Small Group vs Large Group Health Insurance

A group health policy is an insurance plan that is sponsored by an employer or a leader of a group to reduce or share the financial burden of the employees or members of that group.

This policy provides financial assistance to the employees in case of a health emergency in the future. This offers great comfort and relief to the employees since these policies offer additional benefits for the employees as well as their families.

A small group insurance medical plan is a policy that covers the financial future of a group that is small in size. The group might consist of members from 25 to 50 full-time employees. The minimum and maximum number of people required in a group for small group medical policy differs with every insurance provider.

You will have to verify and align your requirements with the insurance company likewise and then buy group insurance for your small business.

A large group insurance medical plan can cover a large number of people, starting from 50 full-time employees to any number after that. If a company works with hundreds of employees, the employer can divide them into various groups of 50s or 100s and provide health coverage for them with different and suitable large-group medical policies.

Let us understand the different eligibility criteria for small-group vs large-group health insurance.

• A company is eligible for buying small group health insurance if there are 25 to 50 salaried full-time employees. The Insurance Regulatory and Development Authority of India has ruled the abovementioned criteria.

• (The minimum number of salaried full-time employees might differ from one insurance company to another.)

• The insurance provider will assess and analyse the financial stability, income, and capacity of the group before approving the insurance policy. This is to safeguard the financial benefits of the insurance company and ensure that this deal won’t be loss-bearing for the company.

• Some insurance companies require the employer to contribute a certain percentage of their income to the policy’s premium. This percentage of the amount may vary from one insurance provider to another.

• Startups or new small companies might face slightly more scrutiny to ensure the consistency and longevity of the business.

• If a company has 51 or more salaried full-time employees, the company can buy a large group health insurance policy. This number usually changes from one insurance company to another, so you will have to choose the company and the plan accordingly.

• Like small group insurance, insurance providers will need the employers to contribute a certain percentage to the policy’s premium as well. The percentage of the amount will differ from provider to provider.

• The insurance company will conduct an assessment to analyse the financial stability of the group in order to avoid any kind of missed premium payment, leading to policy lapse.

Note: The eligibility criteria might evolve. Keep close attention to the IRDAI protocol in order to stay updated about the latest changes in the rules and regulations.

Let us look at some common or popular inclusions of small as well as large group health insurance plans. These may vary for each provider; however, most of these are commonly offered.

- In-Patient Treatment

Group health policies cover the overall cost that is associated with hospitalisation and in-patient treatment. These expenses will include room charges, nursing expenses, doctor’s fees, pharmacy expenses, and other medical-related expenses that are incurred while the patient is in the hospital for treatment.

- Pre and Post Hospitalisation

Group insurance will extend the coverage for hospital stays by providing pre-hospitalisation expenses like diagnostics, check-ups, and pre-treatment visits. Apart from that, the policy will also cover your post-hospitalisation expenses, including follow-up visits and prescribed medications.

- Day Care Treatments

Most group health policies will cover your daycare treatments. These treatments refer to the healthcare procedures that include single-day treatments. Such treatments do not need an overnight stay in the hospital, but need medical attention from the doctors.

- Organ Transplant

An organ transplant surgery demands extensive care and costs. Group health insurance will provide coverage for surgical procedures, post-operative care, immunosuppressant medication, and post-hospitalisation costs.

- Maternity Cover

The group health insurance policies include maternity coverage for women in the workforce. These costs include expenses that are related to prenatal care, delivery, and postnatal care treatments. The delivery charges will include hospitalisation costs, nursing expenses, doctor’s fees, pharmacy bills, and sometimes also the newborn’s healthcare.

- Ambulance Cost

Most times, the patient is carried in an ambulance in cases of emergencies, surgeries, or deliveries. The group health insurance policy coverage can cover the cost of an ambulance.

- Add-Ons and Riders

There are various add-ons that an insured can include in their policy. There are add-on features that include specific critical illness cover, convalescence cover, vision care, mental health provisions, and other optional features. The policy premium will increase when one adds a rider; hence, it is advised to verify and compare the policies when one adds these optional features.

Note: Some of the abovementioned coverage may be optional and only available if you choose for those. Your policy’s standard coverage might not include all of the above features. It is recommended that you read your policy carefully before applying for a cashless claim or reimbursement from the insurance company. Apart from that, the insurance company will only cover the percentage of the expenses mentioned in the insurance policy.

- Financial Employee Benefits

Insured employees receive health and financial benefits once they are covered under the group health insurance plan offered by their company. This helps the employees feel safe and secure working and continuing to work with the company. This boosts the company’s goodwill and, consequently, attracts better talent. It also increases employee loyalty and retention, benefitting the company.

- Tax Benefits

Group health policies often offer tax benefits for both the parties, employees and employers. The premium that both of these parties pay for the policy gets deducted from the total taxable income. This leads to a reduction in the payable amount for taxes. This is possible because the premium is deducted from the employees’ salaries, and hence, it can be shown as a reduced income.

- Increased Productivity

When employees receive such physical and monetary benefits, they tend to work better. It is a pronounced tendency for employees to work better in better conditions. This increases the overall productivity of the company and enhances its performance.

- Preventative Care Programs

Usually, group health policies offer preventative care coverage. This keeps the employees from getting healthier, enables early detection of illnesses, and reduces long-term healthcare costs for the employers.

Including commercial insurance for corporations is non-negotiable in today’s day and age! Tata AIG offers different types of commercial insurance under SME insurance policies; group health insurance policy is one of those policies.

Enjoy the provisions offered by the holistic insurance plans that provide health and financial benefits to your employees. As a responsible employer, ensuring employer health insurance and welfare arrangements for your employees is extremely important.

The difference between small and large group health policies is that they cater to different sizes of groups. The definitions, policy premiums, and eligibility criteria differ from one another. However, apart from that, the advantages these policies offer in the form of employee benefits and coverage are precisely the same.

The growing scale of healthcare costs is overwhelming for everyone alike. Healthcare is getting more and more unattainable for people from a specific background and that must change. As an employer, you can bring about that change by making hospitals and treatments accessible to your employees.

- Do we include the part-time salaried employees in the group health insurance?

Usually, insurance companies do not permit part-time employees to be included in the group health insurance policies since there is a difference in the overall work format and income ratio.

- Can you switch from small-group health insurance to a large-group policy?

Yes! A business can typically switch from a small group health insurance to a large one by following the provider’s protocol.