Things To Know About Your Group Mediclaim Policy


When it comes to healthcare, there is no one-size-fits-all answer. That is why a group mediclaim policy is so important. It offers coverage for employees of an organization and their family members; in other words, even people who are not employees but live in the same household. The best group policies offer optimum coverage at the most reasonable cost.

A mediclaim policy is one type of health insurance policy that provides coverage for group members. This article explains what group mediclaim is and how it works.

What is a Group Mediclaim Policy?

Group mediclaim is an insurance policy that offers comprehensive healthcare coverage to people from the same group or working under the same employer. With individual insurance, the person insured bears the cost of the policy and is responsible for paying a timely premium.

But with group plans, an employer or a group leader is responsible for the premium payment. In some cases, both parties involved share the cost of the policy.

If we compare it to an individual health insurance plan, the premium of these policies is lower, making them more affordable. In addition, there are tax benefits and other reasons that make investing in group policies more lucrative than individual plans while offering appreciable coverage to all the family members of the employees covered.

How Does the Group Mediclaim Plan Work?

Group health policies can be a valuable addition to group members in the event of an accident or illness. By reading the policy thoroughly, insured individuals can understand the coverage and the costs involved.

In most cases, group mediclaim plans cover medical expenses up to a specific limit, which the employer sets. It helps keep the overall costs involved under control.

A group health plan can provide protection from illness and financial stability in the event of an accident or injury. Some group health insurance plans also offer the option to add riders or increase the cover, specific to an individual, at an additional cost. The most popular riders include maternity cover, rent room waiver and critical illness cover.

How to Enrol in a Group Health Plan?

The list of eligible employees to be covered by the policy is to be decided by the employer. As per the Insurance Regulatory and Development Authority of India (IRDAI), a minimum of 7 employees have to be covered for applying for group health insurance.

Employers then provide a deadline within which an eligible employee will have to submit the requisite details. Employers often have a 90-day buffer for new employees before the policy gets activated to ensure they are a good fit for the company. In addition, there are different tiers of coverage, such as pharmacy, vision, and dental, that your employer provides depending on the hierarchy.

In case of a significant change in your life, such as the birth of a child, marriage, or others, you may request your employer to make the necessary changes and update the policy terms. The employer can request the insurer to amend the policy terms to incorporate the changes.

Benefits of Group Health Insurance Plans

A group term life insurance provides life cover to the employees or a group of individuals. Here are the benefits of group mediclaim plans.

  1. Lower Premiums

One of the benefits of a group mediclaim policy is that it typically offers lower premiums than individual health insurance plans. The insurer is happy to offer these plans at a lower premium because it covers multiple individuals, ensuring that the risk stands diluted.

  1. No Waiting Period

It can be frustrating to wait for coverage under insurance policies to become active. Fortunately, it is not the case with group health insurance plans. There is no waiting period – you can sign up and receive coverage immediately!

  1. Coverage for Dependents

Group health insurance policies often include coverage for spouses and children – you may also include parents or step-parents in this category. Pets can also receive group health insurance coverage in an emergency. The employee may be required to pay a reasonable additional cost for covering the dependents.

  1. Pre-Entrance Medical Check-Ups

Pre-entrance medical check-ups are an integral part of every individual policy. While vital, it can be a nuisance for the insured because it includes the hassle of getting themselves and their dependents checked. While individuals are alright with the stringent procedure, parents and other elderly individuals may not be as flexible.

Thankfully, these check-ups are not mandatory for group policyholders, and insurers are happy to provide coverage to all the employees without checking their medical history.

  1. Quick and seamless claim settlement procedure

If something happens to one of your group members and that person needs medical care, you will be able to receive compensation relatively quickly. In most cases, the insurer will handle all the costs related to the claim settlement procedure – from insurance premiums paid to reimbursement of expenses incurred. It makes it extremely easy for you – there are no hidden costs or hassles!

  1. Additional riders

Most group health plans come equipped with the option to allow insurers to add ancillary riders, such as accident cover and more. Individuals would otherwise have to subscribe to a group personal accident insurance or individual policy to get accidental cover. The individuals will have to pay for the additional burden, which is an efficient way to get more value out of the policy.


A group mediclaim policy offers a wide range of benefits for employees and their families. By understanding the types of riders available and the benefits that they offer, you can make an informed decision about whether group health insurance is right for you and your family.

At Plum Insurance, we offer the most comprehensive group mediclaim plans designed specifically for you. These cover all the basic necessities of your employees while seeking medical care and offer you the best value-for-money hassle-free.