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Navigating Pre-Existing Conditions in Group Mediclaim Policies

Posted on 10 Apr, 2024
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Group health insurance is a financial tool that protects your employees from any medical uncertainties that may arise during their employment with your firm. This policy covers your employees' medical screenings, consultation fees, ambulance expenditures, OPD charges, hospitalisation bills, and more. The best aspect of this plan is that employees can use it as soon as they start working for your company.

Although the coverage offered under this plan is clear, many wonder whether a Group Mediclaim Policy covers pre-existing conditions. This article will address this query in detail.

Group Medical Insurance

Understanding Pre-Existing Conditions

A pre-existing disease is a health problem you are diagnosed with 48 hours before purchasing medical insurance . Assume you intend to obtain medical coverage for yourself. You get a routine check-up a few days before receiving coverage. The study shows high blood sugar levels, classifying you as having diabetes.

In this case, your insurer would charge a higher premium and require a waiting period to treat such conditions. However, under a group health insurance plan, if an employee has a pre-existing ailment, there is little or no impact on the premium, and there is no waiting period.

List of Pre-existing Diseases Covered by Group Health Insurance

The list of pre-existing diseases covered by the Group Mediclaim Policy is exhaustive. Here are some common examples:

  • Diabetes
  • Thyroid
  • Asthma
  • High Blood Pressure
  • Kidney Ailments
  • Cardiac Diseases
  • Kidney related issues

How do Pre-existing Conditions get covered in the Group Mediclaim Policy?

Group health insurance is a broad plan. You can tailor it to your employees' specific needs. If an individual wishes to increase his/her coverage, the person can purchase add-ons or top-up health insurance plans for an additional premium.

Group health insurance automatically covers pre-existing conditions. However, it may be subject to certain terms and conditions.

For example, when someone joins your organisation, he/she must disclose any pre-existing conditions on the insurance form. If the person’s want tailored coverage, the insurer will ask him/her to undergo a medical screening before accepting the application.

Choose the Pre-existing Diseases Waiver

It is possible that the insurer will refuse coverage for pre-existing conditions during the underwriting process. Assume you run a business with 50 employees. All of your employees here are over the age of 45. In this instance, it is likely that the majority of your employees are suffering from major or minor health issues that will result in the submission of several claims in the near future.

To ensure you offer broad coverage to your workforce, it is best to pay a small premium for a pre-existing disease waiver add-on.

Key Features of Group Health Insurance

Some notable features of this plan are:

  • Group health insurance provides flexibility. You can increase the sum insured and purchase add-ons to enhance the base plan.
  • You can add direct family members of your employees, such as spouses, parents, and dependent children, to the plan at any time.
  • Given the number of deaths caused by COVID-19, the IRDAI has mandated that all insurers include coverage for this condition regardless of plan type.
  • Group Mediclaim Plans offer coverage for outpatient treatment.
  • In the event of a medical emergency, your employee can request telemedicine services using a medical app and be reimbursed for them.
  • Organising fitness programs and encouraging your employees to participate in them can help you reduce your overall policy premium, as healthier employees are less likely to file a claim.
  • Mental illness has become more widespread as a result of our hectic work lives and demanding jobs, but group health insurance covers it as well by reimbursing for sessions with nutritionists and mental health professionals.

Conclusion

Group Mediclaim Policy offers broad coverage for various medical requirements, including pre-existing diseases, without imposing high premiums or waiting periods. By selecting an appropriate plan and exploring add-ons, such as pre-existing disease waivers, you can safeguard your workforce, promoting employee well-being and financial stability.

Help us know you better!

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. (GHI Insurance, 4016 , ICIHLGP21381V052021)