Industry Trends

Eligibility & Process for Purchasing a Group Health Insurance

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Post the covid-19 pandemic; the IRDAI has made it mandatory for all industrial and commercial establishments to provide comprehensive group health insurance eligibility cover to their respective workforces. 

Previously, group health insurance was only available to employees of certain companies and governments. Group health insurance is now available to every institution in India that meets eligibility criteria. In this blog article, we will discuss who is eligible for group health insurance in India based on the provisions of the IRDAI. So if you’re looking to get health insurance coverage, read on!

Who is eligible for group health insurance in India 

If you’re a salaried worker of a state or central government agency or under the direct supervision of a minister (IAS, IPS, IFS), you’re eligible to receive group health insurance through the GHIS. Additionally, the employee’s spouse, unmarried child below the age of 18, parents aged 60 or above, grandparents aged 60 or above, and siblings are also covered. 

Non-residents of India can be covered if they’re legally resident in an EU/EEA country and have been residing there for a continuous period of three months or more or if they’re working as employees on assignment from an industrial organisation registered in an EU/EEA country. 

Indian citizens/individuals who are residents of India and have been working in an Indian organisation for a minimum of six months are eligible for group health insurance. 

By default, any working group in India with a workforce of 20 members can select a group health insurance cover. Let us understand this further. 

What is the definition of a group?

When it comes to health insurance, group coverage is usually mandatory in countries with social welfare systems. It provides the individual members of the group with protection from medical expenses and reduces their risk by pooling resources. The definition of a group can vary considerably from company to company and even country to country- so it’s important for you as an individual policyholder to be aware of this before making a purchase or comparing policies. A group policy is also known as employee benefits, corporate wellness, group life insurance,or self-employed health insurance. 

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The IRDAI states that the following entities come under the umbrella of a group:

  • employer-employee group
  • non-employer-employee group
  • Trusts and associations
  • Registered groups with a common interest
  • Registered clubs and societies
  • Cultural and social associations

The minimum number of employees 

The minimum number of employees requirements vary from state to state, but the general rule is that your company needs to have 20 employees to avail of group health insurance. The minimum age requirement ranges from 18 years old in some states to 60 years in others. Also, many new-age insurtech startups provide medical benefits subscriptions for teams as small as two members. 

The group health insurance eligibility criterion for insurance cover usually depends on the company’s size and type of business. However, there are specific exceptions where certain small businesses can offer health coverage even if they have less than ten employees. 

And lastly, note that family members of an employee who is covered under your employer-sponsored plan are also included in the coverage. 

Group health insurance eligibility – who is not covered?

Students 

Students are only allowed to use individual health insurance while they are students. If they don’t have any other form of coverage, they can still get group health insurance through their parents or guardians. 

Students are not eligible for group health insurance because they are not considered full-time employees under IRDAI rules and regulations – this means that employers cannot offer group health insurance as a benefit to students. In a few exceptional cases, working interns who are still pursuing their college degrees might be included under an employee-only category plan. 

Self-employed persons 

If you are self-employed and looking for medical cover, make sure to research your eligibility first. Group health insurance is not available to self-employed persons because there are no employees to cover. 

Group health insurance can only be a good option if you have employees because it will cover their medical costs too. If any of these facts are applicable to you as a sole proprietor, visit the insurer’s website for more information on what policies might best suit your needs.

Family business – HUF

In a family business, if the spouse of the head of the HUF is not an employee, they will not be entitled to group cover. Only members and non-members of the family business who are employees and their spouses/children will be covered under group insurance. 

Eligible and handicapped dependents 

Dependent children above the age of 25 years are not covered under group mediclaim insurance. If you are the parent of a child who has a disability, you may be eligible for group health insurance through your employer. In order to qualify, your children must meet specific eligibility requirements and reside with you full-time. 

How does one get group health insurance in India? 

Group medical insurance is a way to cover healthcare expenses in the event of an accident or health emergency. The process of getting GMC insurance is slightly different for each organisation, but the eligibility requirements are relatively straightforward. If your organisation meets the criteria, the next step is to apply online from a reputed broker/aggregator. Ensure you have all the required documents – like a company registration certificate – PAN/TAN, Company GST number, and employee details. 

Once you’ve applied online and are accepted, you’re good to go! The policy is generally activated instantly and emailed within 15 minutes. Group medical insurance is a good way to save money on healthcare costs and can be a life-saving insurance policy for the workers who need it the most. 

Compare various online plans 

There are multiple ways to get group health insurance online. You can directly check the policy features, premium quotes, type of cover, rider options and much more from the best insurers in India. If you are sole proprietor or own your business, you can usually obtain coverage through a health insurance company.  

In some cases, buying individual health insurance policies for yourself and your family members from the same insurer may also be possible. If you are a salaried employee, your organisation usually offers health benefits as part of the employment package.  

It’s essential to check with your company’s HR before making any decisions on this matter – not all companies provide group health insurance uniformly across their workforce. 

Go for a purely digital experience

Online group insurance offers superior onboarding and a seamless purchase experience with minimum documentation. If you are in the place for a digital insurance policy, it is essential to keep a few things in mind. First, ensure that you are suited to using technology and have an internet connection. Next, be familiar with the terms and conditions of the policy before buying it so that there are no surprises down the line. Once you’ve determined these key factors, it’s time to explore different providers to find the right one for your needs. By doing this carefully and systematically, you will end up with a policy that meets your company’s requirements.

Frequently Asked Questions

Can I join a pre-existing condition pool if I have coverage through my employer? 

No, you cannot join a pre-existing condition pool if you have coverage through your employer. Pre-existing condition pools are available only for people who have health insurance through their job. If you do not currently have coverage, you will likely need to purchase a policy on your own. 

How do I cancel my group coverage if I no longer need it? 

Generally, group health insurance plans allow you to cancel your coverage only if it is due to military service or an emergency. Cancellation deadlines vary based on your insurance type, but usually, it is within a specific time frame. By default, if you move to another employer, the previous GMC insurance will no longer be applicable. 

Conclusion

Group policy is essential health insurance coverage for people working in the public sector or small/medium or large businesses. Individuals eligible for group health insurance in India are government employees or a company with 20 or more employees.

Once you have group health insurance, you will be able to receive coverage for medical expenses incurred while on the job, including family health insurance coverage. Remember that group health insurance is not the same as individual health insurance, so make sure to read the fine print before enrolling.

Hi everyone! I'm a growth marketer at Plum Insurance. I specialise in crafting functional and structural articles for search engine optimisation. I joined the insurtech space in 2018 and have been writing ever since. Also, I'm fluent in intermediate Python 🐍 as well.