Dear Seniors, Could u please help me to understand the differene between Group Mediclaim policy and Group Accident Insurance policy and the importance of it. Kindly reply
29th October 2009 From India, Guwahati
Miss Rath,



To understand in simple terms:-

Group Medicalim Policy - It is the insurance policy taken by the Employer to cover the medical expenses of the employee & the dependents of his/her choice. It is at the discretion of the employer what is the coverage amount that the employer is opting for. In this kind of policy employee can cover himself/herself & his family members who are dependent on him. It depends on the policy taken that how many members can be covered, whether is its 1+3 or 1+ 4 or 1+5.

Along with himself /herself the employee can cover his/her Mother /Father, OR Wife /Kids Or a combination of his/her choice covering the above members.

While taking a Group Medicalim Policy there are certain clauses which are attached to it & depends on what kind of policy has been taken by the Employer :-

• Pre –existing diseases are covered or not.

• Only Employer will bear the premium cost or some amount needs to be borne by Employee also.

• After spending how many years one can have those diseases covered which were not covered at the time of taking the policy.

• Maternity Cost is Covered or not.

• Whether the policy has both Cashless and Reimbursement option Or either of these two.

• Does the policy get applicable only on the condition of 24 hours hospitalization or OPD is also covered.

Group Personal Accident Insurance- It is another part of Group Insurance Policy which covers all the expenses related to the accident of the employee. Out here no other dependent is covered.

The amount again depends on what kind of policy has been taken by the employer.

Also if in an unfortunate incident there is a loss of employee life then after doing the paper work the nominee or dependents gets the amount of the policy.

In a uncertain world like today it holds a lot of importance both for Employer & employee.

For employer it works as way to take care of a very big personal need of an employee & the employee feels more connected to the organization and also sometimes it works as a good retention tool.

For Employee it is something which gives them a monetary safeguard against the big amounts that needs to be spend in the event of illness of his/her near & dear ones.

-Prashant
29th October 2009 From India, Delhi
Miss Rath,
Frankly speaking I will not be able to recommend you any specific policy. It all depends on your Company's decision that how much they want to invest in Insurance Policy, whether they will like to make it a joint contribution policy where both employee & employer contribute or they would like to make just the employer contribution, whether your company would like to make it a Group Policy or just one like (Accident Policy OR Mediclaim Policy OR both ), employees interest to contribute in the policy premium, total headcount etc.
All I can suggest is that if you are asking for a policy in Manufacturing concern i will suggest that you can take the policy which have amount more in the Personal Accident Clause as usually employees in manufacturing concern work extensively on machines so there is a greater risk of accidents also , so this kind of policy will help them to get the coverage.
2nd November 2009 From India, Delhi
The good health of the employee is in the best interest of the Employer. Therefore many corporate take this policy, as in a uncertain world like today it holds a lot of importance both for Employer & employee.

For employer it works as way to take care of a very big personal need of an employee & the employee feels more connected to the organization and also sometimes it works as a good retention tool.

For Employee it is something which gives them a monetary safeguard against the big amounts that needs to be spend in the event of illness of his/her near & dear ones.

Some general questions on Group Mediclaim :-

What is Group Mediclaim Insurance.

Group mediclaim is a policy which an organization / employer / Association / corporate takes for its employees.

How it is different from Individual Mediclaim?

Individual Mediclaim Policy is taken by an individual for himself and his family, where as Group Mediclaim policy is for group of people and their families. There are certain benefits / coverage which are available in Group Mediclaim Policy and not in Individual Mediclaim . listing herewith some of them . These could be –

Pre-Existing Disease coverage

Room Rent capping removal

Maternity Benefit inclusion

Baby day 1 Coverage

30 days waiting period waiver

Corporate Buffer.

Who do you define as your dependants?

Immediate and first family which includes, employee, spouse, 2 kids and employee's parents.

Are parents also usually covered under this policy?

Employees' parents are covered. Again, it depends on the employer.

Is the coverage given to employees based on the grade at which one is?

Can be made flexible. Managers and above . But it is not necessary. Policy can be tailor made.

Do Insurance companies have a floater policy?

Yes, Insurance companies do have floater policy. It would be beneficial if you have a headcount of more than 100 or so, because insurance companies normally don't extend floaters for a lesser headcount.

Does it make sense to have a floater policy?

It does make sense from the employee's point of view if dependent family is covered.

What if in a floater policy the group coverage amount is utilized by other dependants & when it comes to the employee's illness there is nothing left... in such case what do you do?

That is a risk which the employee needs to take. Because the deciding power is left with the employee. The employer cannot pool in for the employee's illness.

However, there is another clause which can be introduced in the policy called Corporate Buffer, where the employer takes an additional coverage e.g Rs. 10 lakhs or so and extends the coverage to employees on a case to case basis. This would work best with a fixed coverage, where the employers over head is also not very high( low premiums for fixed policy) and the employee also can request for an extended coverage (@ the discretion of the management).

Is there a min. for which an employee needs to be insured for?

The minimum amount covered for is Rs. 50000/- pa.

Breif about my self :-

My name is Deepak Gupta and I am an insurance professional from Delhi. If you have any requirement or any kind of problem and or any query related to insurance,

you may send me the detail.

You may ask regarding any sort of Insurance . I Can help you in

• Inviting quotes from insurance companies on your behalf and I am sure I will be able get you the best coverages in the lowest premium.

• I Conduct interactive session to ensure that you are well informed as to the process followed in case, a claim arises.
20th March 2014 From India, Delhi
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