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Group / Corporate health Insurance

Group / Corporate health Insurance - Simply put, corporate medical insurance is health insurance offered by an employer to its employees.

Features of Group / Corporate health Insurance:

Medical and hospitalization expenses of the employees are covered by the group health insurance policy. Employees are the most valuable assets of a company and employers try their best to secure employee satisfaction in the form of various facilities. Group health insurance policy is one of the facilities provided by the employer. Also, due to the features provided by this policy, its benefits are valued by the employees. Following are the features available for group health insurance for employees:

No-waiting period

An employee can avail the coverage of the group health insurance plan from the first day of his service in the firm. The best group health insurance plans do not have the waiting clause. The benefit of a no-waiting period is that the employee can immediately avail the expenses for even the chronic diseases like diabetes and knee related problems.

Cashless hospitalization at network hospitals

The cashless hospitalization facility is the most important facility offered by the group health insurance policy. This means that the employee does not have to go through the tiring tasks of paperwork.

The facility of network hospitals includes the facility to avail the reputed healthcare centres. The insured can avail discount due to such facility. The employee can avail the top-class facilities provided by the reputed hospitals in the network.

Pre-and post-hospitalization charge

Pre-hospitalization expenses are incurred when the insured is prescribed to conduct specific tests or investigations before getting hospitalized. Examples of such expenses are a blood test, urine test and X-rays.

After the patient is discharged, he may require conducting certain tests to ascertain the progress of his health. Thus, post-hospitalization charges are incurred by an individual after he or she is hospitalized and it includes charges like diagnostic charges, consulting fees and medicine costs.

A group health insurance policy, covers for pre-and post-hospitalization charges for a specific period as per mentioned in the policy document.

Coverage for Pre-illness

In the group health insurance policy, there is no need of getting a prior health check-up. All the previous illnesses and the medical expenses arising out of it are covered under it. Some group insurance policy also covers for the critical illnesses, but it depends on the plan selected by the employer. Hence it is essential to know what the policy covers.

Coverage for dependents:

Apart from the employee himself, the group health insurance plans offer coverage to the depending members of the employee’s family like his spouse, children and parents.

Coverage for ancillary charges

Ancillary charges can include the ambulance charges. Group health insurance for employees also covers such charges.

Group Health Insurance vs Individual Health Insurance

1. Group insurance cheaper premium as it cannot be customized. Renewal premium is more as risk is spread across all the employees

2. Individual health insurance premium is costlier as it is customized for specific individual needs. Renewal premium doesn’t increase as only individual risk is covered

Definitions

Group Insurance is simply an insurance package an organisation buys for the benefit of its employees. The organisation may design a self-insured plan itself or select a pre-planned insurance policy from an insurance company.

Individual insurance is self-explanatory too - it is the insurance package an individual buys for themselves, or for a group of people, such as for his or her family. Though the name suggests otherwise, it isn't true that an individual insurance package covers only a single person.

Differences

Cost

Understandably, group insurance plans cost less and can be availed at low or no cost to the employee, much like buying in bulk sometimes gets you discounts. Each employee will not have to pay any additional fees unless anyone opts for additional benefits that are not offered to the group.

Additionally, premium for group plans is deducted from the salary, as opposed to individual plans wherein premium is paid separately. This is why some may choose not to purchase an individual health insurance plan if they feel that the employer's group health insurance package covers their needs.

Convenience and control

Although not too common a scenario, an individual may be denied the insurance package, for a variety of reasons, be it medical or financial history. However, with group insurance packages, every individual who is an employee of the company is eligible for the insurance package and is automatically granted approval for the insurance package. This is also because with group insurance plans, the process of underwriting, wherein the to-be insured's medical history is closely examined, is sometimes waived off. Thus, it's a lot easier to obtain an insurance package through the organisation.

However, with individual insurance packages, the individual has full freedom to set the terms of the policy . Only you can choose for the policy to be discontinued. The policy can be decided on the basis of your own personal medical, financial and social situations, rather than spread over a number of individuals like in Group Insurance.

No Claim Bonus

With a group policy, even if you don't make a claim throughout the tenure of the policy, you, as an individual, do not get any benefit. In contrast, with an individual insurance plan, if you do not make a claim throughout the tenue of the policy, you are eligible for a No Claim Bonus- which can be thought of as a reward for being healthy- and appears in the form of discounted renewal premium or incremental cover at no additional cost.

Additionally, if you do not make a claim but another individual covered under the group plan makes a claim on the ground of having a baby, having contracted a critical illness, etc., the overall cover being offered to the group may be reduced if the employer is unwilling to pay more premium on the group's behalf.

Applicability

Unlike Individual Insurance plans that are applicable no matter at all times, Group Plans only offer cover for as long as you are employed and the employer is paying the premium. When you retire/resign, you may have an option to convert the group cover to an individual policy. However, the conversion premium typically is much higher than that for a new individual life insurance policy. So it is advisable to convert only if the premium works out lower than a new policy or if you are otherwise uninsurable. If you decide to convert, you will have to produce the certificate of coverage that your employer had given you under the group insurance policy.

Which should you choose?

Group insurance plans can be a real cost-saver for the company and the employee, making it more of a bargain, but affordable individual insurance packages are certainly a necessity that even those covered by their companies cannot afford to do without. This is mainly because individual insurance policies allow you to choose exactly what's covered and what is not. You can decide which critical illnesses and diseases you want to cover- based on your family's and your medical history , how many members of your family you want to cover, and even how much of a sum you are assured . In contrast, group insurance policies are constructed according to the company's policies and the will of your employer.

Also, the group insurance cover through your employer only lasts as long as you continue working for your employer . If and when you switch jobs, you may or may not receive health insurance cover from your new employer as it is not mandatory for your employer to provide group health insurance cover. Also, you will most likely not enjoy the same extent of cover as you had with your previous employer.

Lastly, you may find it difficult to get an individual health cover post retirement (if you don't already have one), especially if you have developed any health issues. Even if you do get covered, the premium for such policies will invariably be quite high.

For the above reasons, it is advisable to get yourself an individual health insurance cover even if you are covered under a group plan through your employer.

Once you have decided to opt for an individual plan, it's important you do your research, obtain the best quotes and make comparisons. You can consult an expert if necessary. After all, it's your money that's going to make the purchase and your health at stake.

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