Group Mediclaim Policy is the insurer's flexible group indemnity health insurance product, designed specifically to address the basic health insurance needs of both employer-employee groups (companies covering their staff) and non-employer-employee groups (associations, societies, alumni networks, professional bodies covering their members). Each insured person gets an individual sum insured within the group structure, with coverage for hospitalisation, day care, 12 modern treatments, HIV/AIDS, mental illness, and optional maternity — all at group-discounted premiums.
Probitas Insurance Brokers· takemyinsurance.com
"Group Mediclaim Policy is a group indemnity health insurance product designed specifically to address basic health insurance need of both employer-employee and non-employer–employee groups. The Policy covers Hospitalization Expenses for In-Patient Care (allopathic, Ayurveda and homeopathy) or Day Care Treatment Reasonably and customarily incurred for treatment of an Illness contracted/Injury sustained during the Policy Period." — the insurer's own product page. Although issued as a single group policy, each insured person carries their own individual sum insured — the policy simply aggregates many individual covers under one administrative umbrella for a group/organisation.
"Target Group can be all combinations viz, Employer-Employees, Non-Employer-Employee covering all Social Sectors, Corporates / Non-Corporates." Whether you're an HR team, a professional association, an alumni network, or a society — NGMP fits.
All Group TypesGranular sum insured selection in 15 slabs: ₹50,000 increments from ₹50,000–₅L, then ₹1 lakh increments from ₆L–₁₀L. Different employee/member tiers can be assigned different SI levels within the same group policy.
15 SI Options"Minimum group size: 7 members." A low entry threshold makes NGMP accessible even to small businesses, small associations, and modest-sized professional bodies — not just large corporates.
Low Entry Threshold"Entry age: Min- 3 Months, Max- No Limit." Newborns from 3 months old to employees/members of any age — including senior employees and retirees — can be covered, subject to group composition rules.
No Maximum AgeRobotic surgery, immunotherapy, oral chemotherapy, stem cell therapy, and 8 more advanced procedures — confirmed as standard coverage (within sub-limits), not an exotic add-on. Modern medicine, covered for every group member.
Standard Inclusion"The following group discounts are available: Up to 500 — NIL, 501–2000 — 5%, 2001–5000 — 10%, 5001 and above — 15%." Larger groups unlock meaningfully lower per-member premium.
Scales with Group SizeProbitas Insurance Brokers· takemyinsurance.com
"Target Group can be all combinations viz, Employer-Employees, Non-Employer-Employee covering all Social Sectors, Corporates / Non-Corporates." NGMP is deliberately designed to be flexible across organisational types — the single most defining feature distinguishing it from the insurer's individual and family retail products.
Probitas Insurance Brokers· takemyinsurance.com
| Criterion | NGMP Terms |
|---|---|
| Age at entry — Adults | 18 years and above |
| Age at entry — Children | Children between 3 months and 18 years may be covered, provided parent(s) is/are covered at the same time |
| Who can be covered | Self· Spouse· Dependent legitimate or legally adopted children up to 18 years· Dependent male child above 18 and up to 25 years, if a bonafide student and not employed· Dependent female child if not employed, till marriage· Dependent parents |
| Mid-term inclusion | Newborns between 3 and 6 months· Spouse within 60 days of marriage· Other family members may be included only at renewal |
| Policy period | 1 year (also available as 1, 2, or 3-year terms per confirmation) |
| Sum insured | Minimum ₹50,000· Maximum ₹10 lakh |
| Minimum group size | 7 members |
| Policy type | Individual basis within the group (each insured person carries their own SI) |
's "at a glance" data states entry age as "Min- 3 Months, Max- No Limit" (suggesting the 3-month threshold applies broadly), while 's detailed eligibility table specifies adults at 18+ with children 3 months–18 years (provided a parent is concurrently covered) — the standard family-structure rule used across most the insurer group and family products. Both are the insurer-sourced; the apparent difference likely reflects "at a glance" summarisation versus the detailed policy wording. For your specific group's exact age structure, confirm with Probitas at 022 4302 0000.
Probitas Insurance Brokers· takemyinsurance.com
"This plan has a wide sum insured ranging from INR 50,000 to INR 10 Lakhs in 15 slabs (in the multiples of x value in ascending order). The value of the sum insured is attended in two ways: Sum insured- INR 50,000 - 5 Lakhs (comes in a multiple of INR 50,000), Sum insured- INR 6 - 10 Lakhs (comes in multiples of INR 1 Lakh)."
Because each insured person carries their own individual sum insured within the group structure, organisations can assign different SI tiers to different employee/member categories under a single NGMP policy — for example, senior management at ₹10L, mid-level staff at ₅L, and entry-level staff at ₂L — all administered under one group policy with one renewal date, while each individual's claims are assessed against their own assigned SI.
Probitas Insurance Brokers· takemyinsurance.com
As a basic, affordable group product, NGMP applies sub-limits to several expense categories rather than offering unrestricted coverage up to the full sum insured on every item. Understanding these sub-limits is important for HR teams and group administrators setting member expectations.
| Coverage Parameter | Sub-Limit |
|---|---|
| Room charges | 25% of Sum Insured |
| Medical practitioner's fees | 25% of Sum Insured |
| Other expenses | 50% of Sum Insured |
| Modern treatment expenses | Up to 25% of SI (extendable to 50% as optional cover) |
| Hazardous/adventure sports (non-professional) | 25% of Sum Insured |
| Pre-hospitalisation expenses | 30 days |
| Post-hospitalisation expenses | 60 days |
| Ambulance charges | 1% of SI, max ₹1,000 per policy period per insured person |
If an insured person has ₹5,00,000 SI, room charges are capped at 25% = ₹1,25,000 for the policy period (not per hospitalisation, depending on policy wording — confirm exact application with Probitas), medical practitioner's fees similarly capped at ₹1,25,000, and "other expenses" (medicines, diagnostics, surgical items etc.) capped at 50% = ₹2,50,000. These sub-limits work alongside, not instead of, the overall SI ceiling — a claim is capped by whichever limit (sub-limit or overall SI) is reached first for that category.
Probitas Insurance Brokers· takemyinsurance.com
"All the expenses related to hospitalization, such as anesthesia, blood, oxygen, operation theatre charges and surgical appliances, medicines and drugs, diagnostic procedures, prosthetics, and other devices or equipment, if implanted internally during a surgical procedure, are covered under this plan."
Comprehensive In-Patient Cover"The Company will indemnify the Hospital or the Insured Person for the Medical Expenses (including Pre and Post Hospitalisation Expenses) incurred for Ayurveda and Homeopathy treatment, provided the treatment is undergone in an Ayush Hospital."
Ayurveda + Homeopathy"140+ daycare procedures" are covered — confirmed across both and. Procedures that historically required 24+ hour hospitalisation but now, due to medical advancement, require less than 24 hours, are covered subject to prior approval of the Company/TPA.
140+ Procedures"The policy will cover the Medical Expenses (including Pre and Post Hospitalisation Expenses) related to Mental Illnesses, provided the treatment will be undertaken at a hospital with a specific department for Mental Illness under a Medical Practitioner qualified as a Psychiatrist." Confirmed as Clause 3.1.4 in the real-world IEEE policy document.
Standard InclusionConfirmed as a standard covered condition (Clause 3.1.3 in the real-world IEEE policy document) and listed by among NGMP's advanced treatment inclusions. A meaningful inclusion given many older or basic health policies historically excluded HIV/AIDS.
Clause 3.1.3"The Company will indemnify the Hospital or the Insured Person, the Medical Expenses (excluding Pre and Post Hospitalisation Expenses) incurred for the organ donor's treatment during the course of organ transplant to any Insured Person."
Donor Hospitalisation Only"The Company will reimburse the Insured Person the expenses incurred for emergency ambulance charges, up to 1% of the Sum Insured subject to a maximum of Rs. 1,000/- in a Policy Period for each Insured Person.. Ambulance Charges will be admissible provided a Hospitalisation claim has been admitted under the Policy."
1% SI, Max ₹1,000Listed by among standard inclusions: "morbid obesity treatment" is covered (subject to policy terms and applicable waiting periods) — a condition often excluded entirely from basic group products elsewhere in the market.
Inclusion"Correction of eye sight due to refractive error equal to or more than 7.5 dioptres, subject to Waiting Period of 02 (two) years." — the insurer product page. High-degree refractive error correction surgery is covered after the 2-year wait.
2-Year Wait, ≥7.5 DioptresProbitas Insurance Brokers· takemyinsurance.com
"What are the modern treatments covered under Group Mediclaim Policy?"'s FAQ (sourced directly from the insurer policy wording) lists all 12 by name, below. Standard coverage is up to 25% of SI, extendable to 50% as an optional cover (see Optional Covers section).
"Modern Treatment Cover: Coverage is provided for 12 listed modern treatments. For hospitalisation related to these, a maximum of 25% of the sum insured is applicable." As an optional cover, this can be enhanced: "Modern Treatment: Coverage for 12 modern treatment procedures, subject to 50% of the sum insured for each treatment" — meaning groups can opt to double the modern treatment sub-limit from 25% to 50% of SI as an add-on. Call Probitas at 022 4302 0000 to discuss whether the enhanced 50% modern treatment option makes sense for your group's risk profile and budget.
Probitas Insurance Brokers· takemyinsurance.com
"The plan offers two optional covers" Both are add-on enhancements that organisations can choose to include for an additional premium, tailoring NGMP's basic structure to their group's specific needs.
"Modern Treatment: Coverage for 12 modern treatment procedures, subject to 50% of the sum insured for each treatment." Doubles the standard 25% sub-limit to 50% for all 12 modern treatments — valuable for groups with higher exposure to conditions like cancer (oral chemo, immunotherapy) or cardiac/neuro conditions requiring these procedures.
25% → 50% of SI"Maternity Benefit (Optional): The policy will pay Maternity Expenses up to Rs. 50,000/- for up to the first two deliveries or terminations of pregnancy of the Insured Person, as described below, and pre-natal and post-natal hospitalization expenses per delivery." Up to ₹50,000 per delivery/termination, limited to the first two such events per insured person, with pre-natal and post-natal hospitalisation included.
₹50,000/Delivery, Max 2Probitas Insurance Brokers· takemyinsurance.com
"What is a group discount under the Group Mediclaim Policy?"'s FAQ confirms a tiered discount structure based on the number of primary members in the group, applicable on the total premium.
| Number of Primary Members | Group Discount |
|---|---|
| Up to 500 | NIL |
| 501–2,000 | 5% |
| 2,001–5,000 | 10% |
| 5,001 and above | 15% |
"Premiums paid for the Group Mediclaim Policy are eligible for tax benefits under Section 80D of the Income Tax Act, 1961."
"Opting for a 5% co-payment provides a 4% discount on premiums. Choosing a 10% co-payment offers an 8% discount on premiums."
"No change (increase or decrease) of the sum insured is to be allowed during the policy period. Enhancement of SI is allowed at renewal."
from the insurer Product Page
"Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy." — the insurer product page. Illness-related claims excluded in the first 30 days; accident claims payable from Day 1.
30 Days, Accidents Day 1"Correction of eye sight due to refractive error equal to or more than 7.5 dioptres, subject to Waiting Period of 02 (two) years." — the insurer product page.
2-Year Wait"All pre-existing diseases included after first forty eight months (48) of Policy." — the insurer product page. Note: separately states a 4-year PED wait ("Pre-existing diseases, as specified in your policy schedule, are covered after a waiting period of 4 years") — consistent with 48 months.
48 Months / 4 Years"90 days, One, Two and Four Years waiting period for specific diseases." — the insurer product page. A graded waiting period schedule applies to specific named conditions (e.g. hernia, cataract, joint replacement, morbid obesity) per the policy's specific disease list.
90D / 1Y / 2Y / 4YProbitas Insurance Brokers· takemyinsurance.com
"Change-of-Gender Treatments, Cosmetic or Plastic Surgery, Excluded Providers." — the insurer product page.
"Vitamins, Tonics Drug/alcohol abuse, Self-Inflicted Injury." — the insurer product page. Self-inflicted injury, suicide, or suicide attempt also separately confirmed by.
"Dental treatment (unless arising out of accident and requiring hospitalization) and Out Patient Department treatment (OPD treatment)." — the insurer product page.
Hazardous or adventurous sports (skydiving, paragliding, scuba diving etc.) excluded for non-professionals unless taken as an optional cover at 25% of SI sub-limit — confirmed by both the insurer product page and.
"Any treatment cost related to obesity control will not be compensated by the policy" — confirmed by, though note morbid obesity treatment is separately listed as covered by subject to waiting periods; bariatric/weight-control treatment outside this defined scope remains excluded.
"Injury incurred due to the participation in any unlawful act or due to war, war-like situation, riots, public unrest, etc, will not be covered by the policy."
"Treatment taken outside the geographical limits of India" — confirmed excluded by (the insurer sourced).
"Birth control, sterility and infertility" excluded — confirmed by. "Gestational Surrogacy and reversal of sterilization are excluded" — also confirmed by.
"Investigation and evaluation" and "Rest cure, rehabilitation and respite care" excluded — confirmed by. "If you are having bed rest and do not have any medical treatment for the disease, it is not covered" — confirmed by.
Probitas Insurance Brokers· takemyinsurance.com
NGMP supports both cashless treatment at TPA network hospitals and reimbursement claims for non-network treatment, following the insurer's standard group claims process.
"Written intimation/mail/fax about hospitalisation is to be sent to TPA/Company within 72 hours of hospitalisation in the case of emergency hospitalisation and 72 hours prior in case of planned admission." — the insurer product page.
"On admission, a Pre-Authorisation Request for cashless will be sent to the TPA by the hospital – duly signed by the insured and Hospital Authorities giving the details of admission, illness, proposed line of treatment and the estimated expenses." — the insurer product page. Available only at networked hospitals (Preferred Provider Network or other network hospitals) of the Company/TPA.
"Before leaving the hospital, Discharge Summary, investigation report and other relevant documents (Claim form – Part A & Part B) may be obtained from the hospital authorities. All the documents in original are to be submitted to TPA/Office within 15 days from date of discharge." — the insurer product page.
"Pre and post hospitalisation expenses can be claimed separately after treatment. All documents in original are to be submitted within 15 days to TPA, after completion of Post Hospitalisation treatment." — the insurer product page.
For accident-related claims: "lodging an FIR at the nearest Police Station if necessary" is recommended, followed by submission of the claim form with Police Reports, Doctors' Prescriptions, Pathological test reports, Cash Memos, Admission/Discharge Certificates, and Surgeon/Doctor receipts as applicable — confirmed by (the insurer sourced). The policy-issuing office may appoint a Surveyor/Loss Assessor or refer to panel doctors before final settlement; provisional payment may be made pending final processing in some cases.
Group Mediclaim Policy — Frequently Asked Questions
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By submitting you agree to our Privacy Policy and Terms & Conditions. Group Mediclaim Policy (NGMP)· IRDAI Licensed. For employer-employee and non-employer-employee groups (minimum 7 members). SI: ₹50,000–₁₀ lakh in 15 slabs. Entry age: 3 months (children, with parent concurrently covered) to no upper limit for adults. Group discount: NIL up to 500 members, 5% for 501–2,000, 10% for 2,001–5,000, 15% for 5,001+. Co-payment discount: 4% (5% co-pay) or 8% (10% co-pay). 12 modern treatments covered up to 25% SI standard (50% SI optional). Maternity optional cover: ₹50,000/delivery, max 2 deliveries. Initial waiting period: 30 days (accidents from Day 1). PED: 48 months/4 years. Refractive error (≥7.5 dioptres): 2-year wait. SI changes only at renewal. All terms per NGMP policy document. Probitas Insurance Brokers Pvt. Ltd.· IRDAI Lic. No. 528.