Quick Summary
This blog explains what a group mediclaim policy is, who can buy it, key features, employer and employee benefits, coverage, pricing, and how HRs can choose the right plan for their workforce.
What is a group mediclaim policy?
A group mediclaim policy is a health insurance policy purchased by organizations to offer medical coverage to employees and their dependents under one consolidated contract. Unlike individual policies, group mediclaim insurance is easier to manage, more affordable, and provides broader coverage, making it an essential benefit for today’s employee-centric companies.
For modern employers, offering a group mediclaim insurance policy for employees strengthens compensation packages, improves employer branding, and builds a culture of care and wellness.
Who can buy a group mediclaim policy?
Any registered organization with as few as 7 employees can purchase a group mediclaim insurance policy, including:
- Startups and SMEs
- Corporations and MNCs
- Partnerships and LLPs
- Societies, associations, and trusts
- Gig-work and contract-based teams (if structured as a group)
Key features of a group mediclaim policy
1. Cashless hospitalization
Employees can access treatment at network hospitals without paying upfront.
2. Pre- and post-hospitalization cover
Covers medical expenses before and after hospitalization for typically 30/60 days.
3. Day-care treatments
Includes small procedures that don’t require 24-hour admission.
4. Maternity & newborn coverage
Supports family planning and covers delivery expenses, including newborn premiums from day one.
5. Coverage for pre-existing diseases
Unlike personal insurance that requires waiting periods, group plans cover PEDs immediately.
6. Customization options for employers
- OPD & pharmacy benefits
- Teleconsultation
- Parental coverage
- Mental health therapy sessions
- Annual health check-ups
Benefits of group mediclaim insurance policy
For Employers
- Improves retention and reduces attrition.
- Enhances employer brand and employee trust.
- Easy to implement and centrally managed.
- Tax benefits under Section 37(1) & Section 17(2) of the Income Tax Act.
- Supports productivity and reduces sick leave.
For Employees
- Financial protection against unexpected medical bills.
- Zero or subsidized premium cost.
- Faster, simplified claims processing.
- Option to cover spouse, children, and parents.
How much does group mediclaim cost?
Factors affecting premium
Typical cost range in India
Cost-saving strategies for HR
- Choose higher group size for better pricing.
- Limit high-cost add-ons like parental and maternity.
- Opt discounted rates through corporate wellness programs.
- Select an experienced broker / digital TPA partner for optimization.
Who is covered under a group mediclaim plan?
Depending on the policy structure:
- All full-time employees by default.
- Optionally: spouse, children, and parents.
- Interns & contract workers (if chosen by employer).
How to choose the right group mediclaim policy
- Compare insurers based on features, pricing & flexibility.
- Review network hospital coverage across multiple cities.
- Check insurer claim settlement ratio.
- Consider TPA/broker support for smooth claims.
- Align benefits with workforce demographics such as average age, family status, gender, work type.
- Benchmark sum insured using industry standards.
Use platform-based solutions like Pazcare for expert consultation, digital claims, and admin dashboard support.
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