Employee benefits · India
Most small employers arrive here having been told their company is too small for a group policy. It is half true, and the useful part is what to do about it. There is no market-wide minimum, the threshold is usually counted in lives rather than employees, and there are four routes that work when the headcount is small.
Almost nobody arrives here wanting a definition. They arrive having been told, usually by an insurer's call centre, that their company is too small for a group policy, and wanting to know whether that is true and what to do about it.
It is partly true. Indian insurers set a minimum group size, the threshold differs between them, and a very small employer sits below where most are comfortable. It is not the end of the conversation, and being told it is usually means you were speaking to somebody who sells one insurer's products.
There is no market-wide minimum. Each insurer sets its own, they differ, and they move. Any page quoting you a single figure for the whole market is guessing.
What matters more is that the minimum is usually counted in LIVES, not employees. If you cover employees with their spouses and children, a company with a handful of staff can reach a group size several insurers will write. That single distinction resolves a great many enquiries that started out being told no.
We confirm each insurer's stated minimum in writing before recommending one, rather than working from what is generally believed.
Count dependants as lives. Employee plus spouse plus children multiplies the headcount and often clears the threshold outright. It is the first thing to test and it costs nothing to ask.
Cover everybody rather than only the eligible. Employers with a waiting period before benefits start often ask to insure only those who have qualified. Covering the whole payroll is a larger group and easier to place, and the eligibility rule can stay as an internal matter of who the company pays for.
Individual policies held on a company account. Each employee is underwritten on their own health, every insurer in the market will write them, and the company still pays and controls the renewal. The cover is often wider than a small group scheme would be, and the policy stays with the employee if they leave.
Start now and convert later. Waiting periods for pre-existing conditions run from the day cover begins. Beginning small means those months are being served while you grow, and they carry across when a group scheme eventually suits you better. Waiting saves nothing and costs your people a year of protection.
On a large scheme the numbers average out. On a small one they do not, and the ages of the specific people covered drive almost everything. One older employee changes the terms for the whole group in a way that would be invisible at scale.
After age, the things that move it are the sum insured, whether families and parents are included, and the add-ons. Cover for pre-existing conditions from day one, waiting periods waived, maternity and the room rent basis change the cost far more than the headline sum insured does, and they are what your team will actually notice.
Anyone quoting a small business a premium before seeing dates of birth is guessing. We do not, and we would treat a figure offered on that basis with caution.
Buying on premium and discovering the room rent cap at the hospital counter. A capped room rent proportionately reduces the whole bill, not just the room, which is where small-group claims quietly shrink.
Assuming employees' compensation or ESIC covers this. They do not. Statutory cover answers for accidents arising out of employment; it does nothing for illness, and it stops at the factory gate.
Leaving joiners off the schedule. An employee who never made it onto the policy is not covered, whatever anybody intended. On a small account this is the single most common uninsured loss.
Not declaring a known condition at proposal. It is far better handled openly, it frequently costs nothing extra, and it is the thing most likely to sink a claim if it surfaces later.
There is no single market-wide minimum. Each insurer sets its own and they differ, so the useful answer is the one confirmed in writing for your case. It is usually counted in lives rather than employees, so including spouses and children often reaches a size several insurers will write.
Frequently yes, though the field of insurers narrows. Counting dependants as lives, covering the whole payroll rather than part of it, or placing individual policies on a company account are the three routes that work. Being told no by one insurer is not the market's answer.
Not automatically, and on a very small group often not. A group scheme prices the group as a whole, and with few lives one person's age or health shapes the terms for everybody. Individual policies are underwritten separately, which on a small headcount can produce both wider cover and a better price.
There is no general statutory requirement to provide group medical cover. Employees' compensation and, where applicable, ESIC are separate statutory obligations that answer for employment-related injury rather than illness. Group medical is a benefit, and increasingly an expectation, rather than a law.
It depends almost entirely on the ages of the people covered, then on the sum insured, whether families are included, and which add-ons are taken. On a small group there is no averaging to hide behind, so a figure quoted before anybody has seen dates of birth is a guess rather than a quotation.
Under a group scheme, no: cover ends when they leave the group. Under individual policies held on a company account, yes, and the waiting periods they have already served stay served. For a small employer that is a real benefit to give and it costs the company nothing.
Group medical pays hospitalisation costs for illness and injury against actual bills. Group personal accident pays an agreed lump sum on accidental death or disability, anywhere, at any hour. They answer different questions and neither substitutes for the other.
A census: name or employee code, date of birth, gender, date of joining and city for each person to be covered, plus the same for any spouse and children. Tell us of any health condition, and roughly what the company expects to spend. From that we go to the market and return a written comparison.
Related: group medical cover · group personal accident · the wider employee benefits programme.