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Group health insurance is a type of insurance policy that is provided by an organization to its employees, and in some cases, can also extend coverage to their family members. This policy provides coverage for the reimbursement of medical expenses incurred by the insured person during hospitalization, as well as for any illness or injury suffered in India.
The policy also covers pre- and post-hospitalization medical expenses for up to 30 and 60 days respectively. This insurance policy covers individuals ranging from 91 days old to 80 years of age.
Group health insurance has become increasingly important due to several factors, including:
Rising Healthcare Costs:
With the increase in medical expenses, it has become difficult for individuals to bear the costs of healthcare services. Group health insurance provides financial protection by covering medical expenses, thereby reducing the financial burden on individuals and their families.
Medical Emergencies:
Medical emergencies can happen unexpectedly, and the cost of treatment can be overwhelming. Group health insurance ensures that individuals and their families are protected against such emergencies.
Employee Retention:
Group health insurance is an important employee benefit that can help organizations retain their employees by providing them with comprehensive health coverage.
Health and Wellness:
Group health insurance policies often include wellness programs, which can help individuals maintain good health and prevent illnesses.
Regulatory Compliance:
In many countries, providing group health insurance to employees is mandatory as per regulatory requirements.
Overall, group health insurance provides financial security and peace of mind to employees and their families, while also benefiting organizations by increasing employee retention and promoting a healthy workforce.
Group health insurance provides coverage for various healthcare needs, which are determined by the coverage options selected. The following are some of the areas that may be covered:
Pre- and post-hospitalization expenses
Pre-existing medical conditions
Maternity-related expenses
Expenses related to new born care from day one
Pre- and post-natal medical expenses
In-patient department expenses
Ambulance charges
Day care medical expenses.
Group health insurance offers several advantages, including:
• Coverage for both the employee and their family members
• No requirement for a physical health check-up
• Coverage for individuals of all ages
• Customizable healthcare options
• Boosts employee morale by providing comprehensive health coverage
• More affordable compared to purchasing an individual health insurance policy
• Family members are covered under the same sum insured.
The process of settling health insurance claims has been simplified and automated with the use of AI/ML algorithms. The following steps are involved:
• The insured individual requires hospitalization.
• They are admitted to a network hospital.
• The hospital submits a pre-authorization request through a web portal.
• The system automatically adjudicates the request and provides instant approval.
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