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Health insurance for your company employees in one place, covering pre- and post- hospitalisation expenses, pre-existing diseases, critical illnesses, and more.
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PRODUCT OVERVIEW
Group Medical Cover (GMC), also known as Group Health Insurance or Corporate Health Insurance, is an employer-sponsored health cover designed to provide medical protection to employees under a single policy. Businesses can also extend coverage to employees' spouses, children, and parents based on the selected plan structure.
These policies typically offer immediate coverage for pre-existing diseases with no waiting period, along with benefits such as hospitalisation cover, maternity benefits, daycare procedures, and wellness support. Group health insurance helps organisations strengthen employee benefits while ensuring financial protection against rising healthcare costs.
HIGHLIGHTS
One policy designed to cover the entire employee group under a unified plan, making it cost-effective.
Minimal documentation and generally no pre-policy medical screening for employees.
Immediate coverage for pre-existing conditions with no waiting period in most plans.
Employers can extend coverage to spouses, children, and parents.
Covers pre- and post-hospitalisation expenses, daycare procedures, and related medical treatments.
Employees can avail of cashless treatment at network hospitals without upfront payments.
Businesses can customise coverage and sum insured based on workforce requirements.
Plans may include maternity cover, preventive health check-ups, OPD, and wellness support programmes as optional riders.
ADVANTAGES
Employees receive health insurance coverage at no or minimal cost.
Most group health insurance plans offer instant coverage without long waiting periods.*
Pre-existing illnesses are generally covered from day one under many GMC policies.*
ADVANTAGES
A practical and affordable way to offer healthcare benefits to employees.
Employers may avail tax benefits on premiums paid towards group health insurance.
Strengthens employee satisfaction and helps reduce attrition rates.
WHY GMC
According to the Society for Human Resource Management (SHRM), nearly 60% of employees consider health insurance an important factor while evaluating a job offer, strengthening your employee value proposition.
As per the World Health Organisation (WHO), poor employee health and untreated conditions reduce workplace productivity. Timely healthcare support maintains workforce efficiency and reduces absenteeism.
Premiums paid by employers towards group health insurance are generally eligible for tax benefits under applicable provisions of the Income Tax Act.
Certain sectors, contracts, or policies may require employers to provide healthcare benefits, including provisions linked to the Social Security Code, 2020.
With healthcare and hospitalisation expenses rising in India, group mediclaim policies help employees manage unexpected medical costs while reducing financial stress.
Comprehensive healthcare benefits improve employee well-being and job satisfaction, helping businesses reduce attrition in competitive hiring markets.
INCLUSIONS & EXCLUSIONS
Pre-Existing Diseases
Coverage for pre-existing illnesses is often available from day one or after a minimal waiting period.
In-Patient Hospitalisation
Covers hospitalisation expenses, including room rent, ICU charges, doctor's fees, and nursing expenses.
Pre & Post-Hospitalisation
Covers medical expenses incurred before admission and after discharge, including diagnostics and follow-up treatments.
Daycare Procedures
Covers treatments and surgeries that do not require 24-hour hospitalisation, such as cataract surgery, chemotherapy, and dialysis.
Ambulance Charges
Emergency ambulance expenses are covered up to policy limits.
Cashless Treatment
Access to cashless treatment facilities at network hospitals across India.
Wide Range of Medical Treatments
Covers various illnesses, surgeries, and medical conditions as specified in the policy.
Cosmetic or Aesthetic Treatments
Generally excluded unless medically necessary due to an accident or reconstructive treatment.
Routine Dental & Vision Care
Regular dental and optical treatments are usually not covered unless specifically included in the policy.
War & Nuclear Risks
Injuries or illnesses arising due to war, nuclear events, or related risks are excluded.
Substance or Alcohol Abuse
Conditions arising from alcohol, drug, or substance abuse are generally not covered.
Non-Medical Expenses
Personal comfort items, transportation, or non-medical consumables during hospitalisation are excluded.
Experimental Treatments
Unproven or experimental medical treatments and procedures are not covered.
Illegal or Criminal Activities
Injuries or illnesses resulting from unlawful acts are excluded from coverage.
Note: Coverage, inclusions, exclusions, waiting periods, and benefits may vary depending on the insurer, policy type, and add-ons. Please refer to the policy wording for detailed terms, conditions, and coverage scope.
ADD-ONS
Covers pregnancy-related medical expenses, including childbirth and hospitalisation, up to specified policy limits.
Option to reduce or waive the standard waiting period applicable to maternity benefits.
Covers newborn babies under the maternity sum insured for specified medical expenses.
Covers outpatient expenses such as doctor consultations, pharmacy bills, and diagnostic tests without hospitalisation.
Provides additional coverage once the employee's base sum insured is exhausted, subject to policy terms.
Option to extend health insurance benefits to employees' parents and parents-in-law.
ELIGIBILITY
Private limited companies, public limited companies, LLPs, and MNCs can purchase GMC policies for employees.
Small and medium-sized businesses can avail group health insurance based on minimum employee requirements set by the insurer.
Large enterprises can customise group health plans for employees and dependents.
Eligible business entities can buy group mediclaim policies for their workforce.
Schools, colleges, and universities can provide health coverage to staff members.
Registered associations, clubs, and societies may purchase group health insurance for members.
Most insurers require a minimum number of members or employees to issue a group health policy.
Organisations must provide a GST certificate, company registration proof, PAN, and employee/member data during policy issuance.
Insurers generally require a valid employer-employee relationship for corporate group health insurance policies.
DIFFERENTIATION
| Basis | Group Health InsuranceCORPORATE COVER | Individual Health InsurancePERSONAL COVER |
|---|---|---|
| Coverage Type | Covers a group under one policy | Covers a single individual or family |
| Premium Cost | Lower, shared across the group | Higher, based on individual risk |
| Pre-existing Diseases | Covered from day one (in most cases) | Covered after waiting period |
| Waiting Period | Minimal or none | Standard waiting periods apply |
| Customisation | Limited flexibility | Highly customisable plans |
| Continuity | Ends if you leave the group | Continues as long as the premium is paid |
| Add-ons & Riders | Limited options | Wide range of add-ons available |
| Claim Process | Easier with employer support | Handled individually by the policyholder |
CLAIMS
Get admitted to a network hospital and present your health card and valid ID proof.
For planned hospitalisation, submit the pre-authorisation form at least 48 hours before admission.
The hospital forwards the request to the insurer or TPA for review and approval.
Once approved, treatment is provided without upfront payment for covered medical expenses.
The insurer settles eligible expenses directly with the hospital, while non-covered costs are borne by the insured.
CLAIMS
Notify the insurer, TPA, or relationship manager within the specified timeline after hospitalisation.
Settle hospital expenses and collect all original bills, reports, prescriptions, and discharge documents.
Submit the completed claim form along with all required supporting medical documents.
The insurer reviews the submitted documents and verifies treatment details and policy coverage.
Once approved, the eligible claim amount is reimbursed to the insured's registered bank account.
CLAIM DOCUMENTS
Keep the following documents ready when filing a Group Medical Cover claim. Required documents may vary depending on the insurer, TPA, and policy terms.
Duly Filled Claim Form
The claim form completed and signed by the insured member or employer.
Hospital Discharge Card
Issued by the hospital at the time of discharge.
Doctor's Prescription Papers
Prescriptions and advice notes issued by the treating doctor.
Original Hospital Bills
Itemised original bills and payment receipts from the hospital.
Diagnostic Reports
Test reports, scans, and investigation results related to the treatment.
Pharmacy Bills with Prescriptions
Medicine bills supported by the corresponding prescriptions.
Copy of Health Card
A copy of the group health insurance / e-card of the insured member.
Valid Photo ID / KYC Document
Government-issued photo identity / KYC proof of the insured member.
Cancelled Cheque or Bank Details
For reimbursement of the eligible claim amount to the registered account.
Implant Invoices / Stickers
Invoices and stickers for any implants used during the procedure.
FIR / MLC Documents
Required in case of accident or medico-legal cases, where applicable.
COVERFOX EDGE
Get customised Group Medical Cover options from multiple trusted, IRDAI-approved insurance partners under one platform.
Choose coverage based on your company size, employee needs, industry risks, and budget requirements.
Dedicated assistance for cashless hospitalisation, claim documentation, employee queries, and claim tracking.
Enhance your GMC policy with add-ons like maternity cover, parental coverage, OPD benefits, and wellness programmes.
Get expert guidance and ongoing support for policy renewals, onboarding, endorsements, and employee servicing.
Manage employee additions, deletions, policy updates, and documentation with a streamlined process.
Yes, many insurers offer Group Health Insurance plans for startups and SMEs with a small employee base, depending on eligibility criteria.
Yes, employees working remotely or from different cities can generally be covered under the same Group Mediclaim policy.
Some employers allow employees to opt for higher coverage through voluntary top-up plans or additional premium contributions.
In most cases, Group Health Insurance policies do not require pre-policy medical tests, especially for standard employee groups.
Yes, depending on company policy and insurer approval, interns, consultants, and contractual staff may also be included.
Yes, premiums paid by employers towards employee health insurance are generally treated as business expenses under applicable tax laws.
Coverage usually remains active only until the employee's last working day or as per the employer's policy terms.
Many Group Mediclaim policies provide coverage from Day 1 of employment, subject to company policy.
Some insurers offer wellness benefits such as health check-ups, teleconsultation, mental wellness support, and fitness programmes.
Yes, employees can make multiple claims during the policy period until the sum insured limit is exhausted.
Disclaimer
Group Health Insurance coverage, inclusions, exclusions, waiting periods, add-ons, premiums, and claim settlement terms may vary depending on the insurer and policy selected. Coverage is subject to underwriting guidelines, policy terms, and conditions laid down by the respective insurance company. Please read the policy wording carefully before purchasing the policy. *Coverage terms, waiting periods, and benefits may vary depending on the insurer and policy terms.
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