Group medical policies
Group medical policies and the various provisions available under those policies.
Q: Who all are eligible to take the group mediclaim policies?
A: Group Mediclaim Policy is available to any Group/Association/Institution/Corporate body, provided it has a central administration point. It is also subject to a minimum number of persons to be covered. The group shall fall clearly under the same categories as specified for Group Personal and Retail Insurance.
Q: What is the coverage under the policy?
Coverage under the policy is the same as under individual mediclaim policy with the following differences:
- Cumulative Bonus and health check-up expenses are not payable
- Group discount in the premium is available
- Renewal premium is subject to Bonus/Malus Clause
- Maternity benefit extension is available at an extra premium
Q: Is there any discount on group policies?
A: Yes. Group discount is allowed according to the scale. It depends upon the total number of insured persons covered under the group policy at the inception of the policy.
Q: What are Bonus and Malus?
A: Bonus is known as Low Claim Ratio discount allowed on the total premium at renewal only, depending upon the incurred claims ratio for the entire group. Malus is known as High Claim Ratio loading applied to the renewal premium for adverse claims experience.
Maternity Expenses Benefit Extension
Maternal expenses are not covered under individual mediclaim policies.
Are maternity expenses covered under group mediclaim policies?
Yes. This is an optional cover, which is available on loading of the total basic premium, for all insured persons under the policy.
Total basic premium means the total premium computed before applying group discount and/or high claim ratio loading or low claim discount.
Option for maternity benefits has to be exercised at the inception of the policy period. No refund is allowable in case of insured’s cancellation of this option during the currency of the policy.
Maximum benefit is up to Rs. 50,000 or the sum insured opted by the members of the group, whichever is lower.
These benefits are admissible only if the expenses are incurred in a hospital/nursing home as in-patients in India.
- A waiting period of 9 months is applicable for payment of any claim relating to normal delivery or cesarean section or abdominal operation for extrauterine pregnancy. The waiting period may be relaxed only in case of delivery, miscarriage or abortion induced by accident or other medical emergencies.
- Claim in respect of delivery for only first two children will be considered in respect of any one insured person. Those insured persons who already have two or more living children will not be eligible for this benefit.
- Expenses incurred in connection with the voluntary medical termination of pregnancy during the first 12 weeks from the date of conception are not covered.
- Pre-natal and post-natal expenses are not covered unless admitted to hospital/nursing home and treatment is taken there.
Details of Insured Person
- The insured is required to furnish a complete list of insured persons according to the sum insured in the prescribed format
- Any additions and deletions during the currency of the policy should be intimated in the same format
- No change of sum insured is permitted within the currency of the policy
- No refund of premium is allowed for deletion of insured person if he has recovered a claim under the policy