Understanding Group Mediclaim vs. Group Accident Insurance: What's the Real Difference and Why Does It Matter?

Dear Seniors,

Could you please help me understand the difference between Group Mediclaim policy and Group Accident Insurance policy, and the importance of it.

Kindly reply.

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

Miss Rath,

Frankly speaking, I will not be able to recommend you any specific policy. It all depends on your company's decision on how much they want to invest in an insurance policy. Whether they would like to make it a joint contribution policy where both the employee and employer contribute, or if they prefer just the employer's contribution. Additionally, whether your company would like to opt for a group policy or a single policy like an Accident Policy, a Mediclaim Policy, or both. Consider also the employees' interest in contributing to the policy premium, total headcount, etc.

All I can suggest is that if you are inquiring about a policy for a manufacturing concern, I would recommend selecting a policy with a higher amount in the Personal Accident Clause. Employees in manufacturing concerns typically work extensively with machines, posing a higher risk of accidents. Therefore, this kind of policy will provide them with the necessary coverage.

Please let me know if you need further assistance.