After COVID-19 IRDAI made it mandatory for employers to provide Group Health Insurance for employees. But beyond compliance, group health insurance is your most powerful employee benefit — attracting talent, boosting retention, and showing your team you care. the insurer Group MediCare covers all employees from day one — no waiting period, no medical check-up, no pre-existing condition exclusion — with 12,000+ cashless hospitals and seamless claim settlement so your team gets care when they need it most.
Group Health Insurance · Corporate Mediclaim · Employee Health Benefits · the insurer Group MediCare · IRDAI Mandatory · Min. 7 Members
Group Health Insurance — also called Corporate Health Insurance or Group Mediclaim — is an insurance policy that covers the medical expenses of a group of employees under a single master policy held by the employer. the insurer's Group MediCare policy provides comprehensive hospitalisation, daycare, maternity, and domiciliary treatment coverage for all employees from day one — with no waiting period, no medical check-up requirement, and no exclusion for pre-existing conditions. Coverage can be extended to employees' dependents (spouse, children, and parents) under the same policy. After COVID-19, IRDAI made it mandatory for employers to provide Group Health Insurance in India for their employees.
Coverage begins from the first day of the policy — no waiting period for initial coverage, no waiting period for pre-existing conditions, and no waiting period for maternity. Employees are covered from the moment the policy is activated, regardless of their health history.
DAY ONEAccess to a network of over 12,000 hospitals across India for cashless treatment — the hospital settles bills directly with the insurer. Cashless is available at both in-network and non-network hospitals, ensuring employees are never turned away in an emergency.
CASHLESSNo pre-medical examination is required for any employee, regardless of age or health condition. Employees with chronic conditions, pre-existing illnesses, or older workers can be enrolled without medical screening or additional premium loading at the individual level.
NO MEDICALSCoverage can be extended to employees' dependents — spouse, dependent children, and dependent parents — under the same group policy. Mid-term additions allowed for newborns and spouses after marriage, ensuring family coverage is always current and complete.
FAMILYMaternity coverage with zero waiting period — unlike individual policies where maternity typically requires a 2–4 year waiting period. Covers delivery expenses, complications, and newborn medical care from birth (Baby Day One Cover add-on). Applicable with no prior waiting period requirement.
MATERNITYEmployer: Premium is a deductible business expense under Section 37(1) of the Income Tax Act — reducing taxable profit by the full premium amount. Employee: Premium contribution (if any) is deductible under Section 80D — providing personal tax benefit to contributing employees.
TAX BENEFITFull Coverage Scope — In-Patient, Daycare, Maternity, Domiciliary & More
the insurer Group MediCare provides comprehensive coverage across the full range of medical treatment scenarios — from planned hospitalisations and emergency admissions to daycare procedures, home treatment, and maternity.
The core coverage — all expenses arising from a hospital admission of at least 24 hours:
• Room and boarding charges: Room rent up to the sum insured limit (subject to room rent capping if specified in the policy). Note: room rent capping affects proportional deductions on other costs — choosing a room within the insured category avoids proportional deductions.
• Surgeon, anaesthesiologist, and specialist fees: All doctor fees connected to the treatment during hospitalisation
• Operation theatre charges: Costs of surgical facilities and supporting equipment
• Nursing charges: ICU and general nursing care costs
• Medicines and consumables: Drugs, IV fluids, surgical consumables used during treatment
• Diagnostics during hospitalisation: Blood tests, X-rays, scans (CT, MRI, ultrasound) conducted as part of the admitted treatment
• Pre-hospitalisation: Medical expenses for the defined period before admission (typically 30–60 days) — OPD consultations, blood tests, and scans that led to the hospitalisation
• Post-hospitalisation: Follow-up consultations, medicines, and diagnostics for the defined period after discharge (typically 60–90 days)
Pre-existing conditions: Covered from day one — no waiting period. An employee with diabetes, hypertension, cardiac conditions, or any other pre-existing condition is covered immediately upon policy activation, for hospitalisation required for that condition.
Daycare Treatments (less than 24 hours hospitalisation):
Modern medical technology has made many treatments that previously required overnight hospitalisation possible in a few hours. The policy covers all listed daycare procedures:
• Chemotherapy and radiotherapy for cancer (each session)
• Cataract surgery (typically 45–60 minutes per eye)
• Dialysis (each session for kidney patients)
• Lithotripsy (kidney stone treatment)
• Arthroscopic procedures
• Angiography and cardiac catheterisation
• Endoscopic procedures (gastroscopy, colonoscopy)
• Dental surgery requiring general anaesthesia
• Surgical dental procedures (tooth extraction under GA)
• Many other procedures on the daycare list
Domiciliary (Home) Treatment:
When a patient requires treatment that would normally require hospitalisation but is treated at home due to unavailability of hospital beds or the physician’s recommendation — covered if the home treatment continues for more than 3 days. Covers doctor visit fees, medicines, and nursing care at home. Excludes enteral feeding (tube feeding) and end-of-life care.
Ambulance Cover:
Emergency ambulance expenses for transporting the employee to the hospital during a medical emergency, or for transferring between hospitals for better treatment — covered for in-patient admissions and daycare procedures.
Family Transportation Benefit:
Transportation expenses for one immediate family member to the hospital if the insured employee is admitted to a hospital more than 200 km from their home — recognising the reality of employees working away from their families.
Maternity Coverage — Zero Waiting Period:
Unlike individual health policies where maternity requires a 2–4 year waiting period, Group MediCare covers maternity from day one:
• Normal delivery: All hospital and delivery expenses for normal vaginal delivery
• Caesarean section: Surgical delivery expenses including surgeon and anaesthesiologist fees, OT charges, and hospitalisation
• Complications of pregnancy: Medical complications during pregnancy requiring hospitalisation (pre-eclampsia, placenta previa, gestational diabetes requiring admission)
• Legal termination of pregnancy: Medical termination expenses when recommended by a doctor (ectopic pregnancy is covered under in-patient treatment, not maternity)
• Newborn medical care: Expenses for newborn medical care during the delivery admission
• Mid-term newborn addition: A newborn child can be added to the policy from the date of birth without waiting for the next renewal cycle
Pre-and Post-Natal Care (Add-on):
An optional add-on covers routine ante-natal check-ups, pregnancy-related tests (ultrasounds, blood tests), and post-natal follow-up visits — the regular healthcare during pregnancy that standard in-patient cover does not address.
Baby Day One Cover (Add-on):
Covers treatment expenses of a newborn baby from the date of birth — including NICU (Neonatal ICU) care if required for premature or unwell newborns. Essential for companies with young female employee populations.
Organ Transplant:
Medical and surgical expenses for an organ transplant when the insured employee is the recipient — covered when the transplant is claimed under in-patient treatment. Covers the recipient’s surgical expenses; donor expenses may be covered separately.
| Feature | Details |
|---|---|
| Policy Name | the insurer Group MediCare |
| Policyholder | Employer (master policy) or association/society |
| Insured Members | Employees + (optionally) spouse, dependent children, dependent parents |
| Minimum Group Size | 7 members (as per IRDAI definition) |
| Pre-Medical Examination | Not required for any employee |
| Waiting Period | No waiting period — for initial cover, pre-existing conditions, or maternity |
| Cashless Network | 12,000+ hospitals across India |
| Cashless Claim Notice | Emergency: within 24 hours; Planned: at least 48 hours in advance |
| Coverage Scope | In-patient, pre/post-hospitalisation, daycare, domiciliary, organ transplant, ambulance, maternity, family transport |
| Add-ons Available | Pre/post-natal care, Baby Day One Cover |
| Mid-Term Addition | Newborns from birth; spouses from date of marriage |
| Portability on Exit | Employee can port to individual policy — apply 45 days before renewal (not earlier than 60 days) |
| Employer Tax Benefit | Section 37(1) of Income Tax Act — full premium deductible as business expense |
| Employee Tax Benefit | Section 80D — premium contribution deductible for contributing employees |
| Claim Settlement Timeline | 7 to 30 days after all documents received |
Why Group Health Insurance Makes Business Sense for Employers
Group Health Insurance is one of the few employee benefits that simultaneously serves legal compliance, talent strategy, productivity, financial efficiency, and tax optimisation — making it the highest-ROI employee benefit a company can offer.
Following the COVID-19 pandemic, IRDAI issued a circular making it mandatory for employers in India to provide Group Health Insurance to their employees. This regulatory requirement has made GHI a compliance obligation rather than an optional benefit. Employers who do not provide Group Health Insurance risk:
• Regulatory non-compliance consequences
• Labour law complications under the Employees’ State Insurance (ESI) framework — where employers above the ESI applicability threshold are expected to provide equivalent health protection
• Reputational damage as an employer, especially in sectors where talent competition is intense
ESIC vs Group Health Insurance:
ESIC (Employees’ State Insurance Corporation) is mandatory for employees earning below ₹21,000/month in notified areas. However, ESIC coverage is limited in scope (facility-based, not cashless at premium hospitals) and many employers who are subject to ESIC still supplement it with Group Health Insurance for a broader employee base. Employers of employees above the ESIC wage threshold are specifically expected to provide Group Health Insurance.
Group Health Insurance provides significant tax advantages for the employer:
Section 37(1) of the Income Tax Act:
The entire premium paid by the employer for Group Health Insurance is deductible as a business expense under Section 37(1) of the Income Tax Act. This means:
• For a company paying ₹50 lakh/year in GHI premium, at a corporate tax rate of 25.17%, the effective after-tax cost is approximately ₹37.5 lakh (the government effectively subsidises ₹12.5 lakh of the cost)
• The deduction applies to the full premium — both the employee portion and any company-funded portion
• The deduction is available for the policy year in which the premium is paid
Cost comparison to alternatives:
Providing ₹3 lakh annual health insurance to each of 100 employees individually would cost ₹15 lakh–₹20 lakh vs approximately ₹6 lakh–₹10 lakh for the equivalent coverage in a group policy. The group premium savings alone justify the GHI purchase — the talent and retention benefits are additional value.
Talent attraction:
• In campus recruitment, Group Health Insurance is consistently ranked among the top 3 benefits that fresh graduates consider
• For lateral hires, comprehensive family health cover (including parents) can be the deciding factor between two similar offers
• For senior management hires, high sum insured with parental coverage and maternity benefits signals organisational maturity
Retention:
• Employees who have experienced their family member’s hospitalisation covered by the company policy develop strong emotional loyalty to the employer
• High healthcare cost anxiety is a leading cause of employee financial stress — eliminating this stress through comprehensive GHI directly reduces attrition
• The cost of attrition (hiring, onboarding, productivity loss) for a single mid-level employee is estimated at 50%–150% of annual salary; GHI that prevents even a few attrition events pays for itself many times over
Productivity:
• Employees with health coverage seek early medical intervention rather than delaying until conditions worsen
• Early treatment means shorter sick leave periods and faster return to full productivity
• Health anxiety reduced → mental focus increased → output quality improved
Employer brand:
Companies known for excellent employee health benefits attract better talent pipelines, receive more referrals from current employees, and rank higher on employer review platforms (Glassdoor, Ambition Box, LinkedIn) — creating a self-reinforcing talent attraction advantage.
What Group Health Insurance Means for Employees — Benefits vs Individual Policy
Group Health Insurance gives employees benefits they simply cannot get from an individual policy at the same cost — particularly no waiting period, no medical check-up, and day-one coverage for pre-existing conditions.
| Feature | Group Health (GHI) | Individual Health |
|---|---|---|
| Who buys? | Employer | Individual |
| Pre-medical exam? | Not required | Required above age/sum |
| Waiting period? | No waiting period | 30 days initial; 2–4 years PED |
| Pre-existing conditions? | Covered from day one | Excluded for 2–4 years |
| Maternity? | Covered immediately | 2–4 year waiting period |
| Cost to employee? | Zero or minimal (employer-funded) | Full premium by individual |
| Dependents? | Spouse + children + parents | Self or family floater |
| Flexibility? | Employer decides terms | Individual chooses plan |
| Portability? | Yes — to individual on exit | Portable between insurers |
| Continuity on job change? | New employer's GHI from day one | Policy stays regardless of job |
Recommendation: GHI provides unparalleled benefits for employees with pre-existing conditions or maternity needs — but lacks portability and flexibility. An individual policy as a supplement to GHI provides permanent, portable, fully flexible coverage. Ideally every employee should have both.
Which Organisations Can Take Group Health Insurance
Any registered organisation or group with a minimum of 7 members can purchase Group Health Insurance. Both employer-employee groups and non-employer-employee groups are eligible under IRDAI's group insurance framework.
How to Use Group Health Insurance — Cashless & Reimbursement Claims
the insurer Group MediCare offers two claim modes — cashless at network hospitals (most convenient) and reimbursement at any hospital. Both modes are straightforward when the right documents are prepared.
For treatment at any of the 12,000+ the insurer network hospitals, the cashless claim process eliminates the need to pay hospital bills out of pocket:
Step 1 — Inform the insurer / Probitas:
• Emergency hospitalisation: Notify within 24 hours of admission
• Planned hospitalisation: Notify at least 48 hours in advance
• Call 022 6489 8282 or use the the insurer app / self-service portal
• Also inform Probitas on 022 4302 0000 — we assist in claim notification and tracking
Step 2 — Present Health Card at the Hospital:
Each employee receives a Health Card containing name, policy number, member ID, and policy details. Show the Health Card to the hospital’s TPA (Third-Party Administrator) desk upon arrival.
Step 3 — Pre-Authorisation:
The hospital’s TPA desk submits a pre-authorisation form to the insurer on behalf of the patient, describing the proposed treatment and estimated cost. the insurer reviews and approves the cashless authorisation (or requests additional information if needed).
Step 4 — Treatment and Discharge:
Once pre-authorisation is approved, the employee receives treatment. At discharge, the hospital submits the final medical bills and reports directly to the insurer for settlement.
Step 5 — Direct Hospital Settlement:
the insurer reviews the bills and settles the covered portion directly with the hospital. The employee pays only any non-covered items (consumables not under policy, co-pay if applicable, amounts above room rent limit if applicable).
Documents for Cashless Claims:
• Health Insurance Card / Policy Copy
• Company photo ID
• Customer address proof
• CKYC Form (if claim above ₹1 lakh)
• Admission notes from treating doctor
• Previous OPD papers and reports
• Previous discharge summary (if any)
For treatment at non-network hospitals, or when the employee paid bills upfront and is seeking reimbursement:
Step 1 — Inform the insurer:
• Emergency: Within 24 hours of admission
• Planned: At least 48 hours in advance
• Toll-free: 022 4302 0000 or the insurer app
Step 2 — Get Treatment and Pay Bills:
The employee receives treatment at the hospital and pays all bills at the time of discharge. Keep ALL receipts, reports, and documents safely.
Step 3 — Submit Claim Documents (within 15 days of discharge):
Submit all of the following:
• Duly filled and signed claim form
• Health insurance card or policy copy
• Medical certificate signed by the doctor
• Original discharge summary and final consolidated bill
• Detailed break-up of the final bill
• Original cash receipts from hospital, pharmacy, and lab
• Bank account details for reimbursement transfer
• Supporting investigation reports (blood tests, scans, X-rays)
• Invoices for any implants used
• MLC / FIR if the treatment was due to an accident
• Nominee details and ID/address proof (for death claims)
• CKYC form if claim value exceeds ₹1 lakh
Step 4 — Reimbursement Settlement:
the insurer reviews the documents and reimburses the covered expenses to the employee’s bank account. Typical timeline: 7 to 30 days after all documents are received and verified.
The Health Card is the employee’s gateway to cashless treatment — it must be presented at the hospital TPA desk for cashless claims:
What the Health Card contains:
• Employee name and member ID
• Policy number and insurer details
• Policy period (coverage dates)
• Age and date of birth
• Gender and sum insured details
• TPA helpline number
How to download the Health Card:
• the insurer mobile app: Login to the the insurer app and download from the policy/member section
• Email: The health card is shared as an email attachment by the employer when the policy is activated
• Employer HR portal: Many companies with HR management systems integrate health card distribution through their HRMS
Practical tip: Every employee should save their Health Card on their smartphone the moment they receive it — during an emergency is not the time to be searching for documents. We recommend employees save a digital copy and share a copy with a trusted family member.
Probitas assists with health card distribution, employee helpdesk queries, and claim support for all group health policies we manage. Call 022 4302 0000 for any claims assistance.
What Group Health Insurance Does NOT Cover
While Group MediCare covers a comprehensive range of medical treatments, certain categories of treatment are excluded from standard coverage.
Diagnostic tests and evaluations (blood tests, scans, X-rays) not connected to an ongoing in-patient or daycare treatment are not covered. OPD diagnostics done for routine health monitoring or diagnostic work-ups that do not lead to a covered treatment are excluded. Pre- and post-hospitalisation diagnostics connected to a covered admission ARE covered.
Bed rest, temporary care, and nursing home admission purely for respite (caring for a patient with a chronic, incurable condition who is stable and not receiving active treatment) are not covered. Only active, curative medical treatment qualifies for coverage.
Surgical treatment for obesity (bariatric surgery, lap band) is not covered unless specifically recommended by a doctor as medically necessary based on standard medical guidelines (e.g., Class III obesity with comorbidities). Cosmetic weight loss procedures are not covered.
Medical expenses related to gender reassignment or gender change surgery are not covered under the standard Group MediCare policy.
Cosmetic surgery, aesthetic procedures, and elective plastic surgery are excluded unless required due to an accident, burn, cancer, or other medically necessary reason documented by the treating physician. Dental treatments are also excluded unless arising from an accident or specified dental procedures.
Medical treatment, rehabilitation, or hospitalisation for alcohol addiction, drug abuse, substance abuse, or any related conditions are not covered. Withdrawal management in a hospital setting is also excluded.
Medical treatments, therapies, or medications that are not scientifically validated, not approved by relevant medical authorities, or classified as experimental by the insurer are excluded. Only established, evidence-based medical treatments are covered.
Treatment for refractive error (glasses/contact lens prescriptions); injuries from adventure sports and dangerous activities; treatments arising from breach of law; sterility and infertility treatments; assisted reproduction (IVF); and enteral feeding (tube feeding). Please refer to the policy document for the complete exclusion list.
Inclusions and exclusions may vary based on the specific policy terms negotiated for each group. Large employers can negotiate enhanced coverage terms including reduced or waived exclusions for specific conditions. Probitas advises on optimal policy structuring to maximise coverage for your specific employee population. Please read your Group MediCare policy document for the complete and definitive terms applicable to your group. Probitas Insurance Brokers Pvt. Ltd. · IRDAI Lic. No. 528.
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By submitting you agree to our Privacy Policy and Terms & Conditions. Group Health Insurance premium depends on group size, age profile, coverage scope, and claims history. IRDAI mandates Group Health Insurance for all employers post-COVID. Minimum group size: 7 members. Coverage terms per the insurer Group MediCare policy document. Probitas Insurance Brokers Pvt. Ltd. · IRDAI Lic. No. 528.