Group Coverage · sub-product

Group Medical Coverage (GMC)

Cashless hospitalisation for employees and their dependants. Structured to satisfy ESIC exemption conditions, corporate benefit expectations and sector-specific mandates. The single most-claimed employee benefit in Indian corporates.

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Coverage at a Glance

Cashless Hospitalisation

Empanelled network across India with direct insurer settlement

Family Floater

Employee + spouse + children + dependent parents, structured for ESIC exemption

Pre & Post-Hospitalisation

Medical expenses 30 days before and 60 days after the admission

Maternity & Newborn

Optional cover with waiting-period waivers for corporate group

Coverage

What this sub-cover provides

A focused placement that responds to the specific transit, treatment or workforce event this cover is designed for.

Cashless inpatient treatment

Direct settlement with empanelled hospitals across India for room rent, ICU, surgical, anaesthesia, nursing and diagnostic charges during admission.

Pre and post-hospitalisation expenses

Medical expenses incurred 30-60 days before and 60-90 days after the inpatient admission, including diagnostic tests and prescribed medication.

Day-care procedures

Over 150 procedures requiring less than 24 hours of admission, including cataract, chemotherapy, dialysis and selected orthopaedic procedures.

Maternity and newborn cover

Optional but standard in modern corporate GMC, with waiting-period waivers and newborn cover from day one of birth.

Pre-existing condition cover

For corporate group policies, the standard waiting period for pre-existing conditions is typically waived from day one.

Domiciliary hospitalisation

Cover for treatment at home where admission is not possible, subject to a minimum treatment duration and medical practitioner certification.

Group Coverage

Our Approach

The premium is not the metric. The claims experience is.

Most corporate GMC programmes are placed on the cheapest available premium, then drift into auto-renewal at progressively worse terms. A well-managed GMC is rebenchmarked annually, re-tendered every two to three years, and audited for actual claims experience against the insurer's published reserves. The metric that matters is what employees actually receive when they claim, not what the proposal form quoted at inception.

Comparing Quotations

What actually differs between two group medical quotations

For an employer of twenty to a hundred people, the premium is the last thing worth comparing, because every item below changes what that premium buys. These are the six that decide what an employee is actually paid when they are admitted. We put them side by side across insurers before anyone looks at the figure.

Room rent limit

The line that decides the most and is read the least. Where the room taken exceeds the eligible category, most policies scale the whole claim down proportionately - so a room rent cap quietly caps the surgeon, the anaesthetist and the diagnostics too, not just the bed.

How the family is defined

Employee only, or with spouse, children, parents and parents-in-law. Each step changes the risk being carried and therefore the terms. Parents are usually the step that decides the programme.

Whether waiting periods are actually waived

On group cover the pre-existing disease waiting period and the thirty-day initial waiting are commonly waived - but commonly is not always. A quotation that carries them is a materially different product from one that does not, at any price.

Continuity for members moving across

Employees coming from a previous policy should carry their served waiting periods with them. This is negotiated at placement, not granted automatically, and it is the item most often lost when a programme changes insurer.

Co-payment and named-procedure sub-limits

A co-payment is a fixed share of every claim borne by the employee, and per-procedure caps sit on cataract, hernia and joint replacement in many group policies. Both reduce the premium and both move the cost onto staff at the moment they claim.

Who answers the telephone at two in the morning

Whether claims run through a third-party administrator or the insurer's own desk, which hospitals in Udaipur are genuinely on the network by name, and what the cashless approval standard is in the policy rather than in the presentation.

Group medical is bought once a year on a fixed date, and the incumbent insurer must give you the claims experience report on request. Asking for it sixty to ninety days before expiry is what turns a renewal from a rate you are handed into a rate you can argue. Leave it to the last fortnight and there is no time to market the risk properly.

Key Benefits

What you get when we place this cover

ESIC exemption compliance

Cover structured to satisfy ESIC exemption conditions including the requirement to cover spouse, children and dependent parents at appropriate sum-insured levels.

TPA co-ordination

We manage the relationship with the third-party administrator, escalate cashless denials where cover clearly applies, and resolve pre-authorisation disputes.

Annual re-benchmarking

Premium and terms re-benchmarked against the market every renewal - not left to incumbent insurer auto-renewal calculations.

Sub-limit-free placement

We actively select policies without room-rent sub-limits or disease-wise capping - the two most common sources of claim disputes in corporate GMC.

Smaller companies

Fewer than a dozen employees?

Most Indian insurers set a minimum group size, and below it the answer for a small company is usually a different structure rather than a refusal. Group health insurance for a small business sets out what the minimum actually is, why it is counted in lives rather than employees, and the four routes that work when the headcount is small.

FAQ

Common Questions

Most insurers require a minimum of 7 covered lives for a GMC policy. For smaller groups (5-6 lives), specialist insurers will accept the placement at a higher per-life premium. We place groups from 5 lives upward.

Yes. Standard corporate GMC covers employee + spouse + up to 2-3 dependent children. Dependent parents can be added as an extension, typically at an additional premium per parent. For ESIC exemption, employee + spouse + dependent children is the minimum required.

Departing employees can port their GMC cover to an individual health policy within 30 days of leaving employment, retaining their waiting-period credits under IRDAI portability rules. We co-ordinate this process for departing employees.

For corporate group policies with 50+ covered lives, insurers typically waive the standard 3-year waiting period for pre-existing conditions from day one. For smaller groups, some exclusions may apply in the first year. We negotiate the specific waiver at placement.