Health Insurance is no longer just a personal responsibility; it's increasingly becoming an essential part of employee benefits offered by organisations. Among the various types of health plans available, the Group Mediclaim Policy stands out. But a common question many employers and employees ask is: who exactly can be covered under a Group Mediclaim Policy? Let us break down the answer in detail.
What is a Group Mediclaim Policy?
A Group Mediclaim Policy is designed to provide Medical Insurance to a defined group of people, usually employees of a company or members of an organisation. The key feature is that a Group Policy is not bought by individuals but by an employer, association, or any group administrator for the benefit of its members.
The sum insured, premium, and benefits are negotiated between the insurer and the group administrator based on the number of members, their average age, and risk profile.
Who can be covered?
The coverage under a Group Mediclaim Policy can extend to various categories of people, depending on how the plan is structured. Here are the most common inclusions:
Employees
Permanent, full-time employees and sometimes contractual workers and interns, depending on the policy. Employees are the primary beneficiaries under any Group Mediclaim Policy. Employers can opt to cover all employees uniformly or tailor coverage based on seniority, for instance, a higher sum insured for senior staff.
Spouse of the employee
Most policies allow employees to add their legally married spouse under the group Mediclaim Plan. This inclusion is standard and usually does not require additional medical checks.
Children
A Group Mediclaim Policy covers up to 2 or 3 dependent children per employee. Age limits vary by insurer, but coverage is generally available up to 25 years of age. Some policies offer paediatric coverage from day one of birth, while others start after 90 days.
Dependent parents
Many insurers offer the option to add parents or in-laws of the employee under the same group plan. This is a highly valued benefit for employees, especially in India, where living in a joint family is very common. However, higher premiums may apply due to the higher age of dependents. Pre-existing diseases may or may not be covered, depending on the negotiated terms.
Benefits of broad group coverage
- Employee satisfaction: Offering dependent cover helps in attracting and retaining talent.
- Tax benefits: Premiums paid by employers are eligible for tax deduction under business expenses.
- Simplified administration: One master Mediclaim Policy covers all, making it easy to manage.
- No medical tests: Most members and dependents are included without pre-policy medical checks.
Conclusion
A Group Mediclaim Insurance is more than just an employee benefit; it's a safety net for entire families. While the employee is always the primary insured, most policies offer the flexibility to cover spouses, children, parents, and even in-laws, depending on the company's structure and the insurer's terms. If you're an employer, offering comprehensive Group Health Coverage makes your organisation stand out in a competitive job market.
