Prioritize Your Team’s Well-Being with Group Health Insurance
Care for your team - Because a protected team is a productive team.
Group Health Insurance
For small business owners and corporate HR professionals, hiring and retaining skilled professionals is a key concern. Offering valuable employee benefits or perks is one of the best ways to achieve this, and group health insurance stands out as one of the popular choices.
Group medical insurance helps employers offer extensive healthcare benefits to all employees under one policy. This is more efficient compared to providing health insurance to each employee separately.
TATA AIG’s group health insurance offers wider coverage, simple purchase options and a large hospital network, making it easier for you to manage your team while we take care of their health.
What is Group Health Insurance?
Group health insurance, also called corporate health insurance, is an insurance policy that covers the medical expenses of a group of individuals. Many organisations offer group health insurance coverage as part of employee benefits. By offering health insurance coverage, you can promote a healthier, happier and more productive workplace.
Group medical insurance covers a range of medical services and benefits, including hospital stays, daycare treatments, maternity care and surgeries. Additionally, the group health insurance policy can cover your employees’ or group members’ families, including their spouses, dependent children and dependent parents.
Who should buy Group Health Insurance?
Small and Medium Enterprises
Small and Medium Enterprises (SMEs), such as small-scale textile units, logistic firms and regional food processing units.
Start-ups
Start-ups, such as new tech companies, mobile application developers and online service providers.
Large corporations
Large corporations, such as IT service providers, manufacturers and large-scale retail businesses.
Associations or societies
Associations or societies, such as social welfare associations for rural development.
Companies
Companies, such as banks or other financial institutions that want to establish a strong relationship with the customers.
Types of Groups Covered in Group Health Insurance
Let us quickly understand what a group means and what groups are covered under Group Health Insurance policies.
According to IRDAI, a group, under a group health insurance policy, is defined as members coming together to engage in a common economic activity but not merely formed to obtain health insurance coverage benefits. Groups can broadly be classified into two categories:
Employer-Employee Groups
Includes companies and organisations offering health insurance to their employees. It can be small or medium-sized companies or larger corporations and their employees. Employers generally pay the full premium or require a minimal contribution from employees.
Non-Employer-Employee Groups
Includes registered groups like welfare associations or societies offering health insurance coverage to members. It can also include customer groups. For example, banks offer health insurance to their credit card holders. Members usually share the cost of the insurance.
Why Do You Need Group Health Insurance
Simple purchase options
Assess your needs, enter details online, choose features and buy the plan easily.
Customer support
Our team is here to guide and assist you at every step.
Cashless network
Get access to over 12000+ hospitals across India to offer cashless treatments.
Wider coverage
Our plans cover in-patient treatment, maternity care, daycare procedures and more.
Customisable add-ons
Enhance coverage with options like pre-and post-natal care and baby day one cover.
Hassle-free claim process
Benefit from a quick and smooth claim settlement process for both cashless and reimbursement claims.
How Does a Group Health Insurance Plan Work?
Policy Purchase
Employers check eligibility and decide the type of coverage required. Then, they share the company details and purchase the policy.
Premium Payment
The employer pays the full premium or divides the cost with the employee based on company policy.
Enrollment
We add the employee details to the system. If the plan includes family members, their details are also added.
Coverage Commencement
The group health insurance policy becomes active, and employees can start using it to cover their medical expenses.
Claim Filing
If an employee needs treatment, they inform the employer and get the required healthcare services.
Claim Settlement
The employer files a cashless or reimbursement claim and gets the bills settled for the employee.
How Does Corporate Health Insurance Benefit Employers?
To ensure legal compliance
After COVID-19, IRDAI made it mandatory for employers to provide group health insurance in India for employees.
To attract talented applicants to the job
Many skilled professionals prefer companies that offer health insurance coverage while applying for a job role.
To retain employees
Health insurance makes your employees feel valued and encourages them to stay longer. This reduces the need to hire and train new staff.
To support employee well-being
Group medical insurance covers various medical expenses to help your employees stay healthy and stress-free.
To boost productivity
By offering group insurance for employees, you build trust and loyalty within your team. This helps them stay focused at work, boosting their overall performance.
Lower premiums
As the risk is spread across a large group of individuals, the cost is lower compared to reimbursing each employee’s medical expenses separately.
Tax benefit
Employers can claim the premium paid for the policy as a business expense under Section 37(1) of the Income Tax Act.
Enhance reputation
Offering group medical insurance for employees reflects your responsibility as an employer and strengthens your reputation in the market.
What Are the Important Group Medical Insurance Benefits for Employees Under ?
Here are some of the most lucrative benefits of group health policies that the employees of an organisation can enjoy:
Coverage at no or less cost
Most employers pay the premium entirely or require only a minimal contribution from employees for health insurance coverage.
Health insurance coverage for dependents
Employees can also cover their family members, including spouses and dependent children, under the policy.
No waiting period
Group health plans cover employees from day one without the waiting period for pre-existing conditions.
Comprehensive coverage
It includes a broad range of medical expenses such as hospitalisation, ambulance costs, surgeries and more.
Easy access to quality healthcare services
Employees can easily access and get treatment for their health conditions in some of the best hospitals across India.
No medical check-up required
Older employees and others with pre-existing conditions can also get health insurance coverage without medical check-ups.
Tax benefit
Employees who contribute to the group health insurance premium can claim a tax deduction under Section 80D of the Income Tax Act.
Key Features of TATA AIG Group Health Insurance Plans
| Key Features | Details | |
|---|---|---|
Policy | ||
Policyholder | Employer | |
Insured Members | Employees, and if included, their family members, such as their spouse, dependent children and dependent parents. | |
Mid-Term Addition of Dependents | Post marriage, spouses and newborn children can be added. | |
Coverage | In-patient expenses, pre-and post-hospitalisation, daycare procedures, domiciliary (home) treatment, organ transplant, ambulance cover, maternity cover, family transportation | |
Add-ons | Pre-and post-natal care, baby day one cover | |
Cashless claims | Available in-network and non-network hospitals. | |
Network of hospitals | 12,000+ across India | |
Pre-medical examination | Not required | |
Waiting period | No waiting period for initial coverage, specific illnesses, pre-existing health conditions and maternity cover. |
What is Covered in Tata AIG Group Health Insurance?
In-Patient Treatment
Hospital stays and treatment expenses, if the employee is admitted for at least 24 hours due to injury, illness, or disease, are covered.
Pre-and Post-Hospitalisation
Expenses for consultations, blood tests, scans, and medicines before being admitted to and after discharge from the hospital are covered. This applies to the number of days mentioned in the policy and for in-patient treatment, daycare procedures, or home treatments.
Day Care Treatment
Expenses for daycare procedures that take less than 24 hours of hospitalisation in a hospital or daycare centre are covered. Refer to common daycare procedures covered under a group health insurance policy.
Domiciliary Treatment
Expenses for treatment at home if it continues for more than three days are covered. This does not include enteral feeding (tube feeding) or end-of-life care.
Organ Transplant
Medical and surgical expenses for an organ transplant are covered if the employee is receiving the organ. This is provided if the employee has claimed in-patient treatment.
Ambulance Cover
Expenses of moving the insured employee in an ambulance during an emergency or to another hospital for better treatment are covered. This is available for in-patient treatment or daycare procedures.
Maternity Coverage
Maternity expenses for childbirth, termination of pregnancy and newborn medical care are covered. Ectopic pregnancies are not covered under maternity care but can be claimed under in-patient treatment.
Family Transportation Benefit
Transportation expenses for one immediate family member if the insured employee is admitted to a hospital more than 200 km from their home are covered.
Please Note: Inclusions may vary based on individual cases. Please read through your policy document for detailed information.
What is not Covered in Tata AIG Group Health Insurance?
Investigation and Evaluation
Expenses for primary diagnostics and evaluations (blood tests, scans, etc.) not related to the ongoing treatment are not covered.
Rest and Respite Care
Expenses for bed rest and temporary care for insured employees with serious illnesses that cannot be cured are not covered.
Obesity/Weight Control
Expenses related to the surgical treatment of obesity are not covered if it is not recommended by a doctor and supported by standard medical guidelines.
Gender Change Treatment
Medical expenses related to the treatment and surgery for gender change are not covered.
Cosmetic or Plastic Surgery
Expenses for cosmetic or plastic surgery, unless required for accidents, burns, cancer or medically necessary, are not covered. Dental treatments are also excluded in this case.
Addiction
Expenses for treating addiction to alcohol, drug or substance abuse, or any other related condition are not covered.
Unproven Treatments
Medical expenses related to any unproven treatment or medication are not covered.
Miscellaneous
Expenses for refractive error treatment, adventure sports injuries, breach of law, and sterility or infertility treatments are not covered.
Please Note: Exclusions may vary based on individual cases. Please read through your policy document for detailed information.
Important Factors You Must Consider When Buying Group Health Insurance Plans
Employee needs
Consider the number of employees, their age, health conditions, and any specific requirements they might have.
Policy conditions
Read the policy document to understand the medical expenses included and excluded under the group health insurance policy.
Options for additional coverage (add-ons)
Consider including add-ons like pre-and post-natal care to offer additional coverage.
Premium
Make sure the cost fits your budget while still offering essential healthcare benefits to your employees.
Claim Process
Understand cashless and reimbursement claim processes and the documents required to ensure hassle-free claims.
Am I Eligible To Buy Group Health Insurance Policy?
Type of group - As stated before, the group must qualify as a group as defined by IRDAI. It can be an employer-employee or non-employer-employee group.
How Can I Apply for Group Medical Insurance
Analyse coverage needs
Determine the number of employees, their age and basic healthcare requirements to determine the coverage necessary.
Enter company details
Use the calculator on this page to enter GSTIN, email address and mobile number.
Determine the policy
Determine the policy and features that suit your company’s requirements and budget.
Review and customise
Check your policy details and premium and make changes to customise your plan. Include add-ons to enhance the coverage if necessary.
Pay the premium
Make the payment online and complete the group health insurance application process to activate your policy.
Please Note: You can also visit our nearest branch office to purchase group health insurance offline. For any further assistance, please contact us.
How Do I Raise Cashless Claims for Group Health Insurance?
Inform Us
Inform TATA AIG within 24 hours of emergency hospitalisation and at least 48 hours in advance of a planned hospitalisation.
- Use the Initiate Claim (Also available on our TATA AIG mobile app)
- Call us on our customer support number - 022 6489 8282
- Use our self-service portal.
Request for Pre-authorisation
Visit any hospital and contact their TPA (Third Party Administrator) to show your Health Card and submit the pre-authorisation form to request cashless treatment with TATA AIG.
Get Hospitalised
If the request gets approved, the employee or the group member can receive the treatment at the hospital.
Get Discharged
Submit the medical reports and bills to the hospital at the time of discharge.
Get Claim Settlement
We will review the medical bills and settle them directly with the hospital.
How Do I Raise Reimbursement Claims for Group Health Insurance?
Inform Us
Inform TATA AIG within 24 hours of emergency hospitalisation and at least 48 hours in advance of planned hospitalisation.
- Use the Initiate Claim option (Also available on our TATA AIG mobile app)
- Call us on our toll-free number - 1800-266-7780
- Use our self-service portal.
Get Hospitalised
The employee or the group member can get medical treatment at any authorised hospital.
Pay the Medical Bills
Settle the medical bills at the time of discharge and keep all receipts safely for reimbursement.
Submit the Documents
Submit the claim form, medical reports and payment receipts with TATA AIG for reimbursement.
Get Claim Settlement
We will review your documents and reimburse the applicable expenses.
Documents You'll Need to File Group Health Insurance Claim
List of Documents for Cashless Claims
- Health Insurance Card / Policy Copy
- Copy of Company photo ID
- Customer address proof
- Duly filled CKYC Form if the claim amount is above ₹1 lakh
- Admission notes from a treating doctor
- Previous OPD consultation papers with reports, if any
- Previous discharge summary or any other medical records, if applicable
- Any previously approved / settlement letter from TATA AIG for reference (Optional)
List of Documents for Reimbursement Claims
- Duly filled and signed claim form
- Health insurance card or policy copy
- Medical Certificate signed by the doctor.
- Original discharge summary and original consolidated final bill
- Detailed break-up of the submitted final bill
- Original cash receipts from hospital, pharmacy, and lab
- Bank account details of the payee
- Supporting investigation reports
- Invoices of any implants used during treatment
- MLC (Medico-Legal Case) or FIR (First Information Report), in case of accidents
- Nominee’s address and ID proof in case of death claims
- Duly filled CKYC form if the claim value is above ₹1 lakh
What is a Health Card in a Group Health Plan?
A health card is the identity card issued to each employee covered under a group health insurance policy. It contains essential information, such as the policyholder's name, policy number, member ID, policy period, age, date of birth and gender.
Employees must carry this health card to the hospital to benefit from cashless treatment. It facilitates easy and efficient access to healthcare services at hospitals associated with the insurance plan.
Group Medical Insurance Add-Ons You Can Opt For
Pre-and Post-Natal Care
Covers the expenses for regular health check-ups or follow-up visits, medicines and tests during pregnancy and after delivery.
Baby Day One Cover
Covers the treatment expenses of a newborn baby from the date of birth.
How Do You Download a Health Card?
Using TATA AIG mobile application
Employees can log in to their account on the TATA AIG mobile app to easily download the health card.
From the official email
The health card is also shared as an attachment in the official email sent by the employer. Employees can directly download it from there.
Terminologies You Need to Know Before Buying a Group Health Insurance Policy
Premium
The amount you pay periodically (every month, quarter, or year) to keep the group health insurance active.
Deductible
A fixed amount the employer (or sometimes the employee) needs to pay for every claim before the insurance starts covering medical bills. A higher deductible results in a lower premium.
Copayment (Copay)
A fixed amount the employer (or sometimes the employee) must pay while receiving healthcare services, such as doctor visits or prescription medications. The copayment amount may vary depending on the service.
Network
A group of hospitals that have agreements with the insurance company to provide cashless treatments. While cashless services are available at non-network hospitals, the process is quicker and hassle-free in network hospitals.
Pre-Authorisation
The process of obtaining approval from the insurance company before undergoing certain medical procedures or treatments for cashless claims.
Exclusions
Specific medical services, treatments, or conditions that are not covered under the group health insurance policy.
Waiting Period
The period for which the insured members need to wait for the insurance to start covering certain conditions, like pre-existing illnesses. Waiting periods are not applicable to group health insurance plans.
Renewal
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.
Group Health Insurance vs Individual Health Insurance - What's Better For You?
| Differentiating factors | Group Health Insurance | Individual Health Insurance |
|---|---|---|
Who buys the policy? | Employers buy and offer it to their employees. | Any individual can buy it for themselves or their family. |
Who is covered? | Employees and their dependents | Only the insured person |
Coverage | Standard coverage, like in-patient treatment, pre-and post-hospitalisation, maternity care, etc., is common to all employees. | Customisable plans with wider coverage, including critical illnesses, AYUSH benefits, modern treatments, etc., specific to individual healthcare needs. |
Underwriting | Simplified processes with no health check-ups | Detailed checks based on age and health condition. |
Flexibility | Limited flexibility. The employer decides the sum insured and features. | Higher flexibility. Individuals decide the type of policy, sum insured and other features. |
Add-ons | Limited options | Wide range of add-on options available |
Premium | Based on the number of employees, their age, etc. Paid by the employer or partly shared by employees. | Based on the individual’s age, gender, health condition, etc. Fully paid by the policyholder. |
Waiting period | Option to waive off | Waiting period applies |
Portability | Can be converted to an individual health insurance policy when leaving the job. | Remains active and portable regardless of job changes |
Frequently Asked Question
What is the history of group health insurance?
The history of group health insurance dates back to 1798 with the US Marine Hospital for Navy seamen. By the early 1800s, industries such as mining and railways started offering health insurance coverage to workers.
In 1910, Montogomery Ward, a US retail corporation, offered a group health insurance policy for the first time. During World War II, wage controls that restricted salary increases led employers to provide healthcare benefits.
And in 1965, The Social Security Amendments were introduced to provide Medicare and Medicaid, covering retirees and low-income groups, laying the foundation for modern group health insurance.
What makes group health insurance popular?
Group health insurance plans are popular because they offer essential healthcare benefits to employees at an affordable cost. This benefit will attract top talents and retain them for a long-term association with the company. It will also make the employees feel valued at their workplace, building trust and enhancing the business’s brand image.
How does TATA AIG compare with other providers?
TATA AIG offers wider coverage, customisable features, a large hospital network and a hassle-free claim process.
How do group health plans benefit employees compared to individual plans?
Group medical insurance covers a wide range of medical expenses at no cost or at a lower cost for the employees. Additionally, the employees need not go through medical checks or waiting periods. This means the health insurance coverage is applicable to all employees from day one.
What is the waiting period in group health insurance?
The waiting period in group health insurance is the time period an employee must wait before certain coverages become available. Typically, this includes a waiting period for pre-existing conditions or specific treatments. However, TATA AIG offers group health insurance plans with no waiting period.
What are the group health insurance tax benefits?
For employers - Employers can claim the premium paid for the policy as a business expense under Section 37(1) of the Income Tax Act.
For employees - Employees who contribute to the group health insurance premium can claim a tax deduction under Section 80D of the Income Tax Act.
When is the right time to purchase a group medical insurance policy?
The right time to purchase group health insurance is when your organisation is set up, and you start building a team. It creates a supportive work environment, makes employees feel valued and builds trust for a long-term relationship with your company.
What is the waiting period for TATA AIG Group Health Insurance Policy?
There is no waiting period under the TATA AIG Group Health Policy. Coverage starts from day one, including for pre-existing health conditions.
What happens if an employee leaves the company?
If an employee leaves the company, the coverage available under the employee health insurance policy ends. However, the employee can choose to transfer the coverage to an individual health insurance policy with us. The application for this transfer should be submitted at least 45 days (and not earlier than 60 days) before the renewal date.
Can employees port group health insurance to individual health plans?
Yes, employees can port group health insurance coverage to individual health plans by applying for it 45 days (and not earlier than 60 days) before the renewal date. This allows employees to maintain continuity of coverage.
Can I buy both corporate health insurance and individual health insurance at the same time?
Yes, you can hold both corporate or group health insurance and individual health insurance policies simultaneously. This can provide additional coverage and benefits beyond what is offered by your employer.
Many individuals opt for an additional individual health insurance policy to supplement the coverage provided by their corporate health insurance plan.
How is the premium of a group health insurance policy calculated?
The premium for a group medical insurance policy is calculated based on factors such as the number of members, the age and health profile of the members, the type of coverage chosen and the sum insured. Larger groups often benefit from lower per-person premiums due to the spread of risk.
Can you purchase group insurance plans for specific employees?
Yes, you can customise group health insurance plans to cover specific categories of employees within your organisation. This allows flexibility in providing different levels of coverage based on job roles or other criteria.
How is ESIC different from a group medical insurance plan?
ESIC (Employees' State Insurance Corporation) is a social security scheme for workers providing medical and cash benefits, mandated by the government for employees earning below a certain threshold.
Group health insurance for employees, on the other hand, is a private insurance policy that can cover all employees regardless of their salary and offers more comprehensive and customisable benefits.
Is a health check-up necessary before employees take group health insurance?
No, a health check-up or a pre-medical screening is not required for the employees to purchase the group health insurance policy.
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. The employee will have the option to migrate the policy to other health insurance plans offered by us. The application for this migration needs to be submitted at least 30 days before the renewal date.
Who can be covered in a group health insurance policy?
A group medical insurance policy can cover employees of a registered organisation, members of registered welfare associations, credit cardholders of specific companies or banks and customers of businesses offering insurance as an added benefit. Depending on the policy terms, it can also include dependents such as spouses and children.
Does group medical insurance also cover the families of employees?
Yes, group health insurance policies from TATA AIG offer the option to cover the families of employees, including spouses, dependent children and dependent parents, under the same plan.
Can I add maternity coverage to my group health insurance plan?
TATA AIG offers group health insurance for employees that cover medical expenses related to maternity care.
Does group medical insurance cover pre-existing conditions?
Yes, group medical insurance for employees covers pre-existing diseases from day one, with no waiting period required.
Is there a waiting period for maternity benefits in group health insurance?
No, there is no waiting period for maternity benefits in our group health insurance plans.
What is room rent capping in group health plans?
Room rent capping is a limit set by the insurance policy on the amount payable for hospital room rent. For example, the policy might cap room rent coverage at a certain percentage of the sum insured or a fixed amount per day. Any cost above this cap must be borne by the policyholder as mentioned in the policy.
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.
Yes, group health insurance from TATA AIG includes coverage for coronavirus-related treatments, subject to the terms and conditions of the policy.
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.
Are health check-ups covered in group health insurance?
Yes, TATA AIG group health insurance plans include coverage for routine health check-ups as part of preventive healthcare benefits.
Is medical diagnosis and evaluation also covered under TATA AIG Group Health Insurance?
TATA AIG Group Health Insurance does not cover costs for medical diagnosis and evaluation unless they are part of ongoing treatment.
What is a financial emergency cash benefit?
A financial emergency cash benefit is a feature in group health insurance policies that provides immediate cash assistance to insured members during a medical emergency. This benefit helps cover urgent expenses that arise before insurance claims are processed.
What kind of maternity benefit is provided under group health insurance?
Group medical insurance covers expenses related to childbirth, including hospital stay and delivery. It also covers legal termination of pregnancy if advised by a doctor.
How long does it take to settle a group health insurance claim?
Group health insurance claims can be settled within 7 to 30 days after receiving all the necessary supporting documents. The exact timeline will differ and depend on the nature of the claim.
Is pre-authorisation mandatory for cashless claims in group health insurance?
Yes, pre-authorisation is mandatory for cashless claims. You can contact the TPA (Third-Party Administrator) at the hospital to help you with the pre-authorisation process.
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