference between the eligible Room Rent expenses and the actual Room Rent expenses incurred. This applies to hospitals that have differential billing or for expenses where differential billing is based on the Room Category.
What is the coverage mechanism for pre-existing diseases under group health insurance?
The coverage for pre-existing diseases under group health insurance is subject to certain considerations and conditions.
It's important to note that coverage for pre-existing diseases may differ among insurance providers and policies. Some group health insurance plans may offer coverage for pre-existing diseases from day one, while others may impose waiting periods.
Tata AIG's Group MediCare plan offers immediate insurance coverage to employees, including coverage for pre-existing diseases depending upon the plan chosen by the employer.
What kind of maternity benefit is provided under group health insurance?
Group health insurance plans often include maternity benefits to support policyholders during pregnancy and childbirth. Here's an explanation of the maternity benefits typically offered:
Maternity benefits under group health insurance plans cover the expenses related to pregnancy, childbirth, and postnatal care. These benefits typically include coverage for hospitalisation expenses, such as delivery charges, doctor's fees, nursing charges, and room charges. Additionally, expenses for pre and postnatal consultations, diagnostic tests, and medications may also be covered.
Our Group Health Insurance Plan offers to cover maternity. At Tata AIG, we provide also provide coverage extensions for our Group MediCare Policy:
Pre/Post-Natal Cover: This add-on covers pre and post-natal expenses on an outpatient basis. It includes pre-natal check-ups, prescribed medications, and diagnostic tests from the confirmation of pregnancy, as well as post-natal check-ups for six weeks following delivery. The sum insured for this cover applies to pre and post-natal treatments and is part of the Maternity limit.
As an employer, what extra benefits can we get by providing our employees with Group Health Insurance Plans?
By providing employees with group health insurance plans, employers can offer several extra benefits that contribute to their overall well-being and job satisfaction. Here are some key advantages:
- Enhanced Employee Retention: Offering group health insurance can enhance employee retention rates. Employees value the security and financial protection provided by health insurance, leading to increased loyalty and reduced turnover.
- Improved Attraction of Talent: Group health insurance is a valuable perk that can attract top talent during recruitment. It demonstrates an employer's commitment to employee welfare and can give them a competitive edge in attracting skilled professionals.
- Better Employee Health and Productivity: With access to comprehensive healthcare, employees are more likely to prioritise their health and seek timely medical attention. This can improve overall health, reduce absenteeism, and increase productivity.
- Financial Security: Group health insurance helps protect employees and their families from the financial burden of medical expenses. It provides coverage for hospitalisation, treatments, and other healthcare services, alleviating financial stress and allowing employees to focus on their work.
- Peace of Mind: Knowing that a group health insurance plan covers them, employees experience peace of mind and feel secure about their healthcare needs. This can contribute to a positive work environment and employee morale.
Is a health check-up necessary before taking group health insurance for employees?
While a health check-up is not always mandatory, it is recommended before taking group health insurance for employees. A health check-up helps insurance providers assess the overall health condition of employees, identify pre-existing conditions, and determine the risk profile. This information aids in underwriting decisions and ensures accurate premium calculations.
Additionally, it allows employees to address any existing health concerns before obtaining insurance coverage. While it may vary depending on the insurance provider and policy, a health check-up can provide a comprehensive understanding of the employees' health status and help in tailoring the insurance plan to meet their specific needs.
With Tata AIG, while individual health insurance policies often require individuals to undergo health check-ups before the policy is issued, group insurance policies operate differently. With group insurance, the health check-ups of employees are typically not conducted as a prerequisite for coverage.
Is it possible to have both a corporate health insurance policy and an individual health insurance policy simultaneously in India?
Yes, it is possible to have both a corporate health insurance policy and an individual health insurance policy at the same time in India. Many individuals opt for an additional individual health insurance policy to supplement the coverage provided by their corporate health insurance plan. This dual coverage ensures broader protection and allows policyholders to tap into the benefits of both policies when needed.
However, it's important to coordinate with the insurance providers and understand the coordination of benefits clauses to avoid any confusion or claim-related issues. Reviewing the terms and conditions of both policies and seeking guidance from insurance professionals can help individuals make informed decisions regarding dual coverage.