Who Is Eligible for Group Health Insurance?

Group health insurance is a variant of health insurance that is purchased for groups rather than individuals. Group health insurance is usually part of a corporate or SME insurance plan. It also provides coverage for medical expenses to workers and sometimes their family members. It includes features like cashless treatment and comprehensive healthcare. The main advantage of group health insurance is that employees can enjoy essential health benefits, and the company enjoys tax savings. Moreover, group health insurance increases employee satisfaction and retention, thereby contributing to the company's overall well-being and reputation.

What is Group Insurance for Employees in India?

Group health insurance is a type of health insurance policy purchased for a group rather than an individual. Typically part of a corporate or SME Insurance plan, group health insurance provides medical coverage for employees ?nd often extends to their family members. This coverage includes benefits like cashless treatment and comprehensive medical care. Group health insurance is a benefit to both employees and employers. Employees receive essential health benefits, while employers can maximise **tax savings. Additionally, offering group health insurance enhances employee satisfaction and retention, contributing positively to the organisation's well-being and reputation.

Eligibility to Purchase Group Medical Insurance for Employees

A group health insurance can be bought by any organisation, startup, cultural/social establishment, or group with a shared interest. According to the Insurance Regulatory and Development Authority of India (IRDAI), any company or group with at least 20 members is eligible to purchase a Group Insurance Policy. Micro-insurance plans are also available for smaller groups or businesses with less than five members. Here are the detailed requirements for a group health insurance policy in India:

Definition of “Group” in Group Health Insurance:

IRDA defines “group” as either an employer-employee group or a nonemployer-employee relationship group. This former group consists of the organisation plus its staff and the latter represents people united by the same interests or hobbies. Nonemployer-employee group examples include people belonging to the same cultural/social circle or people who hold the same credit cards.

Number of Employees:

The minimum number of employees/group members required to purchase a Group Insurance Plan is typically 20, although this can vary slightly between insurers. However, this requirement may differ from one insurer to another based on various terms and conditions under policies. To know about eligibility criteria for taking up a specific Group Life Insurance Scheme, it is always advisable to consult your insurer.

Intention for Buying Group Insurance:

Also according to IRDA forming a group merely to obtain cheap low-cost Insurance would not work. If you bargain with insurers before setting up your unit then your company will be considered non-legitimate. This means you will not get the benefits of low-cost insurance because you will not be allowed to have a group health insurance policy.

Who Can Buy a Group Insurance Policy?

Organisations can get numerous benefits through a group health insurance policy. Mentioned below are the ones who can buy a group insurance policy:

Small Businesses and Startups:

Small-scale businesses and start-ups are the first respondents to group health insurance. This enables them to retain their employees for the long term and build relationships. Additionally, Health insurance packages help in the acquisition of talented workers.

Growing and Mid-size Companies:

It is highly recommended for growing and mid-sized companies to provide group medical insurance. The provision of health coverage guarantees employee welfare and improves the general organisation's health status. This leads to a happier and more productive workforce that is important in achieving the company’s objectives.

Established Organisations:

Health insurance is one of the basic needs of every employee in well-established organisations. Measuring up to this expectation enhances employees’ morale and is consistent with industry trends. Medical insurance relieves employees from the pressures of paying expensive bills.

Societies and Associations:

Companies, registered societies, welfare associations, and groups of individuals sharing a common interest in the purchase of health insurance. The policies provide members with financial security and health services that make the group members feel secure.

Clubs and Community Groups:

These groups such as sports clubs, and hobby clubs among others. This makes sure that everyone receives essential health care because good health increases the chances of people participating in group activities.

Contractual and Part-time Workers:

Organisations offer group health insurance to contract and part-time employees as well. It is clear from this inclusion that the company values all its workers regardless of their status. It also helps attract a diverse talent pool and a competitive edge in talent acquisitions within the job market. Also Read: Health Insurance Plans for Small Business Owners and Employees

Who is Not Eligible for Group Health Insurance?

Group health insurance primarily caters to employers and their employees, excluding sole proprietors without staff and family businesses where the spouse is the only "employee." In the latter case, coverage for the spouse is possible if the business employs others, both family and non-family members. The plan can also cover eligible dependents, with the employer having the flexibility to contribute to their premiums or allow employees to add them at an additional cost. This type of insurance is not suitable for individuals seeking personal coverage, as it's specifically designed for employer-employee groups.Conclusion

Group Health Insurance is an insurance form that provides a safety net to employers of any group in terms of private medical care. Qualification commonly involves having a registered business or organisation and usually the business must have a minimum of 10 members. This includes firms, societies, associations, and clubs, which requires the engagement of the participants. Group Health Insurance enlist the employees, their dependents or even the part-time or contractual staff as per the policy standard. **Tax benefits are subject to change in prevalent tax laws. #Visit the official website of IRDAI for further details.

*Standard T&C Apply *Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale. The information presented is not meant to be a substitute for medical advice. Any suggestions mentioned should be considered for general use only. For expert guidance on any health ailment or medical issue or any treatment/procedure, please consult a certified medical professional.