Group Health Insurance

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

What is Group Medical Cover (GMC)?

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.

Single Policy Coverage

One policy designed to cover the entire employee group under a unified plan, making it cost-effective.

Easy Employee Enrolment

Minimal documentation and generally no pre-policy medical screening for employees.

Coverage for Pre-Existing Diseases

Immediate coverage for pre-existing conditions with no waiting period in most plans.

Family Inclusion Options

Employers can extend coverage to spouses, children, and parents.

Comprehensive Medical Coverage

Covers pre- and post-hospitalisation expenses, daycare procedures, and related medical treatments.

Cashless Hospital Network

Employees can avail of cashless treatment at network hospitals without upfront payments.

Flexible Sum Insured Options

Businesses can customise coverage and sum insured based on workforce requirements.

Maternity & Wellness Benefits

Plans may include maternity cover, preventive health check-ups, OPD, and wellness support programmes as optional riders.

ADVANTAGES

Benefits of Group Health Insurance for Employees

Affordable Health Coverage

Employees receive health insurance coverage at no or minimal cost.

Immediate Policy Benefits

Most group health insurance plans offer instant coverage without long waiting periods.*

Coverage for Pre-Existing Diseases

Pre-existing illnesses are generally covered from day one under many GMC policies.*

ADVANTAGES

Benefits of Group Health Insurance for Employers

Cost-Effective Employee Benefit

A practical and affordable way to offer healthcare benefits to employees.

Tax Benefits

Employers may avail tax benefits on premiums paid towards group health insurance.

Improved Employee Retention

Strengthens employee satisfaction and helps reduce attrition rates.

Influences Hiring Decisions

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.

Impacts Productivity

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.

Tax Benefits for Employers

Premiums paid by employers towards group health insurance are generally eligible for tax benefits under applicable provisions of the Income Tax Act.

Regulatory & Workplace Compliance

Certain sectors, contracts, or policies may require employers to provide healthcare benefits, including provisions linked to the Social Security Code, 2020.

Rising Medical Costs

With healthcare and hospitalisation expenses rising in India, group mediclaim policies help employees manage unexpected medical costs while reducing financial stress.

Retention & Satisfaction

Comprehensive healthcare benefits improve employee well-being and job satisfaction, helping businesses reduce attrition in competitive hiring markets.

What is Covered Under Group Health Insurance

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.

What is Not Covered Under Group Health Insurance

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

Group Health Insurance Add-Ons

Maternity Coverage

Covers pregnancy-related medical expenses, including childbirth and hospitalisation, up to specified policy limits.

Waiver of Maternity Waiting Period

Option to reduce or waive the standard waiting period applicable to maternity benefits.

Newborn Baby Coverage

Covers newborn babies under the maternity sum insured for specified medical expenses.

OPD Coverage

Covers outpatient expenses such as doctor consultations, pharmacy bills, and diagnostic tests without hospitalisation.

Corporate Buffer Cover

Provides additional coverage once the employee's base sum insured is exhausted, subject to policy terms.

Parental Coverage

Option to extend health insurance benefits to employees' parents and parents-in-law.

ELIGIBILITY

Eligibility Criteria to Buy Group Health Insurance

Registered Companies

Private limited companies, public limited companies, LLPs, and MNCs can purchase GMC policies for employees.

Startups & SMEs

Small and medium-sized businesses can avail group health insurance based on minimum employee requirements set by the insurer.

Corporate Organisations

Large enterprises can customise group health plans for employees and dependents.

Partnership Firms & Proprietorships

Eligible business entities can buy group mediclaim policies for their workforce.

Educational Institutions

Schools, colleges, and universities can provide health coverage to staff members.

Associations & Societies

Registered associations, clubs, and societies may purchase group health insurance for members.

Minimum Member Requirement

Most insurers require a minimum number of members or employees to issue a group health policy.

Valid Business Documentation

Organisations must provide a GST certificate, company registration proof, PAN, and employee/member data during policy issuance.

Employee-Employer Relationship

Insurers generally require a valid employer-employee relationship for corporate group health insurance policies.

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

Group Health Insurance

CORPORATE COVER

Coverage TypeCovers a group under one policy

Premium CostLower, shared across the group

Pre-existing DiseasesCovered from day one (in most cases)

Waiting PeriodMinimal or none

CustomisationLimited flexibility

ContinuityEnds if you leave the group

Add-ons & RidersLimited options

Claim ProcessEasier with employer support

Individual Health Insurance

PERSONAL COVER

Coverage TypeCovers a single individual or family

Premium CostHigher, based on individual risk

Pre-existing DiseasesCovered after waiting period

Waiting PeriodStandard waiting periods apply

CustomisationHighly customisable plans

ContinuityContinues as long as the premium is paid

Add-ons & RidersWide range of add-ons available

Claim ProcessHandled individually by the policyholder

CLAIMS

Cashless Claim Process

Visit a Network Hospital

Get admitted to a network hospital and present your health card and valid ID proof.

Submit Pre-Authorisation Request

For planned hospitalisation, submit the pre-authorisation form at least 48 hours before admission.

Claim Approval

The hospital forwards the request to the insurer or TPA for review and approval.

Receive Cashless Treatment

Once approved, treatment is provided without upfront payment for covered medical expenses.

Final Settlement

The insurer settles eligible expenses directly with the hospital, while non-covered costs are borne by the insured.

CLAIMS

Reimbursement Claim Process

Inform the Insurer or TPA

Notify the insurer, TPA, or relationship manager within the specified timeline after hospitalisation.

Pay Bills and Collect Documents

Settle hospital expenses and collect all original bills, reports, prescriptions, and discharge documents.

Submit Claim Documents

Submit the completed claim form along with all required supporting medical documents.

Claim Verification

The insurer reviews the submitted documents and verifies treatment details and policy coverage.

Claim Settlement

Once approved, the eligible claim amount is reimbursed to the insured's registered bank account.

CLAIM DOCUMENTS

Documents Required for GMC Claims

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.

Multiple IRDAI-Approved Insurers

Get customised Group Medical Cover options from multiple trusted, IRDAI-approved insurance partners under one platform.

Tailored Coverage for Businesses

Choose coverage based on your company size, employee needs, industry risks, and budget requirements.

End-to-End Claims Support

Dedicated assistance for cashless hospitalisation, claim documentation, employee queries, and claim tracking.

Customisable Policy Benefits

Enhance your GMC policy with add-ons like maternity cover, parental coverage, OPD benefits, and wellness programmes.

Dedicated Relationship Management

Get expert guidance and ongoing support for policy renewals, onboarding, endorsements, and employee servicing.

Simplified Policy Management

Manage employee additions, deletions, policy updates, and documentation with a streamlined process.

Can a startup buy Group Health Insurance for a small team?

Yes, many insurers offer Group Health Insurance plans for startups and SMEs with a small employee base, depending on eligibility criteria.

Does Group Health Insurance cover employees working remotely?

Yes, employees working remotely or from different cities can generally be covered under the same Group Mediclaim policy.

Can employees increase their sum insured under a GMC policy?

Some employers allow employees to opt for higher coverage through voluntary top-up plans or additional premium contributions.

Is a medical check-up required for Group Health Insurance?

In most cases, Group Health Insurance policies do not require pre-policy medical tests, especially for standard employee groups.

Can interns or contractual employees be covered under GMC?

Yes, depending on company policy and insurer approval, interns, consultants, and contractual staff may also be included.

Does Group Health Insurance provide tax benefits to employers?

Yes, premiums paid by employers towards employee health insurance are generally treated as business expenses under applicable tax laws.

What happens to the policy during employee resignation or termination?

Coverage usually remains active only until the employee's last working day or as per the employer's policy terms.

Can an employee use Group Health Insurance immediately after joining?

Many Group Mediclaim policies provide coverage from Day 1 of employment, subject to company policy.

Are wellness programmes included in Group Health Insurance?

Some insurers offer wellness benefits such as health check-ups, teleconsultation, mental wellness support, and fitness programmes.

Can multiple claims be made in one policy year?

Yes, employees can make multiple claims during the policy period until the sum insured limit is exhausted.

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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.

Group Health Insurance

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What is Group Medical Cover (GMC)?

Key Features of Group Health Insurance

Single Policy Coverage

Easy Employee Enrolment

Coverage for Pre-Existing Diseases

Family Inclusion Options

Comprehensive Medical Coverage

Cashless Hospital Network

Flexible Sum Insured Options

Maternity & Wellness Benefits

Benefits of Group Health Insurance for Employees

Affordable Health Coverage

Immediate Policy Benefits

Coverage for Pre-Existing Diseases

Hassle-Free Enrolment

Financial Protection

Comprehensive Medical Coverage

Maternity & Newborn Benefits

Cashless Hospitalisation

Benefits of Group Health Insurance for Employers

Cost-Effective Employee Benefit

Tax Benefits

Improved Employee Retention

Enhanced Workforce Productivity

Simplified Policy Management

Customisable Coverage Options

Why Should You Buy a Group Health Insurance Policy?

Influences Hiring Decisions

Impacts Productivity

Tax Benefits for Employers

Regulatory & Workplace Compliance

Rising Medical Costs

Retention & Satisfaction

What is Covered & Not Covered Under Group Health Insurance

What is Covered Under Group Health Insurance

What is Not Covered Under Group Health Insurance

Group Health Insurance Add-Ons

Maternity Coverage

Waiver of Maternity Waiting Period

Newborn Baby Coverage

OPD Coverage

Corporate Buffer Cover

Parental Coverage

Eligibility Criteria to Buy Group Health Insurance

Registered Companies

Startups & SMEs

Corporate Organisations

Partnership Firms & Proprietorships

Educational Institutions

Associations & Societies

Minimum Member Requirement

Valid Business Documentation

Employee-Employer Relationship

Group Health Insurance vs Individual Health Insurance

Cashless Claim Process

Visit a Network Hospital

Submit Pre-Authorisation Request

Claim Approval

Receive Cashless Treatment

Final Settlement

Reimbursement Claim Process

Inform the Insurer or TPA

Pay Bills and Collect Documents

Submit Claim Documents

Claim Verification

Claim Settlement

Documents Required for GMC Claims

Why Choose Coverfox for Group Mediclaim (GMC)?

Multiple IRDAI-Approved Insurers

Tailored Coverage for Businesses

End-to-End Claims Support

Customisable Policy Benefits

Dedicated Relationship Management

Simplified Policy Management

FAQs on Group Health Insurance

Get Group Health Coverage Today!