JAgdis L Trivedi
Senior General Manager H R Unison Pharmaceuticals
Hr Professional
Asso.prof.(commerce & Management) Pg
Learning Change - Practicing People &
Health Insurance ( Mediclaim ) - Policy Design,
+4 Others

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Dear All
can anyone suggest about the mediclaim policy of group insurance scheme for our employees.
And also what all the things we need to taken care of in buying mediclaim and group insurance for our employees.
Awaiting for your response.
With Regards
Sujeet S Rajawat

1. In a group health policy you can decide what benefits to go for within the framework of the policy.
2. The choices you make should depend on the employee population mix (married/unmarried, male/female) and who you wish to cover.
3. Typically the practice is to cover Emplif teh group size is small . and for the group size emp,spouse and 2 kids. This premium is paid by the company.
4. As far as the insurance companies are concerned, if a fair premium paid, then the risk can be placed with any insurer.
you can also contact devarajan who may be helpful to get more detals about group mediclaim policy


Today Group Medi Claim policies are very helpfull to emp's to cover their vital expenses on medical benifits and also helpful to employer by providing a major benifit.
below is the key aspacts one should ask from isurance companies-

1- Coverage of emp's may be as (self +Spouse+ Two Kids+ Parents-optional)
2- you can define the coverage of sum assured to 1 L, 2 L, 3 L, 4 L and above as per hierarchy in your company for GMC while for GPA Sum assured may be doubled or tripled.
3- benifit coverages you can opt like

a. Pre & Post Hospitalization of 30 to 60 Days
b. Meternity Benifit Cover
c. Infant Baby cover from Day One
d. Pre-Existing Desceases etc.

While approacing to Group insurance service provider, directly approach to company not the broker, this may befit you to choose your TPA of your choice for getting hassle free services from insurance company.

Service Provider like - National Insurance Co., Reliance, United Insurance, Cholamandalam are best in terms of services (my personal experience with them)

While taking a fresh policy, one can negotitate upto 30-40% of the preimum quoted by the service providers and if already such a policy exists then things like claim ratio matters a lot + further loadings on premium.

Well, further if you requires any other assistance / information, feel free to call or mail me.

Pramod S. Bhadauriya

Voice -9811449000(M)


My experience with both has shown that it is better to have association with the Nationalized one but again it all depends upon your leverage/exposure to the Insurance schemes. Its better to associate with the insurance company which has other schemes with your organization like fire, burglary, personal accident insurance etc..which would give you the flexibility to flex your muscles. Please remember at the time of pitching for your account they would make many promises while collecting the premium and while during the claims processing they would sing a different tune altogether ! Please note that the claims are processed – not by the insurance company but by the TPA – Third Party Administrators. Please check on their reputation as well.

To Start ? – Give a call to them and ask them to send their representatives.

Documents – Name, Age, Date of birth, Limit of insurance amount .

Would recommend from my experience that it is better to take a floating cover say Rs One Lac for the person and his family than Rs One lac for the individual.

Please note that which ever party you choose – please stick to them atleast 4 years to avail the following advantages viz :
1.Pre-existing diseases are covered only after 4 continuous and claim free renewals
2.Pre-existing conditions like Hypertension, Diabetes, and their complications are covered after two years of continuous insurance on payment of additional premium.



Dear All,

Group Health Insurance ( Group Mediclaim ) covers are increasingly becoming more complex in their design and administration apart from the ever rising premiums. With these complexities, it is highly advisable to get your self an expert organisation to assist in policy design, choice of insurer, claims settlement on behalf of you and your employees.

A large professional partner on your side brings you the advantage of a large pool of experts with the experience of handling complex claims settlement, interpretation of policy features, negotiation with insurer and TPA and overall increasing the employee experience during the emotional times of hospitalisation.

We deal with India's best run companies ranging from 10 employees to 30,000 employees providing them the finest servicing standards. Touch base with us to know more. You can count on us to Revert with Speed, Benchmarked Policy Design, Down to the Wire negotiations with insurers and industry Best customer service. Read more on our website or mail us at

Regards, Deepak Mendiratta
Subject Matter Expert - Health Insurance
Health & Insurance Integrated
<link outdated-removed> ( Search On Cite | Search On Google )

Dear All,
Very good discussion.
One circular from finance minsitry regarding loading the premium at the time of renewal the policy.
Attached herewith reday reference also useful to all concern.

Attached Files
File Type: pdf Ministry Circular-Health.pdf (127.7 KB, 322 views)

Mr. Verma Our management decided to introduce Group Insurance to all employees those who are not covered under ESI. We have 150+ employees. Kindly suggest us best policy and cost per employee.
Can u please clarify waht is co- payment. Is it on the bill amount or on sum insured?
Sum insured is 2.25Lakhs. Co- payment is 25%.
My Bill Amount is 4 Lakhs. If i apply for a claim, 25%of 4Lakhs i.e 1Lakh i have to bare and remaining 3L insurance has to bare. But 3L is more than sum insured. so i should get full sum insurance amount. But insurance company is saying they pay sum insured amount - (25% of sum insured amount) i.e 168750. Is it correct?

Kindly requesting you to share the employee details to take it forward ,meanwhile we shall discuss & advise on the coverages in detail Regards George peter 9444829291

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