Group Health Insurance

Group health insurance, also called corporate health insurance, extends coverage to the employees of an organization.

What is Group Health Insurance?

Group Health Insurance, also known as Corporate Health Insurance, is a health policy that provides coverage to a specific group of individuals, usually employees of an organization. The policy can be extended to include the employee’s family members, such as a spouse, dependent children, and sometimes dependent parents.

This type of insurance offers financial protection during medical emergencies and acts as a valuable employee benefit, enhancing job satisfaction and retention for employers.

IRDAI's Definition of a "Group" in Group Health Insurance

According to the Insurance Regulatory and Development Authority of India (IRDAI), a "group" is defined as:

A collection of individuals who have come together for a common economic purpose, not solely for obtaining insurance.

Recognized groups under IRDAI include:

Employer–employee groups
Non-employer–employee associations
Registered trusts, societies, and clubs
Social or cultural groups with shared interests
Professional or trade associations

Why is Group Health Insurance Required?

In today’s competitive environment, retaining talented employees requires more than just salary. Offering Group Health Insurance:

Improves employee loyalty and morale
Enhances your company’s reputation as a caring employer
Reduces absenteeism through better health access
Offers tax benefits for the organization
Demonstrates a commitment to employee well-being

It's a cost-effective strategy for boosting productivity and team satisfaction—especially critical for small and mid-sized businesses.

Who Should Opt for Group Health Insurance?

Startups & Small Businesses (5+ employees)

Affordable and attractive benefit that helps compete with larger employers.

Established Organizations

Strengthens HR policies and enhances professional work culture.

Associations, Unions & Trusts

Ideal for members who don’t have access to employer-backed health coverage.

People Seeking Affordable, Inclusive Coverage

Group plans offer:

Lower premiums
Coverage for pre-existing conditions
No individual health screening required

Key Advantages of Group Health Plans

Lower premiums than individual policies
Covers pre-existing conditions without extra costs
Option to include family members
Cashless hospitalization at network hospitals
Tax deductions under Section 80D (for the employer)

Benefits of Group Health Insurance for Employees

Affordable Premiums

Group health plans are significantly cheaper than individual or family plans because the risk and cost are shared among all employees.

Boosts Employee Morale

A well-structured health insurance plan makes employees feel valued—leading to higher job satisfaction, better engagement, and improved productivity.

Family Coverage Under One Plan

Employees can cover their spouse, dependent children, and sometimes parents. The plan typically includes maternity care, daycare treatments, and prescribed medications.

Quick & Hassle-Free Claim Process

Unlike individual policies that require extensive paperwork and upfront payments, group insurance often allows cashless claims or simple bill reimbursement with minimal documentation.

Comprehensive Medical Benefits

Includes:

Maternity benefits
OPD (Outpatient Department) consultations
Preventive care and wellness checkups
Coverage for pre-existing conditions from Day 1 (no waiting period)

Creates a Healthier, Happier Workforce

Supporting employee health builds a more resilient and motivated team—reducing absenteeism and promoting a positive work environment.

Helps Attract & Retain Talent

In today’s competitive job market, employees consider health benefits as important as salary and work culture. Offering group insurance gives companies a hiring edge.

Enhances Employer Brand & Reputation

Corporate health benefits improve internal satisfaction and external image—building goodwill and a reputation as a caring employer.

Key Features of Group Health Insurance

Group Health Insurance policies are designed to provide comprehensive medical coverage to a defined group—typically employees of an organization. These plans are more inclusive and cost-effective compared to individual policies and come with added benefits for both employees and their families.

Insurance covers employees, spouses, kids, parents and parents-in-law for a fee or free, depending on the chosen plan.
Pre-hospitalization and post-hospitalization expenses including medical tests, physiotherapy etc. Pre-hospitalization expenses are usually covered for 30 days and post-hospitalization for 60 days, but it can vary.
No waiting period for group health insurance, including pre-existing illnesses and specific diseases.
Under group health insurance, there is no waiting period for pre-existing conditions, allowing for instant claims.
No pre-medical check-up is needed for group health plans.
Group health insurance includes maternity coverage at an extra cost. It covers delivery expenses and some insurers offer newborn coverage too.
Group health insurance companies have tie-ups with hospitals for cashless claims. No lengthy paperwork or payment at the time of hospitalization. You just have to show your health card for settlement.
Group health plans offer extra benefits such as teleconsultation, pharmacy, discounts and diagnostic discounts.

How is a Group Health Insurance Plan Different from Individual Health Insurance?

Feature	Individual Insurance	Group Insurance
Coverage	Covers only the policyholder	Covers a group of people
Purchased by	Policyholder themself	Employer or main family member
Insured	Policyholder only	Policyholder and chosen members
Control	Full control for the policyholder	Limited control for the policyholder
Eligibility	Must be 18 or older	Must be part of a group
Add-ons	Can choose from available add-ons	Limited options
Claims Process	Filed directly with the insurance company	Usually filed through a third party
Medical Checkup	May be required for older applicants	Not required
Sum Insured	Typically higher	Typically lower
Coverage Ends	At age 65 (may vary)	When leaving the employer
Tax Benefits	Tax benefits available	No tax benefits
Critical Illness Coverage	Coverage available as an add-on	No coverage unless chosen as an add-on

Frequently asked questions

Q: Who is eligible for group health insurance?

A: Eligibility coverage typically relies on the employer or association’s plan. Usually, employees meeting the required weekly hours are eligible, alongside dependents like spouses and children.

Q: What if I have a pre-existing condition?

A: Group health insurance is usually unable to deny coverage due to pre-existing conditions, which is a great advantage compared to individual health plans. It is important to note that there might be waiting periods for coverage of certain conditions, so it is essential to carefully go through the plan details to understand all the specifics.

Q: Can I customize my group health insurance coverage?

A: Employers can provide different plan options with varying coverage and costs, allowing you to select the most suitable plan based on your preferences and financial situation. It is important to note that the extent of customization offered is usually determined by the employer’s plan design.

Q: How can I file a claim with my group health insurance plan?

A: The steps for filing a claim can differ from one insurance company to another. Normally, you will be required to fill out a claim form and provide documentation of your medical costs. Your employer or the insurance company should be able to offer detailed guidance on the claim filing process.

Q: What happens to my group health insurance if I leave my job in India?

A: After your employment with the company ends, the group health insurance coverage provided by your employer also comes to an end. This is because the employer pays the premiums for his coverage and once you stop working there, the policy no longer remains active.

Q: What happens if I become disabled and can't work?

A: Some group health insurance plans include disability insurance benefits to provide financial support in case you become unable to work because of a covered disability. These benefits aim to replace a portion of your income during your inability to work.

Q: What if I think my insurance company wrongly denied a claim?

A: You should review your plan documents or the insurance company’s website for specific information on how to proceed with appeals if your claim is denied. The steps for appealing a decision can vary depending on the insurance company, so it is important to follow the guidelines provided. Understanding your rights and the process for appealing a denied claim can help you navigate this situation effectively.

Q: Can My Child Stay on My Group Health Insurance Plan in India?

A: Yes, typically children can remain on their parent’s group health insurance plan until they reach a specific age, often until they are 25 years old. This is a significant advantage of employer-provided group health insurance. However, it is important to consider the specific age limit and any eligibility criteria for continuation of coverage -

Age Limit: In India, the typical age limit for dependent coverage on a parent’s group health insurance policy is 25 years old, allowing children to remain insured under their parent’s plan until they reach this age.
Policy Variations: It is crucial to carefully review the terms and conditions of your group health insurance policy. Certain plans may impose varying age limits for dependent coverage, ranging from 23 to 26 years old.
Marital Status: Some group health insurance plans might stop providing coverage for children once they are married. This is important to consider when evaluating the coverage offered by different plans.