- Employee-employer policy
- Who is eligible?
- Group health policy eligibility criteria
Group Health Insurance Eligibility Requirements in India
Medical expenses and healthcare costs are skyrocketing rapidly, and having health insurance coverage in this scenario, without paying an out-of-pocket premium is an exceptional perk. Employers providing group health insurance policies to their employees covering medical expenses such as pre-existing diseases, hospitalization expenses, daycare procedures, and more are preferred by the modern workforce.
But who is eligible for group health insurance plans? We have answered your query about group health insurance eligibility requirements, inclusions, exclusions, best group health insurance plans, benefits of having group health insurance, and so on. Read on to learn more about the group health insurance eligibility requirements in India.
Best Group Health Insurance Plans in India
| Group Health Plans | USPs |
|---|---|
| Niva Bupa Group Health Insurance | No pre-policy health check-ups required, Coverage for parents, Maternity coverage, Choice of outward portability into an individual policy |
| Star Group Health Insurance | Get covered with a sum insured of upto 1 Crore, Cataract surgery and modern treatment cover, Choice of adding members or removing them from the corporate policy |
| Care Health Group Health Insurance | PEDs are covered from day 1, More than 504 daycare procedures are covered, Critical illness hospitalization expenses are covered from day 1 |
| Aditya Birla Group Health Insurance | It covers ailments which are not covered under any individual health insurance such as PEDs, maternity care, dental care, etc, No need to go through a pre-acceptance medical check-up |
| Tata AIG Group Health Insurance | Medical cover for the employee and their family members, Coverage starting for pre-existing diseases from day 1, Maternity benefits are covered without any waiting period |
Key Takeaways
- A group health insurance provides basic and advanced healthcare facilitations to the employees
- The employee does not have to pay any monthly premiums, it’s covered by the employer itself
- A salaried employee between the ages of 18 to 60 years can get health benefits under a group health policy
- Solopreneurs, family businesses, and even an eligible dependent of the employer’s family cannot be covered under a group health insurance.
Group Health Insurance Eligibility Requirements in India
Here are the terms of eligibility criteria for buying a group health insurance:
-
Age limit
The minimum age of the employee should be 18 and above and the maximum entry age limit is between 60-80 years. -
Type and size of business
Depending on how big the business or employer’s potential of hiring employees is, the group health policy should consist of at least 20 members in the company. -
Citizenship
The policyholders of group health insurance should be the residents of India only.
Why Do You Need Group Health Insurance?
-
Immediate coverage
Employees who join the company immediately get a group health insurance coverage and they can avail of its benefits without serving any waiting period. -
Savings planning
The employee does not have to worry about spending for a healthcare service out-of-pocket if the employer offers a group health policy. It comes with an affordable premium and covers a large group of employees under a single policy. -
Employee retention
With an assurance of health and well-being, employees tend to stay in the company for longer periods which is a perk for both the employees and the employer.
Who is Not Eligible for Group Health Insurance?
Group health insurance policies are intended to provide health and medicare facilities to salaried employees which further helps them manage their finances. On the other hand, it doesn’t provide any policy benefits to individuals in the following occupation/profession:
-
Eligible dependents
The employer does not generally cover the employee’s dependent children, parents, siblings, and grandparents. On the contrary, if a company or an employer invests in their dependent family’s healthcare, an additional premium cost might be applicable.
-
Businessmen/family business
In the case of an individual buying group health insurance for a family member and a non-family member involved in the business, the group health policy will cover the spouse. However, the spouse is not covered if the business holder has no other members in his business, either from the family or external employees.
-
Solo entrepreneur
An entrepreneur who’s working on their own business without any employee or helper, can not buy group health insurance. Whereas, they can invest in suitable individual health insurance to avoid any financial constraints or medical challenges in future.
What are the Inclusions and Exclusions of Group Health Insurance?
| Inclusions | Exclusions |
|---|---|
| Pre-existing diseases | Cosmetic surgery, dental care, etc |
| Hospitalization expenses | Non-medical expenses |
| Daycare procedures | Self-inflicted injuries, suicidal attempts, etc |
| Pre and post-hospitalization | Unproven treatments, infertility, HIV/AIDS, STD, etc |
Note: These are not a full list of inclusions and exclusions, check your policy documents for a detailed list.
Summary
Group health insurance plans offer basic healthcare facilitation in the common interest of salaried employees in a company. Businesses, relevant employers, start-ups, unicorns, etc are eligible to buy group health insurance for their employees. Given, that the small group health insurance requirements or small business group health insurance requirements are different from a large company group health insurance.
To know more about group health insurance eligibility requirements in India, call our experts at 1800-4200-269.
Health Insurer Network Hospitals
Eligibility of Group Health Insurance in India : FAQs
1. How can I get a group health insurance plan?
As per IRDAI, group health insurance is a matter between an employer-employee and a non-employer-non-employee. Hence, the eligible groups can avail of the group health insurance coverage as an additional benefit from their employer.
2. What are the eligibility criteria for employee group health insurance?
The policyholder and the employer should be an Indian resident and they must fulfill the eligibility criteria related to the policy.
3. Can I buy a group health insurance policy with my wife?
Yes, only if the husband and the wife both are the proprietors of a family business they can be covered together under group health insurance. In the case of the businessman having a sole proprietorship, the wife cannot be covered under the group health policy.
4. Should a group health insurance policy have a minimum number of employees?
Generally, the minimum number of employees to get a group health insurance should be 20.
5. What is the minimum and maximum entry age for buying group health insurance?
The minimum age limit to get covered under a group health insurance policy is 18 years, but the maximum age limit is between 60 to 80 years, varying from insurer to insurer.
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Written By: Simran Nirala
Simran has an experience of 3 years in insurance content writing. She transitioned from hospitality to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner she keeps her audience hooked and solves their doubts smoothly.
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