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Group health insurance is a type of health insurance policy which covers the health care expenses of a group of members under a single master health insurance policy. There are certain things which are to be considered for a beginner before taking a group health insurance policy.
It is very important for a beginner to be careful before purchasing a group health insurance policy. If the services provided by the intermediary after taking the group insurance then it would be highly difficult to change the service provider.
- Coverage: The coverage under the group health insurance policy is the most important point if you are taking group insurance for the first time. It is important to know what is covered and what is excluded under your group policy. Since a group health insurance policy is a tailor made policy which can be customized as per the needs and requirements of the customer, it is important to understand the coverage before finalizing the policy.
The group health insurance policy covers inpatient treatment up to the sum insured mentioned under the policy, day care treatments, alternative treatments, room rent etc. The room rent covered under the group health insurance policy would usually be a percentage of the sum insured or a private a/c room. It is important to discuss with your insurance intermediary before finalizing the policy.
It would be beneficial to have a business health insurance brokers to assist you if you are taking the group health insurance policy for the first time when compared to the other insurance intermediaries. This is because the insurance broker can be made liable in case of deficiency in services arising at any future date which is not possible with other insurance intermediaries.
- Sublimits: The sub limits are the limits set for certain illnesses or diseases. For example if the sub limit for cataract operation is ₹20k per eye, then the claim amount would be less than or equal to ₹20k irrespective of whatever charges were incurred by the customer.
The sub limits would be applicable only if it is chosen by the insured customer. When you are taking a GHI for the first time, do not consider the premium only as a policy with less premium might have sub limits and other exclusions and conditions.
- Co-pay: Copay is the amount of claim that has to be borne by the insured at the time of claim settlement. Having a co-pay option in the GHI policy can reduce the premium greatly. But the main intention of taking a health insurance policy is to protect your financial condition in case of hospitalization.
It is important to check if there is a co payment clause in the policy before taking it. Once the policy is taken with co-pay it would not be possible to modify the terms and conditions during the policy period.
- Exclusions: Exclusions are the conditions which are not covered under the policy. There might be temporary and permanent exclusions under the group health insurance policy. Permanent exclusions would not be covered at any cost while the temporary exclusions would be covered on payment of additional premium or after a period of time.
It is important for a beginner to understand the permanent and temporary exclusions under the policy before taking the policy.
- Additions & Deletions: Additions and deletions of members under the group health insurance policy is permitted if the intimation is made within a designated time period. It is important for the beginners to clearly remember the time period to make additions and deletions. If the intimation is made after the specified time, then it might not be taken into consideration by the insurance company.
