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Group Health & Personal Accident Insurance

The health of employees has direct bearing on the health of any organization. Group Health provides complete corporate health solutions for your organization to keep you from worrying about financial risks of your employees due to health problems. These customized policies include insurance to employees and their families in the unfortunate event of illness and hospitalization.
It covers the following:-

  • Hospitalization costs - if the hospitalization is for more than 24 hours.
  • Pre and Post Hospitalization Costs.
  • Ambulance charges.

Better Benefits

Group Health insurance provides significantly better benefits than individual health insurance. For example, employees or group members do not require a medical checkup, waiting periods for existing diseases can be waived off, premiums are lower, maternity expenses or corporate floaters can be added to the cover. Group Health Insurance is an excellent tool to attract and retain talent for organizations.

Lower Cost

In group insurance policies, the risk is spread over a large group of individuals and that helps reduce the premium cost due to the economies of scale. However, the premium can be highly variable for group health insurance due to claim ratio and number of employees/members added to or removed from the cover.

Customized Cover

You can customize the policy according to your needs. You can add more benefits apart from the basic policy provisions already available in any mediclaim policy. For example, parents can be covered, day care treatments can be increased, accidental cover rider and maternity benefits can be increased. This flexibility allows the group health insurance to be tailored to your budget with your specific requirements.

Guaranteed Issue

As there is no medical checkup prior to the issuance of the policy and no waiting period clause for pre-existing ailments, the issue of group health insurance is assured. Group mediclaim is administratively much easier to place and you need not spend time in medical checks or in dealing with the aftermath of insurance getting rejected.

Benefits Overview of Group Health Insurance

Pre-existing Diseases Covered

  • Our group insurance waives of the waiting period for pre-existing diseases
  • Each individual is fully covered irrespective of their personal medical history
  • Medical history of an individual has no bearing on their future coverage
  • No medical check-up done for individuals to determine eligibility for coverage
  • Coverage applicable for chronic ailments such as diabetes

Maternity benefits With ZERO Waiting Period

  • Our group health insurance policies cover maternity benefit for employees and their spouse
  • Maternity benefits are covered immediately with no waiting period
  • Avail pre and post natal expenses along with delivery expenses
  • New born baby will also be covered immediately without the standard 90 day waiting period
  • Internal congenital diseases are covered

No disease Wise restrictions

  • All diseases are covered from day one, without standard waiting period of one to four years
  • Common surgeries like Cataract, Hernia, Piles, Knee Replacement are covered from day 1
  • No waiting period on critical ailments
  • Full sum assured available for all diseases
  • No copay on specific ailments

How does Group Insurance work?

How to get a quote?

To get the tentative quotation for the Group health insurance of your employees, please follow the below mentioned 5 easy steps:-

  • Step 1: Enter your contact details
  • Step 2: Choose Sum Insured and put number of employees to be covered.
  • Step 3: If you want to cover dependents of Employees also, put the number of dependents to be covered.
  • Step 4: If you want to get the quotes for the renewal of your Group Health Insurance Policy, please mention the claim ratio & click on next.

Documents required to book the policy?

Following documents are needed to avail group health insurance:-

  • Duly filled, signed and stamped Proposal Form.
  • Complete data of Employees and dependents.
  • Payment details
  • Declaration Form
  • Reports as required by the Insurer
  • Any other Document as required by the insurer

How to file a claim?

Cashless claims are filed directly by the network hospital with the TPA (Third Party Administrator) of the group health insurer or the insurer. They need to submit the following documents for the claim:-

At The Initial Stage:

  • Pre-Authorization Form
  • Investigation Reports
  • ID proof of the patient
  • Health Card of the Patient
  • Doctor’s Note

At The Time Of Discharge:

  • Discharge summary
  • Final bill with breakup
  • All investigation reports

In the case of Reimbursement claims following documents will be needed:

  • Claim Acknowledgment Number
  • Duly Filled and signed Claim Form
  • Original Discharge Card or Discharge Summary
  • Final hospital bill with breakup
  • Investigation Reports
  • Original Copies of Relevant Medical Bills
  • Prescription Details by the Treating Doctor
  • Cancelled cheque of the Employee along with filled ECS form
  • Pre & Post Hospitalization Bills supported with prescription/advice
    of treating doctor

How does Group Personal Accident Insurance work?

You can get quotes for your organisation/group personal accident insurance plan online with few clicks, by following these steps:

  • Step 1: Decide the Sum Insured for each employee/member.
  • Step 2: Get information on the number of dependents for each employee (if they are to be covered under the policy).
  • Step 3: Fill in the information.
  • Step 4: If you had been using a Group Personal Accident Insurance Policy, enter the claim ratio for the last year.

Following documents are needed to avail group personal accident insurance:

  • Proposal Form
  • Declaration Form
  • Reports as required by the Insurer
  • Any other Document as required by the insurer

Group personal accident insurance is a part of group insurance family, to check other Group Insurance Policies check here.

Cashless claims for the medical treatment can be filed directly by the network hospital with the TPA (Third Party Administrator) of the group health insurer or the insurer. However, the documents to be submitted for other types of claims under Group Personal Accident Insurance will be as follows:-

Upon Meeting with an Accident:-

  • Notify the Insurer or Agent immediately on call
  • Written notice of Death before cremation/internment, or loss of limbs to be given
  • Any certificates issued by medical practitioners

Documents Required for:-

Death Claim:-

  • Duly filled up claim form
  • Death Certificate
  • Original FIR
  • Original Panchnama
  • Post-mortem report

Permanent Total/Partial Disablement :-

  • Duly filled up claims form
  • Original FIR
  • Panchnama
  • Hospitalization Report
  • Hospital discharge card
  • Original Certificate from Doctor of Govt. Hospital stating the degree of disability
  • Termination letter for a claim under “Loss of Employment”

In Case of Temporary Total Disablement Claim: :-

  • Duly filled up claims form
  • Original FIR
  • Panchnama
  • Hospitalization Report
  • Hospital discharge card
  • Original Certificate from Doctor of Govt. Hospital stating the degree of disability