What are different types of coverages in group health insurance?

When securing employees' health, a group health insurance policy (GIH) plays a crucial role. Companies and organisations opt for this type of insurance to provide financial protection against medical expenses for their employees. But what does a group insurance policy cover? Let's dive into the different kinds of coverage it offers.

1.     Hospitalisation cover

This is the most fundamental coverage under agroup health insurance policy. It covers expenses related to:

●   Hospital room rent

●   Doctor consultation fees

●   Nursing charges

●   ICU expenses

●   Operation theatre charges

●   Medicines and diagnostic tests

2.     Pre and post-hospitalisation expenses

Medical expenses are not limited to just hospital stays. Many treatments require tests and doctor consultations before and after hospitalisation. Agroup insurance plan usually covers:

●   Pre-hospitalisation expenses (typically for 30 days before hospitalisation)

●   Post-hospitalisation expenses (for up to 60 days after discharge)

3.     Daycare procedures

Not all medical procedures require hospitalisation for 24 hours. Some treatments, such as cataract surgery, dialysis or chemotherapy, can be completed within a few hours. A group health insurance policy covers these daycare procedures, making it easier for employees to get treated without financial stress.

Some common daycare procedures covered include:

●   Sinus surgeries

●   Angiography

●   Radiotherapy

4.     Maternity and newborn cover

Many companies include maternity benefits in their group insurance policy. This typically includes:

●   Normal and C-section delivery expenses

●   Pre and postnatal care

●   Newborn baby cover (usually up to 90 days from birth)

Maternity expenses have increased over time, and including this in the policy ensures financial relief for expecting employees.

5.     OPD and consultation cover

Some policies extend their benefits beyond hospitalisation by covering Outpatient Department (OPD) expenses. This includes:

●   Doctor consultations

●   Diagnostic tests

●   Prescribed medicines

With an increase in lifestyle diseases and preventive healthcare measures, many employees require regular consultations. Having OPD coverage allows them to access healthcare without waiting for a serious condition to develop.

6.     Critical illness cover

Certain policies offer coverage for critical illnesses, such as:

●   Cancer

●   Heart attack

●   Kidney failure

●   Stroke

Since treatments for these illnesses can be costly, having this additional cover can be a financial lifesaver. The cost of treating a major illness can run into lakhs, and this coverage ensures that employees receive the necessary treatment without financial stress.

7.     Mental health cover

With growing mental health awareness, many insurers now offer coverage for psychiatric consultations, counselling and therapy sessions under a group health insurance policy.

Mental health issues such as anxiety, depression and stress-related disorders are becoming common in the workplace. Coverage for mental health treatment benefits employees and contributes to a healthier and more productive work environment.

8.     Alternative treatment cover

Alternative treatments have gained popularity due to their holistic approach and fewer side effects. Some employees prefer alternative treatments such as Ayurveda, Homoeopathy or Unani medicine. Many group insurance plans now cover these treatments, provided they are taken in government-approved hospitals.

9.     Covid-19 and infectious disease cover

Given the recent pandemic, insurers have included coverage for Covid-19 and other infectious diseases. This ensures that employees are financially protected in case of hospitalisation due to such illnesses.

This coverage usually includes:

●   Covid-19 hospitalisation expenses

●   RT-PCR and diagnostic tests

●   Quarantine-related expenses (if hospitalised)

●   Post-Covid complications coverage

10. Personal accident cover

Some group health insurance policy come with accidental coverage, which provides financial support in case of:

●   Accidental hospitalisation

●   Permanent or partial disability

●   Accidental death

In case of unfortunate accidents, this coverage helps in reducing financial burdens on employees and their families.

11.Organ donor expenses

In cases where an employee requires an organ transplant, certain group insurance policies cover the cost of the procedure, including expenses related to the donor's hospitalisation.

Organ transplants are expensive, and this coverage provides much-needed financial relief for employees undergoing such critical procedures.

12. Dental and vision cover

Some comprehensive group health insurance policy extend dental treatments and eye care coverage. This includes:

●   Dental surgery

●   Root canal treatment

●   Vision correction surgery

●   Spectacle and contact lens costs

13. Preventive health check-ups

Many group insurance plans offer free annual health check-ups to promote overall wellness. This helps employees detect potential health risks early and take preventive measures.

Why is group health insurance Important?

A group insurance plan is not just a benefit for employees but also a great asset for employers. It helps in:

●   Employee retention and satisfaction

●   Providing financial security

●   Enhancing workplace productivity

●   Encouraging preventive healthcare

Employees feel valued when their health is cared for, boosting morale and job satisfaction.

How to choose the right group health insurance policy?

When selecting a group health insurance policy, companies should consider:

●   Coverage amount per employee

●   Inclusion of critical illness cover

●   OPD and daycare procedure coverage

●   Maternity and newborn benefits

●   Mental health and alternative treatment coverage

Conclusion

A group health insurance policy offers comprehensive coverage, making it an essential employee benefit. From hospitalisation to maternity, OPD to critical illness cover, a well-structured policy ensures employees get the medical care they need without financial stress. By investing in a group insurance plan, companies create a supportive environment and ensure the well-being of their workforce.