Who is eligible for group health insurance?

What is a group insurance scheme?

A group insurance scheme is an insurance plan that provides financial cover to all the employees/members of a particular group or business organization. These plans are feature-rich and typically are highly customizable. These prove to be highly cost-effective given the higher number of plans in a bundle. Besides providing cover to the employee/members, it may also have the possibility to cover family members of the insured.

Why Group Health Insurance 🌡️?

A group health scheme policy is advantageous to both employees and employers. Employers benefit from employee loyalty while reducing their financial burden and covering treatment costs. Choosing a suitable partner to identify and tailor a plan that fits your organizational needs is of utmost importance.

Features and benefits of a group medical plan

A group insurance scheme provides comprehensive coverage that can be tailored to meet the needs of employees in general. Some of the most common benefits are:

Cashless claims: Group policies include cashless claims at network medical centres. The process of claiming is quite simple; all that is required is a policy number and valid identity proof. Because the group claim process is a direct claim-filing system, it is more efficient.

Amount insured: 💵 The sum insured varies depending on the needs and levels of the insured at the organisation. Typically, all inpatient treatment expenses are covered up to the sum insured, regardless of the amount of the sum insured.

Annual health check-ups:👨‍⚕️ Group health insurance includes free yearly health check-ups. It is a useful feature for group medical plans because it can serve as an effective team-building event for businesses.

Flexibility: When choosing a group policy, there is flexibility at all levels to select the sum insured and a system to tailor the cover to the specific needs of the individual employee. This eliminates the one-size-fits-all approach and increases employee appreciation.

Ambulance cost: The group policy generally provides benefits of ambulance 🚑 charge coverage that ranges to different amounts depending on the policy selected.

Coverage for pre-and post-hospitalization: Under the group policy, pre-and post-hospitalization coverage adheres to a predefined system. The system entails pre-hospitalization cover of the insurance of a defined number of days and post-hospitalization cover as per the policy document mentioned duration.

Pre-existing conditions: One of the most common concerns when purchasing health insurance is the individual’s pre-existing medical conditions. Many group plans provide coverage in the event of such ailments. A discussion with an insurer’s representative will clarify critical illness coverage.

Coverage for a family:👪 The majority of service providers in the group insurance segment include a clause that protects the insured’s family as well.

Affordable policies: Group medical insurance benefits from economies of scale, making it one of the most affordable policies in the segment. This means that a comprehensive insurance policy can be obtained at a lower cost.

Maternity benefit:👶 Some group plans come with a feature to provide maternity benefits.

Alternative therapy: As the trend of alternative treatments and therapies is growing, the group plan providers are increasingly adaptive with these benefits in their plans.

Eligibility for Group Insurance: ✔️

Company Eligibility:

  • Availability of at least one full-time employee who is not the owner of the business or a member of his immediate family.
  • Businesses must be registered per applicable laws and must have a legally valid business license.
  • Group plans vary and one of the eligibility for the business to obtain a group plan is the size of the group. Different insurers have different criteria of the minimum required size for being eligible for a group plan. Following the same, a company may not qualify if it doesn’t have the required headcount.

Employee Eligibility:

  • There must be a valid employer-employee relationship between the business owner and their employees to avail the group medical plan benefits.
  • To avail of the group insurance benefits, the members should be legally and medically fit to obtain an insurance plan.
  • As a group plan covers employees of a company, any person obtaining the group insurance plan must be a member of the company’s staff.
  • If there are ex-pats working in an organization, the validity of the coverage is to be identified.
  • Part-time members and freelance consultants cannot be a part of a group plan.
  • To qualify for a group insurance policy, one must be of at least 18 years of age.
  • There is a maximum capping on the person’s age who can obtain a group plan as a member, and the respective insurance service provider must clarify the same.

Several factors, including a member’s age and professional standing, determine a group’s medical plan eligibility. Rather than a standard single cover, it is prudent to choose group plans that offer various coverage options. Premiums can be paid annually/semi-annually/quarterly/monthly, and members can be easily added and deleted in group insurance schemes. Get a quote here for a no-hassle, best-in-class group insurance option.


Nowadays, organizations offer a variety of benefits to their employees. Employee satisfaction and motivation, admittedly, are critical drivers of successful operations. Group medical insurance is one such benefit, in which a company provides health insurance to its employees. Since the need for group health insurance cannot be extrapolated, most insurers offer group policies with personalization options.

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