mediclaim insurance newsletter

Insurance Advisory Newsletter: Group Mediclaim Insurance Policy – March 2023

Group Mediclaim Insurance Policy

A Group Mediclaim Insurance policy (“GMC”) is a group insurance scheme specifically curated to cover and provide health insurance benefits to a group of people, usually, employees of a company, organisation or association that have been identified in the insurance policy. In India, GMC is a popular form of health insurance, for organizations or entities (“Policyholder”) who want to provide effective health insurance coverage for their employees (“Insured Persons”). GMC can evoke a sense of financial security in the Insured Person and fuel better employee-employer relationships, becoming a factor leading to enhanced performance.

Under a GMC policy, the premium is paid by the Policyholder entity and, at times some benefits can be paid on co- sharing or co-pay basis with the Insured Persons. The premium and amount of sum insured of a GMC is calculated on the basis of the risk involved and also takes into consideration parameters like the job profile, industry type, average age of an Insured Person and the amount of sum insured.

Standard Coverages and Exclusions under GMC

A GMC is a tailor-made policy typically providing the following hospitalisation coverages:

Insurance inclusions

However, a GMC comes with certain standard exclusions such as: 

GMC exclusions


Benefits and Limitations of GMC


Employer/ Policyholder Perspective:

  1. Low cost and affordable as risk is spread across a large pool. 
  2. Retention & attraction of quality talent
  3. Savings in taxes

Employee/ Insured Person Perspective:

  1. Coverage for pre-existing diseases without waiting period.
  2. No Medical Check-Up Is Required
  3. Coverage can be extended to spouse, children and also parents.

  1. Lack of Control by Insured Person on choice of applicable and necessary coverages.
  2. Apprehension about continuity of insurance.
  3. Insurance coverage is dependent on the Employer.
  4. No tax benefits can be availed by the Insured Person.
  5. Unreliable for reasons of personal financial planning.
  6. Marginal increase in Premium for successive years due to claims in the preceding years.

Characteristics of a robust GMC

  • Flexible plans: The health insurance plan that a Policyholder chooses for its employees should offer the Policyholder the flexibility of adding or removing its employees. Moreover, the Insured Person(s) should also be able to extend coverage to their family members as per their requirements.
  • Room rent limit: Room rent is the amount charged by the hospital for occupying the room on a 24-hour basis. Opting for a policy with no room rent limit or a higher one is beneficial because if the Insured Person(s) occupies a higher category room, then the additional expenses along with the associated expenses of consumables, doctor fees, etc. would be charged as per the higher room category chosen.   
  • Network hospitals: the Insured Persons would be eligible to receive cashless treatment at these ‘Network Hospitals’, thereby ensuring a swift claims process.
  • Maternity Coverage: If the Policyholder has a young team then it is advisable to procure and maintain a GMC as it provides coverage for maternity expenses (both normal and caesarean delivery). 
  • Home healthcare: Health insurance companies offer coverage for home healthcare i.e., the treatment of a medical condition from the comfort of the Insured Person’s home. This is covered only if there are no hospital beds available or the Insured Person is in no condition to be taken to the hospital.

Related Posts