Group Health Insurance

Group Health Insurance / Group Mediclaim Policy

In 2026, group health insurance, often called corporate medical insurance, has become the primary health safety net for India's workforce. Following the 2020 IRDAI mandate, it is now standard practice (and often a legal requirement) for companies to provide comprehensive medical insurance for employees, ensuring that rising healthcare costs don't disrupt the financial stability of their teams.

What is Group Health Insurance?

Group health insurance is a single "Master Policy" purchased by an organisation to provide health coverage to its members, usually employees and their dependents. Unlike individual plans, it treats the entire group as one entity, allowing for lower premiums and broader benefits. In 2026, these group health insurance plans have evolved to include holistic wellness, mental health support, and digital-first claim experiences.

Why Do Businesses Need Group Health Insurance?

• Legal Compliance: IRDAI guidelines now require most functional businesses to provide health cover as part of safe office operations.
• Talent Attraction: High-quality employee health insurance is a key differentiator in the 2026 job market.
• Reduced Absenteeism: Early access to medical care and preventive check-ups keeps the workforce healthy and productive.

Key Features of Group Health Insurance Plans

• Zero Waiting Period: Most plans cover pre-existing diseases (PED) from Day 1.
• No Medical Check-ups: Employees are enrolled regardless of their current health status.
• Maternity & Newborn Cover: Includes delivery expenses and medical care for infants from the moment of birth.
• Mental Health Support: Modern 2026 plans often include teleconsultations with psychologists.

Optional Add-Ons in Group Health Insurance

• OPD Cover: Reimburses doctor consultation fees and pharmacy bills.
• Critical Illness Rider: Pays a lump sum upon diagnosis of major illnesses, such as cancer.
• Corporate Buffer: An extra pool of money available if an employee's individual sum insured is exhausted during a major surgery.

Eligibility Criteria for Buying Group Health Insurance

• Minimum Group Size: Usually, a minimum of 7 to 10 employees is required, though some modern insurers now cover "micro-groups" of 3 to 5 people.
• Registered Entity: The group must be a legal entity (pvt ltd, LLP, NGO, etc.) with a valid PAN and GST.
• Employer-Employee Relationship: Most members must be on the company's payroll.

Claim Process Under Group Health Insurance

Cashless Claim (Planned/Emergency)

• Identify Hospital: Visit a network hospital and show your digital E-card.
• Pre-Authorisation: The hospital's TPA desk sends a request to the insurer.
• Settlement: The insurer pays the hospital directly, excluding non-medical items.

Reimbursement Claim (Non-Network)

• Payment: Pay the hospital bills in full at the time of discharge.
• Submission: Upload original bills, discharge summary, and reports on the insurer's app within 15-30 days.
• Refund: The approved amount is credited to your bank account within 7–10 working days.