Group Health Insurance
Employee Benefits That Work When Your People Need Them
Group health insurance covers your employees — and, if you choose, their families — under one company-paid policy. It is one of the most valued benefits an employer can offer. As an IRDAI-licensed Life & General broker, MILES designs and places group mediclaim, group personal accident and group term life programmes, negotiates renewals using your claims data, and runs a claims desk for your employees.
Reviewed by Vinay Jain, Principal Officer (IRDAI Reg. No. 954) · Last reviewed
What We Set Up For Employers
Group Mediclaim (GMC)
Hospitalisation cover for employees and dependants, typically with day-one cover and pre-existing diseases included.
Group Personal Accident (GPA)
Accidental death and disability benefits for employees, on or off duty.
Group Term Life (GTL)
Life cover for employees, arranged with life insurers under our Life & General licence.
Policy Design
Room-rent limits, maternity, parents cover, co-pay and corporate buffer structured to your budget.
Renewal Negotiation
Claims-ratio analysis and multi-insurer benchmarking before each renewal.
Claims Desk & Enrolments
Help for employees with cashless approvals and reimbursements, plus additions and deletions through the year.
What is group health insurance?
Group health insurance — often called group mediclaim (GMC) — is a single policy bought by an employer to cover the hospitalisation costs of its employees and, optionally, their spouses, children and parents. Because the risk is spread across the whole group, group policies usually offer terms that are hard to get individually, such as cover for pre-existing conditions from day one and no initial waiting period.
The three core employee benefits
| Cover | What it pays | Insurer |
|---|---|---|
| Group Mediclaim (GMC) | Hospitalisation, day-care procedures, and pre- and post-hospitalisation expenses | General or health insurer |
| Group Personal Accident (GPA) | Lump sums for accidental death and permanent or temporary disability | General insurer |
| Group Term Life (GTL) | A life cover payout to the employee’s nominee | Life insurer |
MILES holds an IRDAI licence as a Direct Broker (Life & General), so we can arrange all three and manage them as one programme.
Designing the policy
The main choices that drive cost and employee experience are:
- Sum insured — a flat amount for everyone, or graded by level.
- Family definition — employee only; employee, spouse and children; or including parents and parents-in-law.
- Room-rent limits — capped per day or as a percentage of the sum insured. Capping rooms can lead to proportionate deductions on the whole bill, so we model the effect before you choose.
- Maternity cover — including newborn cover from day one.
- Co-payment — often used for parents’ cover to control cost.
- Corporate buffer — an extra pool the employer can release for serious illnesses once an individual’s cover runs out.
Renewals: where a broker earns its fee
Group health premiums are driven by the group’s claims ratio — claims paid compared with premium. Before each renewal, MILES analyses your claims data, identifies what is driving cost, benchmarks terms from several insurers and negotiates the renewal on your behalf. We can also advise on plan changes that control cost without cutting cover employees actually use.
Claims and day-to-day support
- A claims desk to help employees with cashless approvals and reimbursement claims, working with the insurer and third-party administrator (TPA).
- Adding new joiners and removing leavers through the year.
- Employee communication: what is covered, network hospitals and how to claim.
- Escalation support when a claim is delayed or disputed.
Who it suits
Group health cover can be arranged for teams of almost any size, from small businesses and start-ups to large employers. Minimum group sizes and terms vary by insurer; MILES will tell you what is available for your headcount.
What we need for a quote
- Number of employees and the family members to be covered
- An age band (or dates of birth) for those covered
- Your current policy and the last two to three years’ claims data, if you already have cover
- The sum insured and features you have in mind
Buying for your own family instead? See health insurance for individuals and families.
Cover, exclusions and premiums depend on the insurer’s policy wording and underwriting. MILES Insurance Brokers Pvt. Ltd. is an IRDAI-licensed direct broker (Life & General, Reg. No. 954); the insurance is issued by the insurer. Insurance is the subject matter of solicitation.