Who is Eligible for Group Health Insurance?
A group health insurance policy offers health-related financial coverage to a group of people for any medical emergency or necessity under a single policy. It is a highly valuable tool that can protect you from miserable financial instability or liability.
Apart from financial compensation, a group health policy offers multiple benefits, such as cashless hospitalisation, quality healthcare, financial protection and, most importantly, peace of mind. However, there are a few entry-level barriers to purchasing group health insurance policies.
In this blog, we will discuss the definition of a group, eligibility criteria and who can and cannot buy this GHI policy.
Definition of “Group” in Group Health Insurance
A group refers to a collection of people. With reference to a GHI policy, a group signifies a department of employees from a company or members of an organisation. Mostly, a GHI policy is suitable for employees working in a company. IRDAI, however, has determined two types of groups: an employer-employee group and a non-employer-employee group.
Group health insurance offers financial cushioning to multiple individuals who fall under the abovementioned “group” categories under one policy. The coverage, inclusions, sum assured, and add-ons are decided by the manager or employer of the concerned group.
To get the best and most affordable coverage, employers use smart techniques. For example, a group health insurance premium is calculated using online tools, making it easy to compare policies and providers. Companies that offer more benefits at lower premiums are considered better than the others, which makes companies like TATA AIG an excellent choice.
Let us now understand the eligibility criteria for purchasing a group health insurance policy.
Group Health Insurance Eligibility Criteria
● Group
The first criterion is that it must be a group defined by the IRDAI. The individuals who are the subjects of policy must work or exist under one group. It might be an organisation, company, cultural association, social group, same credit card holder group, etc.
● Number of Members
In order to purchase a GHI policy, your company should have at least 20 interested, full-time employees. According to IRDAI, the requirement for the minimum number of members in the concerned group is 20. However, if the startup or small enterprise has fewer employees, they can invest in micro insurance policies for financial protection.
● Purchase Intent
The intention of buying the policy should be strictly limited to the medical and financial protection of the concerned group. The organisation, association or company must submit documents to prove that it is a legitimate group and not a formation built to enjoy low-cost insurance perks.
In short, group health insurance for small businesses, medium enterprises, cultural associations, growing companies, established organisations, clubs, community groups, contractual workers and such entities is a good choice. Let us understand what entities cannot buy a GHI policy for themselves.
Entities That Cannot Buy Group Health Insurance Policy
- Sole business-owners
- Businesses where family members are the only staff and employees.
- Family businesses
- Hindu Undivided Family
- Students
- Eligible and handicapped dependents.
Group Health Insurance Policy Coverage and Inclusions
Group health insurance for small businesses offers sufficient coverage for SMEs and growing companies. One of the biggest benefits of a GHI policy is that it extends financial compensation for the insured member’s family members as well. The most common inclusions of a good group health insurance policy are given below.
- In-patient treatment coverage, which refers to the financial compensation for the insured group who is admitted or hospitalised. The expenses are compensation for the healthcare facility you consume as an in-patient.
- Pre and post-hospitalisation expenses, such as checkup visits, medical consultations, post-recovery consultations, physician visits and medications, are covered.
- Ambulance costs (if any).
- The GHI policy covers organ transplant surgery expenses. Expenses usually include the cost of getting the organ from the donor.
- Family transportation costs.
- Maternity costs coverage for the insured employees and their spouses.
It is important to read the policy documents in order to stay updated with the exclusions. You will not be compensated for the events and emergencies that are excluded in the policy.
Ending Note
A group health insurance policy is a practical and often cost-effective way for employers and companies to provide healthcare, financial stability and medical benefits.
The GHI policy ensures that your employees are motivated, protected, and in the best of health. Understanding the eligibility criteria will save time and help you navigate the purchasing process with ease.
