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Group Health Insurance

Get flexible medical benefits with group health insurance

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About Group Health Insurance

Group health insurance plans are tools designed and developed to provide comprehensive coverage to a specific group of individuals that are usually employees of an organization or members of a company. Group medical insurance members are benefited in several ways, first of all, they get insurance coverage at comparatively lower prices as the risk profile is quite evenly distributed amongst the employees. Secondly, these plans provide are provided without much formalities and paperwork for individuals, which makes them quite popular in the corporate world. 

In case of group health insurance plans both the parties are addressed in a group and hence it requires the employer as well the employee to be the beneficiaries. One of the features of group medical insurance that makes it an efficient tool that secures your financial future is its diversity in terms of premium and coverage. Unlike the conventional health insurance plans that are expensive, these group plans are available at varying prices and coverage offered by the employer. 

The primary idea behind providing group health insurance to employees of a company is that it secures employees from burgeoning cost of medical treatments, it helps an organization to retain its valuable resources and also contribute to the overall growth and progress

Understanding Group Health Insurance in the UAE

It is remarkable to witness the growth of UAE from a small country to the modern-day business and trading hub not just for the middle east but for the entire globe. If you travel back approximately fifty years in time, UAE was not the way it appears to be right now. It was a small country with tiny ports that acted as the bridge between Asia and Europe due to their strategic locations, and one of them was Dubai. 

With the discovery of oil and gas reserves, the country started gaining prosperity and building infrastructure, industry, and other mediums that would support the overall economy of the nation. Within five decades Dubai emerged from a small fishing port to a bustling metropolis home to almost every multinational company you can possibly think of. Not only Dubai, but several emirates in the UAE have progressed extensively mainly by the oil and gas industry along with tourism, business, and trading making it one of the richest countries in the world.

With the growth of business and the establishment of companies, there has been a rise in the number of expatriates in the nation. In fact, UAE is home to one of the largest expatriate population in the world. As a common corporate practice in the corporate world, various organizations in the UAE started offering group health insurance in UAE. Later, the Dubai health authority made it mandatory for all registered companies to issue group health insurance for its employees. Followed by the issuance of these guidelines, more and more companies following the pattern offering group medical insurance in Dubai and the UAE to its employees.

The major benefit is that by issuing group medical insurance the company can protect itself against the unforeseen medical expenses of its employees and dependents. Furthermore, based on the size and volume of the company the payable premium for the medical insurance plan can be determined which is always less than what one will end up paying for an individual medical insurance plan.

Features and Benefits of Group Health Insurance Plans

The features of group health insurance plans are as follows-

  • Group health insurance is issued only to the members of an organization that is already in existence. In case, an organization or group is created solely with the purpose of getting a group medical insurance policy then it would be not be accepted. 
  • In order to get a group health insurance plan, the organization needs to have a minimum number of employees. The minimum number of employees required to get a group of medical insurance varies from insurance provider to provider. 
  • The majority of group medical insurance plans are issued for a period of one year, after which the plan needs to renew for all the covered members. The process of renewal is carried out by the organization and the members are not involved in the procedure. 
  • The coverage offered by group health insurance plans are either basic that takes care of mandatory requirement or Enhanced which is slightly better in terms of benefits from Basic or Comprehensive which is complete program covering all health needs with up to a limit.
  • The coverage and the payable premium in case group medical insurance plans are based on a plethora of factors. Some of them are size, type, gender, average age, salary band and health condition of the insured members. 

Here’s a quick rundown on the benefits of Group Health Insurance Plans in the UAE-

No Waiting Period

One of the major benefits of group medical insurance plans is the no waiting period. Right from the moment an employee joins the organization with a group health insurance plan he/she is covered from that very moment, This allows the employees to get the reimbursement or cashless hospitalization in case of an illness or medical emergency. 

Cashless Hospitalization ( Direct Billing)

Most of the group health insurance plans offer the feature of cashless hospitalization( Direct Billing) with their network hospitals. This means the covered members can choose a network hospital to obtain the facility of cashless hospitalization (direct billing) All the expenses until the coverage limit will be cashless if the insured member seeks treatment in a cashless hospital under the group health insurance plan. 

Pre and Post Medical Expenses

The majority of group health insurance plans offer pre and post hospitalization expenses that include expenses incurred in medicines, surgeries, and other medical procedures. With this benefit, the overall financial burden over the shoulder of covered members is reduced substantially. 

Coverage for Family Members

Group health insurance plans are not just limited to providing coverage to the insured members, in fact, these plans provide coverage to the dependents and family members of the employees. 

No Medical Check-up

In order to get an individual health insurance plan, one needs to undergo a mandatory health check-up to assess health status. Contrary to this, in the case of group health insurance plans one does not needs to undergo any sort of medical examination for getting coverage.

In Patient Services

  • Daily hospitalization expenses
  • Ambulance costs
  • Emergency accident cover
  • Surgical expenses
  • Diagnostic X-ray and laboratory expenses
  • Intensive care expenses
  • Doctor’s visits
  • Maternity services

Out Patient Services

  • Clinical examination expenses
  • Investigative procedure expenses
  • Medicines, and follow-up treatments
  • Minor surgeries and day-care
  • Doctor’s visits (GP, specialist and consultant)
  • Maternity services
  • Vaccinations

Additional Coverages

Dental, Optical, Worldwide coverage, Emergency Assistance (Emergency Medical evacuation), Preventive and Wellness Services. Mental Health (Psychiatry), Alternate Treatment (Ayurveda, Homeopathy, Chiropractic )

Eligibility Criteria for Group Health Insurance

When it comes to the eligibility of group health insurance plans, there are numerous factors to consider. Initially comes the eligibility for the business and the organization, followed by the eligibility of an employee and lastly the eligibility of dependents. In this section, we will look closely upon the eligibility criteria for various levels to get a group health insurance plan. 

Eligibility Criteria for Business/ Organization

In order to get a group medical insurance plan, the business must fulfil the following criteria of eligibility- 

  • The business/ company must be registered and approved legally by the regulations and guidelines of the country (with Valid Trade license)
  • The business must have a minimum number of employees specified by the provider to apply for group medical insurance. 

Eligibility Criteria for Employees

The eligibility criteria for employees under a group medical insurance are as follows- 

  • The employee must be listed on the payroll of the company and ministry of labour list
  • Employees working full time with valid visa issued by the company

Eligibility Criteria for Dependents

Here’s a rundown on the eligibility criteria of dependents-

  • Legal spouses and children are offered coverage under group medical insurance.
  • Dependents should be sponsored by the employees      

Factors Affecting Premium of Group Health Insurance Plans

The factors that affect the premium of group health insurance plans are as follows-

  • The number of employees covered under the plan
  • Strength of the organization 
  • Coverage offered by the plan to every employee
  • Dependents covered under the plan 
  • Age, Gender, Marital Status, Salary band, Nationality
  • Last year’s claims

Group Health Insurance Claim Process

The overall procedure of claiming group health insurance is simple and user-friendly. The employee can either opt for cashless hospitalization (Direct Billing) in case the treatment is being carried out in a network clinic, and hospitals, pharmacies or go for reimbursement of the expense incurred in the treatment. If you’ve opted for cashless hospitalization you can present your health card, e-card of app or emirates id and carry out treatment without paying anything till the limit of the coverage. 

However, if you are seeking treatment at a non-network hospital, first you need to check if such facilities are provided under your policy, unless it’s an life threatening medical emergency, then you need to inform the HR for intimation to insurance company, then you need to submit bills validating all the expenses along with the claim form to the insurance company/TPA or via online portal if extended by the insurance co, Claims team will initiate the claim investigation and once completed you will receive the reimbursement of all the expenses incurred in the treatment.

FAQ's

Do group medical insurance plans cover pre and post-hospitalization expenses?

Yes, group medical insurance plans cover pre and post-hospitalization expenses.

Can family businesses opt for group medical insurance plans?

Yes, family businesses can opt for group medical insurance plans where partners, employee and dependents will be covered.

Do group medical insurance plans cover dependents of the insured members?

Legal spouse and children of the insured members are covered under group health insurance plans. 

Can we include Parents of employees in the group medical insurance plans?

Parents will not be included in the group medical insurance plans, Individual Health Insurance plans can be taken for parents.

Do employees need to undergo, medical examination for getting group medical insurance?

No, employees do not need to undergo medical examination for getting group medical insurance plans. 

Are pre-existing illnesses covered under a group health insurance plan?

Yes, pre-existing illnesses are covered under a group health insurance plan as there is no provision of health check-ups of employees at the time of issuance of the policy, however groups less than 20 members will have to submit Medical declaration form.

Do group health insurance plans offer comprehensive coverage to the insured members?

Yes, group medical insurance plans offers comprehensive coverage with a limited Sum Insured which varies from policy to policy.

Can part-time working employees benefit from group health insurance plans?

Any employee listed under companies ministry of labour list, with active visa status will be insured under the group policy.

Is there any waiting period in case of group health insurance plans?

No, there is no waiting period associated with group health insurance, employees are covered right from the moment they join the organization, unless this is the first policy of employee in the country.

How can we pay group medical premium?

Premium can be paid either by credit card, bank transfer, cheque.