Group Health Insurance
What is Group Health Insurance?
Group Health Insurance is a specialized medical policy designed to provide comprehensive healthcare
coverage to a group of individuals who share a common bond—be it members of a professional
association, a non-profit organization, a housing society, or a sports club. Unlike individual plans,
group insurance offers the benefit of collective bargaining, resulting in lower premiums and enhanced
benefits.
For any group or association, it is an essential benefit that provides financial security against rising
medical costs. One of the most significant advantages of DigiAssure's Group Health plans is the waiver
of the standard waiting periods for pre-existing diseases, ensuring that all members are protected from
the very first day. With a vast network of 10,000+ hospitals and a streamlined digital claim process, we
ensure that your group's health is never compromised by financial constraints.
Why Opt for Group Coverage?
1. Significant Cost Savings
By insuring a large group together, the per-member premium is drastically lower than individual plans, often making high-quality healthcare accessible to everyone in the group.
2. Immediate Coverage
Standard health plans have 2-4 year waiting periods for existing illnesses. Our group plans can waive these periods, providing 'Day 1' coverage for all medical conditions.
3. No Medical Check-ups
Members can usually join the policy without undergoing time-consuming and invasive medical examinations, regardless of their age or health history.
4. Tailor-made Benefits
Associations can customize their plans to include specific benefits like maternity limits, room rent caps, or OPD coverage based on the group's unique demographics and budget.
Key Features of Our Group Plans
Cashless Network
Direct settlement of medical bills with over 10,000 top-tier hospitals across the country for a stress-free experience.
Pre & Post Care
Covers all medical expenses related to the illness incurred before hospitalization and after discharge (up to 180 days).
Daycare Procedures
Coverage for advanced medical treatments like cataract or dialysis that require less than 24 hours of hospitalization.
Maternity Benefit
Option to include comprehensive delivery and newborn care benefits from day one for all eligible members.
Dedicated Support
A specialized relationship manager to handle the group's policy queries, member additions, and claim settlements.
Digital Management
Manage member data and track claims in real-time through our intuitive group administration dashboard.
Group Health vs Individual Plans
See how group insurance provides superior value for associations.
| Feature | Group Health Insurance | Individual Health Plan |
|---|---|---|
| Premium Amount | Significantly Lower | Higher |
| Waiting Period (PED) | Often Waived (Day 1) | 2 to 4 Years |
| Medical Screening | Not Required (in most cases) | Mandatory for certain ages |
| Maternity Waiting | 0 to 9 Months | 2 to 4 Years |
| Policy Customization | Highly Flexible | Standard Options Only |
| Member Onboarding | Quick (Census-based) | Individual underwriting |
| Continuity of Cover | Depends on Group Membership | Independent |
Scope of Coverage
Understand the comprehensive protection provided to every member.
What is Covered
Essential benefits for member security:
- Inpatient Hospitalization (24 hrs+)
- Surgeon, Anesthetist & Doctor Fees
- ICU Charges & Nursing expenses
- Diagnostic tests (X-ray, MRI, etc.)
- Medicines and Consumables
- Modern robotic surgeries
Common Exclusions
Standard policy exclusions:
- Intentional self-inflicted injuries
- Cosmetic or Plastic surgery (unless trauma)
- Substance abuse or Alcohol related
- External hearing aids or Spectacles
- Weight control or Obesity treatments
- War or Nuclear perils
Valuable Add-On Covers
Enhance your group policy with specialized benefits.
Outpatient (OPD) Cover
Covers doctor consultations, pharmacy bills, and diagnostic tests that do not require hospitalization, reducing the day-to-day medical expenses of members.
Parental Coverage
Allows members to include their dependent parents under the same plan, ensuring quality healthcare for the elderly without standard waiting periods.
Critical Illness Cover
Provides a lump-sum payout upon diagnosis of life-threatening illnesses, acting as an essential financial buffer during long-term treatments.
Dental & Vision Care
Specialized add-ons to cover routine eye check-ups, spectacles, and dental treatments, providing holistic health protection.
Factors Affecting Group Premiums
How we calculate the most competitive rates for your association.
1. Group Size
Larger groups benefit from economies of scale, leading to a lower per-member premium cost compared to smaller associations.
2. Average Age Profile
The demographic distribution of the group plays a key role in risk assessment and final premium calculation.
3. Previous Claims History
For existing groups, the claim-to-premium ratio of the previous year is the most critical factor for renewal pricing.
4. Chosen Sum Insured
The level of coverage chosen (₹3L, ₹5L, or ₹10L per member) directly impacts the total premium for the group.
5. Corporate Buffer Option
Including a secondary pool of funds (buffer) for critical cases will add a specific cost to the base premium.
Documentation List
Simplified requirements to get your group policy started.
Member Census Data
- Full list of members with Names and Date of Birth
- Gender and relationship of dependents (if covered)
- Designation or Category of members
Organization Documents
- Registration Certificate of the Association/Entity
- Organization's PAN Card copy
- GST Registration Certificate (if applicable)
KYC Details
- Authorized Signatory's ID Proof
- Registered Address Proof
- Canceled Cheque for premium payment
Proposal Form
- Signed and Stamped Proposal Form
- Formal acceptance of the finalized quotation
- Board Resolution / Letter of Authority
Simple Claim Experience
Ensuring every member gets care without financial hurdles.
Hospital Selection
Member visits any network hospital. Our network covers 10,000+ top hospitals nationwide.
Card Intimation
Show the digital DigiAssure health card at the hospital's TPA desk for immediate identification.
Pre-authorization
The hospital sends medical reports and a pre-auth request to our TPA team for approval.
Cashless Approval
We provide initial approval within 2-4 hours, allowing the treatment to begin without any deposit.
Medical Monitoring
Our claim experts monitor the treatment to ensure medical necessity and reasonable charges.
Discharge & Billing
Upon discharge, the hospital sends final bills. We settle the admissible amount directly with them.
Digital Tracking
Members can track their claim status and view settlement letters on our mobile application.
Advocacy Support
In case of any query, our dedicated group helpline is available 24/7 to support the member.
Frequently Asked Questions
Common queries about group health insurance policies.
What is the minimum group size for a health policy?
Most insurers require a minimum of 7 to 10 members to issue a group health policy. However, customized 'Micro-Group' plans are available for smaller associations with at least 5 members.
Does every member need to undergo a medical check-up?
No, one of the primary benefits of group health insurance is the waiver of individual medical examinations, provided the group meets the insurer's size and risk guidelines.
Are pre-existing diseases covered from day one?
Yes, most group health policies include a 'Waiver of Waiting Period', which means pre-existing diseases and specific illnesses are covered from the first day of the policy for all members.
Can members add their families to the group plan?
Yes, depending on the plan structure chosen by the association, members can often add their spouse and dependent children to the group policy at subsidized rates.
What is a 'Corporate Buffer' in group insurance?
A buffer is a secondary pool of insurance coverage managed by the association. If a member's individual sum insured is exhausted due to a major surgery, the buffer can be released to cover the remaining costs.
How long does it take to settle a cashless claim?
Cashless claims are usually pre-authorized within 2 to 4 hours at network hospitals. The final settlement at discharge is typically completed within 3 to 6 hours after receiving all medical documents from the hospital.