GMC policy – know it all

GMC policy, commonly known as a group medical cover plan, is provided by your company at no cost to your salary. Yes, you got that right. It is entirely free of charge. When you work in an organisation, the company ensures that GMC insurance is a prerequisite. You can include your spouse, two children and parents as a supplementary benefit. Many policies even provide the option to cover parents-in-law. That’s a win-win situation for all employees and employers. 

By default, the covid19 pandemic has increased the cost of healthcare and access to suitable hospitalisation in India. Medical inflation is at an all-time high. A single few-day trip to a tier-1 hospital can cost INR 1-3 lakhs. Over the next five years, this will surmount to INR 4-5 lakhs. Therefore, the best way to protect your family and your lifelong savings is to be well-equipped with a GMC policy. 

In short, there is no harm in utilising free medical cover sponsored by your employer. It is your right. Just imagine the level of expenses you will be saving for yourself and your family with GMC insurance by your side. 

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GMC insurance – key features

  1. All employer-employee groups, trade unions, associations, companies, startups, SMEs, clubs, and banking institutions are eligible for a GMC policy. 
  2. Group insurance for employees is renewed on an annual basis. The company usually pays the correct premium amount on behalf of each worker. The minimum no of people (workmen) required is 2. 
  3. The sum insured, also known as cover for each employee, depends on the type of master policy subscribed by the company. It can range from INR 5 lakhs to 20/25 lakhs upwards. 
  4. The premium rate of the master policy depends on the nature, composition of the group, size, type, average age of the employees, the sum insured and rider options if selected. 
  5. All group plans come with cashless and reimbursement claims options.
  6. A claim by an individual employee does not impact the SI for other employees. 
  7. The premium paid is eligible for a tax deduction for both – employer and employee. 

Group insurance for employees – advantages

Here is the list of the common benefits of having a GMC policy.

  • It is corporate-sponsored free medical coverage at no cost to the CTC of the workforce.
  • It comes at a low and affordable cost to the organisation.
  • The company can opt for riders such as top-up, wellness sessions, dental treatment, OPD cover, discounted medicines, free health checkups, lab tests, and much more. 
  • Dependents can be included in an ESCP – employee, spouse, children and parents.
  • GMC policy motivates employees to stay in the company for extended periods. Reduces attrition and retains loyalty.
  • The premium paid can be labelled as a business expense. The corporate can claim a tax benefit on the same.
  • Employees get cover benefits from day 1. 

Group insurance policy for employees – disadvantages

Here is a list of the cons of having GMC insurance.

  • Sometimes, the coverage might not be sufficient for employees’ families. Thus, requiring an additional healthcare plan to be purchased.
  • There is no lifelong cover option.
  • If not covered under the group medical health insurance plan, most riders have to be individually purchased by the employee.
  • Lacks customization options. 
  • Employees will not be entitled to cover once they leave the affiliated company. 
  • GPA and GTL plans have to be purchased separately. 

GPA = Group personal accident insurance plan. An accident insurance coverage policy provides a death benefit to the family members if anything happens to an employee (loss of life) due to an accident or physical disablement. 

GTL = Group term life insurance plan. It is a protection policy for the entire group of employees. It gets activated during employment. 

What is covered in a GMC policy?

Here is a standard list of inclusions under GMC insurance. Inclusions refer to all such cases, incidents, instances, conditions, ailments, and more covered under your group insurance scheme. 

  • In-patient hospital bills and expenses for room rent, ICU charges, Doctor/Nurse/Surgeon/Anaesthesia fee. 
  • Cost of surgical operations, blood, medicines, oxygen requirement, etc.
  • Ambulance, air ambulance transportation, and emergency evacuation cover of up to a certain percentage of SI.
  • Day care procedures as per the standard list mentioned in the policy document.
  • Cost of organ donor treatment.
  • Pre and post-hospitalisation bills and expenses up to a specific time period. 
  • AYUSH cover, if applicable, and only if the treatment is conducted in a government-recognised hospital.
  • Home care/domiciliary treatment expenses, if applicable.
  • Special conditions only if mentioned in the master policy.
  • Many insurers have started to provide cover for hospitalisation arising from psychiatric illnesses. 
  • Lasik surgery, provided the eligibility criteria are met. 

What is non-covered in GMC policy?

Here is a typical list of exclusions under GMC insurance. As an employee, always ask your human resources manager to tell you about the policy details, terms and conditions right when you join the company. 

  • Diseases outside the scope of policy cover.
  • Critical illnesses and maternity cover are not covered by default in GMC insurance.
  • Medical treatment taken outside the country in a foreign country’s hospital. 
  • Mental disorders arising out of stress, attempts to life, suicide. 
  • Obesity and weight-related conditions.
  • Cosmetic treatments and augments.
  • Any form of pre-existing diseases and conditions are subject to a general and specific waiting period.
  • Injuries from participating in adventurous and extreme sports.
  • Any form of participation in military and defence-related activities.
  • Conditions related to sterility and fertility. 
  • Injuries due to engaging in unlawful activities.
  • Injury due to any form of substance and narcotics abuse. 
  • Congenital diseases and genetic disorders are permanently excluded. 
  • STDs, HIV, AIDS and venereal diseases. 

Note: The above set of inclusions and exclusions are standard. Different insurance groups and policymakers have their respective terms and conditions concerning the points mentioned above. So do not forget to read the policy document before buying a comprehensive group insurance plan.

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Author

Growth Marketing at Plum Insurance