What is Group Mediclaim Insurance Policy and Its Benefits for Employees?


3 min read

Employees are the most important assets for an organisation. As an employer, your priority would be to ensure their well-being for financial and practical reasons.

Group Health Insurance covers the employees against expenses due to illnesses or accidental injury. The employees may belong to organizations with number of employees more than 20 like banking institutions, multi-nationals or SMEs including both financial and non-financial institutions.

The size of the group can be either small or large as per the requirement.The members can also be covered under different sub-groups with varying sum insured. The conditions for such classification of employees into sub-groups will be decided by the employer or group administrator based on their position or risk category.

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  • Benefits for the employees: While the specifics of the group health insurance policy may vary from company to company, the general coverage comprises of:
  • Hospitalisation costs: Costs including room rent, boarding, nursing, doctor’s fees, anaesthetist’s fees, diagnostic tests medicines & drugs etc.
  • Pre-hospitalisation costs: Expenses prior to hospitalisation, up to certain number of days, as mentioned in the policy schedule.
  • Post-hospitalisation costs: Up to pre-determined number of days, as fixed in the policy schedule, after discharge.
  • Cashless hospitalisation: Cashless services through a Third Party Administrator based on the tie-ups with network hospitals.
  • Protection at a low cost: The cost of buying an insurance policy is shared within the group or entirely by the employer.
  • 24×7 Coverage: Protection against unforeseen events at all times anywhere in India.
  • Benefits for the Employer: Along with giving the benefit to the employees and their beneficiaries, Group MediClaim is also beneficial to the employer.

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  • Exclusions: Subject to company-specific details, the insured will not be covered for the following under the GMC policy:
  • Any claim within 30 days of policy issuance, with the exception of accidental injury or period following policy renewal
  • War-related injuries
  • For the initial year(s) from the- 1yr, 3yr, 4yr waiting period from date of policy purchase for certain diseases and surgeries – specific schedule according to the policy document for specific disease
  • Pre-existing/congenital diseases
  • Cosmetic or aesthetic treatment of any description or plastic surgery, other than as may be required as part of treatment post-accident or owing to any illness
  • Naturopathy
  • Treatment for injuries arising from intentional self-harm, suicide attempt, alcohol/drug abuse
  • Sexually transmitted diseases, AIDS
  • Costs involved in the diagnosis and treatment of infertility, sub-fertility and circumcision
  • Treatment during a period of inactivity or rest cure for convalescence or rejuvenation purposes, general debility or ‘run-down’ condition
  • Dental treatment or surgery of any kind unless requiring hospitalisation
  • Expenditure on vitamins and tonics unless necessitated by the treatment
  • Expenses during childbirth including caesarean section
  • Voluntary medical termination of pregnancy during the first 12 weeks from the date of conception
  • Diagnostic tests not consistent with positive existence of any illness, ailment or injury Add-ons available: Riders or add-ons are extra covers through which a more comprehensive and customised protection can be provided to the employees.

Although several insurance providers offer different combinations of the above-mentioned add-ons as in-built benefits, it is crucial to comb through their scope and limitations before opting them.

  • Pre-existing cover for pre-ailments
  • Maternity cover for normal and caesarian delivery
  • Waiver of 9 month wait period for maternity coverage
  • Pre and post natal coverage
  • Coverage for new-born baby from day one
  • Corporate / organisational buffer
  • Ambulance costs
  • OPD expenses

Choose wisely!

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Mar 15, 2021
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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