Edelweiss Group Health Insurance

Edelweiss Group Health Insurance

Claim settlement ratio (2019-20)

85.57%

Network hospitals

2,578+

Total GHI lives insured (2020-21)

3.1 Lakhs

Total GHI claims incurred (2020-21)

Rs 31.27 Crores

TPA

TPA External

About Edelweiss Group Health Insurance

Edelweiss Group is a multinational corporation offering financial products and services. The Edelweiss company is known for providing health insurance plans all over the country that caters to the insurance needs of the people. By promising a quick, hassle-free and easy process of buying a policy including registering a claim, the Edelweiss group health insurance company also has a dedicated customer team for answering all the queries of the customer to make it a seamless journey. 

With Pazcare, your Edelweiss group health insurance experience becomes even better. We get you the best group health insurance quotes for your employees without burning a hole in their pockets. The HR/Admin can also manage the group health insurance in one place using our Pazcare dashboard which is tech-enabled. Moreover, the employer dashboard can also be integrated with the HRMS tools. 

How to buy Edelweiss group health insurance at Pazcare?

You can purchase Edelweiss group health insurance online at Pazcare using these simple steps-

  1. Visit https://www.pazcare.com/ and click on the products drop down and choose group health insurance
  2. Fill in the information on the form - your name, work email,  company name, phone number, etc. you want to insure. 
  3. Click on submit. You will be contacted by our health insurance consultant within 24 hours. You can tell us your requirements for the tailor-made group health insurance policy.
  4. Our team will get back to you with competitive quotes from Edelweiss group health insurance. You can also see quotes from a few other insurers.
  5. Once you decide on the insurer and accept the terms and conditions of the policy, you process the payment.
  6. The onboarding process will be carried out within 24 hours of making the payment. 

For further information, write to us at support@getpaz.com. You can also call our customer care number at +91 78291 11300. You can also connect with us on Whatsapp using this number - +91 81973 79596.

Types of Edelweiss group health insurance plans

The Edelweiss group health insurance has 3 plan types. They are - 

Group Health Insurance Policy

The group health insurance offers hospitalization expenses along with Ayush treatment. This plan also provides the facility of premiums payments in equated instalments.

Group Total Protect

The group total protect health insurance provides all the features of the existing group health insurance. Moreover, the group health insurance plan provides cover for accidental losses and disability.

Group Domestic Travel Insurance

This type of policy is made especially for corporate groups who have business travel as a nature of their job requirements. It provides coverage against any unforeseen events during the travel. 

Group Corona Policy

This plan provides coverage against Covid treatment including pre-hospitalisation expenses. It also covers treatment through Ayush. 

Why choose Edelweiss group health insurance as your insurance partner?

Edelweiss Health Insurance plans offer maximum protection and are tailor-made for the insured members. They offer the best plans at an affordable price. When you purchase any of the Edelweiss health insurance plans, you can avail of the following benefits:

Single point of contact

Edelweiss group health Insurance provides a single point of contact as a single policy covers a group of people. To get all the queries including reimbursements and claims settled, you can get everything settled through the single concerned authority.   

Quick Decision-Making

Edelweiss group health insurance helps you save a lot of time by making decision processes easier with constant support. 

Minimum Documentation Required

Unlike the regular documentation requirement for the proposal of group health insurance, Edelweiss makes sure that it is kept simple! You can download the proposal form for group health insurance here

Edelweiss group health insurance claim settlement ratio

A health insurance claim settlement ratio (CSR) is the ratio between the number of claims settled to the number of claims made or requested in a financial year by the health insurance company. 

To calculate the CSR ratio, the following formula is implemented-

Claim settlement ratio = Number of claims settled/Number of claims made*100

Financial Year Claim settlement ratio
2019-20 85.57%
2018-19 79.82%

Claim Edelweiss group health insurance

Cashless claims

Cashless facility is valid only if the treatment is taken at network hospitals of Edelweiss General Insurance. Edelweiss insurance company is tied-up with thousands of top hospitals in India. To file a cashless claim, one has to follow the following steps:

Search for a network hospital nearby

A network hospital in your city has to be looked for cashless treatment. You can find the list of the network hospitals on the company’s official website.

Intimate the insurer

Inform the insurer within 48 hours in case of emergency hospitalisation. Also, you have to intimate the insurer within 72 hours before getting admitted in case of a planned hospitalisation. Carry your health card issued by the insurer and a photo ID while visiting the hospital

Fill pre-authorisation form

Fill out the pre-authorisation request form which is given to you by the hospital. After that, submit it to the hospital help desk. After checking your identity, the hospital sends the form to Edelweiss General Insurance

Claim is approved

Once the claim is approved by the insurance company, it pays the hospital bills directly and settles the claims.

Reimbursement of Claim 

The reimbursement claim can be filed for both network and non-network hospitals. The process of reimbursement claim includes the following steps:

Intimate Edelweiss Insurance company 

In case of both planned and emergency hospitalisation, the insurance company has to be informed as soon as possible. Normally, it is 48 hours in emergency hospitalisation and 72 hours in case of a planned hospitalisation.

Collect all the required documents

The next step is to collect the discharge summary, invoices, hospital bills, medical reports, etc. from the hospital. The documents should be sealed. 

Fill out the “claim form”

Download the ‘Claim Form’ from the insurer’s website. Fill it out properly and sign it and annex a valid photo ID and the cashless card.

Send the documents and wait for approval

Send all the collected documents to Edelweiss General Insurance. Once the documents are reviewed including the claim form and documents, the insurer approves the claim. 

Network hospitals of Edelweiss group health insurance

Every health insurance company have a list of network hospitals(or cashless hospitals), where cashless treatment can be claimed. Larger the list of network hospitals, the higher the chances of finding a cashless network hospital near your location. Edelweiss group health insurance has around 2,578+ network hospitals located in pan India. This makes sure that you can get high-quality treatment near your location and you will be able to file for a cashless claim.

Edelweiss group health insurance renewal process

The Edelweiss group health insurance can be renewed easily with Pazcare at end of your policy term. Here are the steps to renew your Edelweiss group health insurance plan.

Step 1: Contact Pazcare. Submit a form containing details like name, name of the company, number of employees you wish to insure, work email address and phone number.

Step 2: Once you submit the form, our consultants will contact you. You will have to submit the following documents as this is not a fresh policy.

  • Current data of the employees - name, age, gender
  • Claim analysis report
  • Claim dump report from the insurer/TPA
  • Policy copy

Step 3: One can select additional add-ons to the existing policy, for instance, maternity insurance riders, dental insurance riders to your existing policy. Furthermore, with Pazcare one can choose additional health and wellness add-ons to your Edelweiss group health insurance. These add-ons include unlimited doctor consultations, comprehensive check-ups, therapy and wellness sessions etc.

Step 4: Our consultants will get back to you with the competitive quotes for your Edelweiss group health insurance.  Based on your claims report and the add-ons you choose, your health insurance premium may vary from the previous financial year.

Step 5: The next step is to agree to the terms and conditions of the policy and pay the premium for your Edelweiss group health insurance policy. The policy is usually valid for a year after the renewal of the Edelweiss group health insurance policy.

Step 6: In case, you are purchasing your Edelweiss group health insurance for the first time with Pazcare, the onboarding process will be carried out in 24 hours. During this time, you will be contacted by our associate and will be provided with all the essential information on how to get started with your group health insurance. 

We make sure that your Edelweiss group health insurance experience will be seamless using our Pazcare dashboard. Using Pazcare’s employee app, your employees can access their policy. Pazcare’s employee app is available on both the play store and the app store. 

 

How is Edelweiss group health insurance premium calculated?

The Edelweiss group health insurance premium is directly proportional to the risks involved. The premium for your group health insurance policy is also calculated based on certain factors, which are -

Average age 

The average age of the people insured determines the premium calculation. The premium gets higher with increasing age. This is because the younger generation poses lesser health risks. 

Nature of the job

In deciding the annual premium, the nature of the job the person insured performs is also considered a factor. Jobs associated with more risks will have a higher premium compared to the lower-risk jobs. For e.g, the group health insurance premiums will be higher for employees working in a factory than the ones working in the IT sector.

Riders opted

The add-ons opted for say, maternity insurance riders, dental insurance riders along with the existing group health insurance policy increases your group health insurance premium. With the type of add-ons opted for, the premium varies.

What is covered under your Edelweiss group health insurance?

Your group health insurance policy is tailor-made to suit your preferences. Here is what your Edelweiss group health insurance covers.

Inclusion of pre-existing diseases

According to the terms and conditions of the Edelweiss policy, 48 months of continuous cover, pre-disclosed and pre-existing conditions would be covered under the policy.

Pre and post-hospitalisation expenses

With Edelweiss group health insurance, you can cover your pre and post-hospitalisation expenses. 

All hospitalisation expenses

The Edelweiss group health insurance provides hospitalisation expenses for treatment along with consumables up to the sum insured. 

Day-care treatments

Day-care treatments include a variety of procedures. For more information, contact Pazcare at

+91 78291 11300.

Ayush Treatment

Treatments through the Ayush regimen are covered by Edelweiss group health insurance. 

What is not covered under your Edelweiss group health insurance?

Following are some exclusions that you should be aware of in your Edelweiss health insurance - 

Non-listed hospital

Any treatment taken from a non-listed hospital is not covered. 

Sexually transmitted diseases

Treatment of sexually transmitted diseases is not covered by the Edelweiss group health insurance policy. 

Vaccinations

Any vaccinations, immunisation and inoculation excluding vaccinations post animal bites are not covered under the policy.

Treatments not prescribed by doctor

Any treatments caused by suicide attempts, unnecessary treatment or surgical procedures, etc are not covered by the Edelweiss group health insurance policy.

Edelweiss group health insurance benefits

The Edelweiss group health insurance benefits include-

Single point of contact

A specific point of contact is assigned to each insurance policy. This leads to a dedicated service and point of contact understanding the requirements and preferences of the client.  

Quicker Processes

Edelweiss insurance is known to be one of the quickest insurance companies to claim to process. This fast-paced process is made possible by the minimal documentation policy of the insurer.

Faster Documentation

The experience of insurance is made seamless for the insured by minimal documentation. Edelweiss removed unnecessary paperwork both at the insurer and at the insured’s end making it a fast and easy process.

Edelweiss Group Health Insurance claim process

1

Claim intimation

In case of emergency hospitalisation, intimation is needed within 48 hours to carry out the claims. In case of planned hospitalisation, the intimation has to be done within 72 hours.

2

Claim processing

Pre-authorization form is to be filled up and submitted to the hospital’s insurance/TPA desk after which the request is initiated.

3

Claim settlement

If the request is approved, the claim is settled immediately. In case the request is not approved, you can claim reimbursement.

1

Claim intimation

In case of emergency hospitalisation, intimation is needed within 48 hours to carry out the claims. In case of planned hospitalisation, the intimation has to be done within 72 hours.

2

Claim processing

Pre-authorization form is to be filled up and submitted to the hospital’s insurance/TPA desk after which the request is initiated.

3

Claim settlement

If the request is approved, the claim is settled immediately. In case the request is not approved, you can claim reimbursement.

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Why buy a group health insurance
policy online from Pazcare?

  • Choose the suitable policy with our consulting approach
  • Custom-made plan with health and mental wellness add-ons
  • The tech-enabled Pazcare dashboard to manage endorsements
  • Integrate the dashboard with your HRMS tool

Edelweiss group health insurance customer care number

For any queries or assistance, reach out to us at any time. We provide 24X7 customer assistance.

Edelweiss group health insurance

Frequently asked questions around Edelweiss group health insurance

What is Edelweiss health card?

Edelweiss health card is an insurance identity proof that consists of your personal details, policy information and financial coverage. It aids in cashless payment options to pay for your medical bills that arise from treatments and hospitalisation. 

Is there any tax benefit under the Edelweiss Group Health Insurance?

Under 80C of Income Tax of India, all premiums paid towards the premium during a financial year can be claimed as a deduction from taxable income.

Are there any restrictions on the number of claims that can be availed under Edelweiss group health insurance policy?

No. Edelweiss policy does not impose any restrictions on the number of claims available. However, the claims must be within the sum insured.