Group Medical Coverage
Comprehensive medical coverage for your workforce under a single master policy with expert advisory and claims support.
Group Medical Insurance
Group Medical Insurance is a single contract that provides coverage to a group of people,most commonly the employees of a single company or members of an association. The Organisation (employer or association) purchases a master policy from an insurance company,and the members of the group are covered under that single policy.
We at MRIBS, provide group insurance services that include assessing an organisation's needs, finding and comparing suitable policies, negotiating terms with insurers, and assisting with claims. We offer expert advice to help clients navigate complex policies and ensuring coverage meets the group's specific requirements, while also managing ongoing policy support and employee communication.
Key Covers, Terms & Add-ons
Pre & Post Hospitalisation
Expenses incurred before and after hospitalisation within the specified period are covered as per policy terms.
Pre-Existing Diseases
Pre-existing diseases are covered from day one under Group Mediclaim, with standard waiting periods typically waived off.
Cashless Treatment
Bills are settled directly with network hospitals, so employees don't have to arrange cash during hospitalisation.
Room Rent & Nursing Charges
Room rent is usually capped at a percentage of Sum Insured (e.g., 1–2% for room, ICU at higher limits) which also influences premium.
Co-pay
A fixed percentage of each claim (often 10–20%) is borne by the insured; a 10% co-pay is often recommended to encourage prudent utilisation.
Disease / Illness Sublimits
Certain procedures, like cataract surgeries, may have fixed caps (e.g., INR 30,000–35,000), while other illnesses follow standard Sum Insured.
Maternity Cover
Normal delivery and Caesarean have defined limits (e.g., INR 35,000 / 50,000) with options to enhance; day-one baby cover when opted.
Corporate Buffer
An additional reserve Sum Insured (e.g., INR 5 Lakhs) that can be used for large claims on a case-by-case basis.
Ambulance Cover
Ambulance expenses are typically covered up to a fixed limit (e.g., INR 2,500) for emergency transfers between home and hospital or between hospitals.
Day Care Procedures
Covers procedures that do not require 24-hour hospitalisation (e.g., cataract, tonsillectomy) as per IRDAI guidelines.
Modern Treatments / Procedures
Coverage for advanced and modern treatment methods is provided in line with IRDAI guidelines and policy wordings.
TPA (Third Party Administrator)
Specialised TPAs manage cashless and reimbursement claims, coordinating between insurer, hospital, and insured employees.
Exclusions & Other Terms
Standard exclusions and detailed terms & conditions apply as per the Group Mediclaim (GMC) policy document.
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Your Questions,
Answered
"From choosing the right policy to making a claim, we've answered your most common questions."
You have different questions? Our team will answer all your questions. We ensure a quick response.
What is Group Medical Cover (GMC) Insurance?
Group Medical Cover (GMC) insurance is a health insurance policy provided to a group, typically employees of an organization, offering medical coverage under a single policy.
Who is eligible for GMC insurance?
Employees of an organization are usually covered under GMC, and in many cases, their dependents such as spouse, children, and sometimes parents may also be included.
What expenses are covered under GMC insurance?
Coverage generally includes hospitalization expenses, pre- and post-hospitalization costs, daycare procedures, and sometimes maternity benefits, depending on the policy.
Is there a waiting period under GMC policies?
Most GMC policies offer immediate coverage from day one, including for pre-existing diseases, subject to policy terms.
What is the sum insured in GMC insurance?
The sum insured is the maximum amount available per insured member or for the entire family, depending on whether the policy is individual-based or floater-based.
How does cashless hospitalization work under GMC?
Insured members can avail treatment at network hospitals without paying upfront, as the insurer settles the eligible expenses directly with the hospital.
Can employees choose their coverage under GMC?
In some cases, employers provide flexible options allowing employees to enhance coverage or include additional dependents by paying an extra premium.
What happens to the GMC policy when an employee leaves the organization?
Coverage under the GMC policy typically ends when the employee exits the organization, though some insurers may offer conversion to an individual policy.
What are the common exclusions under GMC insurance?
Common exclusions may include cosmetic procedures, non-medical expenses, self-inflicted injuries, and treatments not covered under policy terms.
What documents are required to file a claim?
Required documents usually include hospital bills, discharge summary, medical reports, employee ID, and a completed claim form.