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How to Evaluate Your Group Medical Cover?

Posted on 23 Jan, 2024

India is the world’s most populous country, with a predicted annual growth rate of 1.1%. That means by 2030, our country will surpass the 1.5 billion mark. Also, over 60% of this population will be between 15 and 64.

This demographic dividend poses a significant challenge for the health sector, as the risk of non-communicable illnesses, such as cancer, heart disease, and diabetes, is also increasing.

The preceding number is not the sole reason to be worried. Another study found that, at 14%, India has the highest medical inflation rate among Asian countries.

With such an alarming figure, having something like group medical coverage to augment your health insurance becomes critical. Not only that, but you must also evaluate whether the group coverage is adequate to protect your health.

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Understanding Group Health Insurance

A group health cover is an insurance that your employer offers. Such plans provide the same level of coverage to the covered group of employees regardless of gender, age, and socio-economic status. The best aspect of these plans is that you do not need to undergo medical screening to confirm your eligibility. That means getting coverage under group medical insurance is a breeze, even if you have a pre-existing disease.

Factors to Consider When Evaluating Group Medical Cover

You can review the following parameters to ensure the group health coverage meets your requirements.

1. Coverage

This insurance provides coverage based on your designation and a few other factors. In general, it ranges from Rs 3 lakh to Rs 5 lakh.

Start by checking the cost your plan covers. See if there is a provision for daycare expenses, ICU charges, ambulance fees, and AYUSH treatment.

2. Inclusions

Request a copy of the policy document outlining the inclusions and exclusions from the human resources office or manager.

What you need to check here is whether the plan covers your spouse or not. Most employers these days offer this plan that covers your parents as well.

Once you have clarification, check the list of diseases the group plan covers.

3. Co-payment

Next, dive into the co-payment clause. This provision outlines the percentage of the total bill you must pay out of your pocket when a medical emergency arises.

For example, if your co-payment is 10%, and your hospital bill is Rs 2 lakh, you will have to pay Rs 20,000 from your pocket. You must see how much the co-payment is and if you can afford it.

4. Riders

It is likely that you have not invested in riders if you are on a limited budget. In such a situation, it becomes imperative that you confirm whether the group coverage your company offers allows for customisation through the addition of riders. If they do, you must check the various riders available with the insurer.

5. Waiting Period

Next, review the list of network hospitals; use the internet to research the reputations of the nearby associated hospitals. It is crucial to check if there is a good hospital in your area or the closest city if you live in a rural region. If not, your coverage may be useless in an emergency.

Conclusion

Even though group insurance has many advantages and you feel it is worthwhile after reviewing it, getting separate insurance for you and your loved ones is still advisable. The rationale is that you can only access this coverage while being associated with the organisation providing it. There won't be any health insurance if you quit your present job or switch jobs.

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This contains only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale.ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025. . IRDA Reg.No.115. Toll Free 1800 2666. Fax No – 022 61961323. CIN (L67200MH2000PLC129408). customersupport@iciclombard.com. www.icicilombard.com. (Group Health Insurance, 4016 , IRDAN115P0010V01200607)