Group Health Insurance Features
Explore the comprehensive features and benefits of our group health insurance solutions for businesses in Delhi NCR.
At a Glance
- •Room rent capping determines the overall claim payout - higher room = proportional deduction on all charges
- •Zero co-pay policies allow employees to claim 100% of eligible expenses with no out-of-pocket share
- •OPD cover available from as low as Rs.500 per visit with select insurers
- •Pre-existing diseases (PED) covered from Day 1 under most group policies - no individual waiting period
- •Maternity benefit typically carries a 9-month waiting period from policy inception
Key Features in Focus
These specialized features can significantly impact your group health insurance policy's effectiveness.
Room Rent Capping
Understand room rent limits in policies and how they affect your overall claim settlement.
Co-Pay Clause
Learn about co-payment requirements in health insurance policies and their implications.
Cashless OPD Benefits
Discover the benefits of cashless outpatient department services for your employees.
Employee Guide
Help employees understand their group health policy - coverage, claims, and what happens at job change.
Core Coverage Features
Our group health insurance policies provide these essential coverage elements for comprehensive employee protection.
Comprehensive Coverage
Our group health insurance plans offer extensive coverage for hospitalization, surgeries, and medical treatments in Delhi NCR, ensuring your employees receive the best possible care.
Wellness Programs
Integrated wellness programs promote preventive healthcare, helping employees stay healthy and reducing overall healthcare costs for your organization.
OPD Coverage
Outpatient department coverage for consultations, diagnostics, and pharmacy bills, reducing the financial burden of day-to-day healthcare needs.
Learn more →Cashless Treatment
Access to a wide network of hospitals for cashless treatment, eliminating the need for employees to pay upfront and claim reimbursements later.
Pre & Post Hospitalization
Coverage for medical expenses incurred before and after hospitalization, ensuring comprehensive care throughout the treatment journey.
Family Coverage
Options to include dependents such as spouse, children, and parents, ensuring complete family protection under one policy.
No Claim Bonus
Rewards for claim-free years with additional coverage or reduced premiums, encouraging preventive healthcare.
Domiciliary Treatment
Coverage for treatments taken at home under medical supervision, when hospitalization is not possible or necessary.
Customizable Plans
Tailor insurance plans to suit your organization's needs and budget, choosing the right balance of coverage and cost.
Additional Benefits
Beyond the core features, our group health insurance plans offer several additional benefits to enhance your employees' wellbeing.
Maternity Benefits
Coverage for pregnancy-related expenses, including pre and post-natal care, delivery, and newborn baby coverage for a specified period.
- Normal and cesarean deliveries covered
- Pre and post-natal expenses
- Newborn baby coverage from day one
- Coverage for complications during pregnancy
Alternative Treatments
Coverage for AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) promoting holistic healthcare options.
- Ayurvedic treatments
- Homeopathic treatments
- Naturopathy
- Unani medicine
Mental Health Coverage
Coverage for mental health treatments and counseling services, supporting overall employee wellbeing.
- Psychiatric consultations
- Psychological counseling
- Therapy sessions
- Inpatient mental health treatment
Preventive Health Checkups
Regular health checkups covered under the policy to promote preventive healthcare and early detection of medical conditions.
- Annual health checkups
- Specialized screenings
- Diagnostic tests
- Follow-up consultations
Policy Timelines
Waiting Periods in Group Health Insurance
One of the biggest advantages of group mediclaim over individual health insurance is the absence of most waiting periods. Here's a direct comparison.
| Waiting Period Type | Individual Health Insurance | Group Mediclaim (GMC) |
|---|---|---|
| Initial waiting period | 30 days (all illness claims except accidents) | None - Day 1 coverage |
| Pre-existing diseases (PED) | 2–4 years | None - covered from Day 1 |
| Maternity benefit | 2–4 years | 9–12 months (insurer-specific) |
| Specific diseases (cataract, hernia, etc.) | 1–2 years | Usually none in group policies |
| Mental health treatment | No specific waiting period | No waiting period |
| Day-care procedures | Usually 30-day initial wait | Covered from Day 1 |
Maternity Waiting Period
- •9 months from policy inception or joining date - whichever is later
- •Applies to normal delivery, C-section, and pre/post-natal expenses
- •Newborn coverage begins from day of birth (under the maternity sub-limit)
- •Sub-limits typically range from Rs. 25,000 to Rs. 1,00,000 - confirm with HR before planning
PED - No Waiting in GMC
- •Pre-existing diseases (diabetes, hypertension, thyroid, cardiac) covered from Day 1
- •No exclusion, no loading, no medical underwriting for group enrollment
- •Individual policies deny PED claims for 2–4 years - GMC provides this from day one
- •This single benefit alone makes employer GMC extremely valuable for employees with chronic conditions
Specific Disease Waits
- •Individual policies impose 1–2 year waits for procedures like cataract, hernia, joint replacement
- •Group policies typically waive these specific disease waiting periods entirely
- •Always verify your policy schedule - some budget group plans may retain specific sub-limits
- •If in doubt, ask HR or your insurer for the policy exclusion and waiting period schedule
In Depth
Maternity Benefit Under Group Health Insurance
Maternity is an optional add-on that must be specifically included by the employer. Here's everything HR teams and employees need to know before a maternity claim.
What Is Covered
- ✓Normal delivery and C-section expenses up to the defined sub-limit
- ✓Pre-natal expenses: doctor consultations, scans, and tests (30–60 days before delivery)
- ✓Post-natal expenses: follow-up care after delivery (30–60 days)
- ✓Newborn baby cover: typically from birth up to 90 days under the maternity sub-limit
- ✓Complications of pregnancy - covered under the maternity sub-limit in most policies
Sub-Limits by Insurer (Typical Range)
| Plan Tier | Normal Delivery | C-Section |
|---|---|---|
| Basic | Rs. 25,000 | Rs. 50,000 |
| Standard | Rs. 35,000 | Rs. 75,000 |
| Enhanced | Rs. 50,000 | Rs. 1,00,000 |
| Premium | Rs. 75,000+ | Rs. 1,50,000+ |
Key Things to Check Before a Maternity Claim
Confirm whether maternity is included in your company's policy - it's an add-on, not automatic
Check the waiting period - if you joined within the last 9 months, the claim may not be eligible
Find out the exact sub-limit for normal delivery and C-section - metro hospitals often exceed these
Budget separately for the gap: in metro cities, actual bills frequently exceed sub-limits by Rs. 30,000–60,000
Newborn care beyond the first 90 days is typically covered under the base sum insured, not the maternity sub-limit
Consumables, OPD post-natal visits, and pharmacy bills may fall partially outside the sub-limit
Explore Further
Related Resources
Our Services
Dedicated relationship managers, endorsement support, and claims assistance.
Explore →Insurer Comparison
Compare private vs PSU insurers on claims speed, network, and renewal pricing.
Explore →By Industry
See how group health needs differ across tech, NGO, construction, and more.
Explore →How Claims Work
Step-by-step guide to cashless and reimbursement claims under your group policy.
Explore →TPA Partners
How third-party administrators process your group health insurance claims.
Explore →What Is Covered & What Is Not
Standard group mediclaim policies in India cover 300+ day-care procedures and provide cashless access at 8,000–15,000 empanelled hospitals. Here is a quick reference before you buy.
| Covered ✓ | Not Covered ✗ |
|---|---|
| ✓ Hospitalisation (24+ hours) | ✗ Cosmetic / aesthetic surgery |
| ✓ Pre-existing diseases from Day 1 | ✗ Self-inflicted injuries |
| ✓ Maternity (9-month waiting period on some plans) | ✗ Fertility / IVF treatment |
| ✓ Day-care procedures (300+) | ✗ Dental (unless add-on purchased) |
| ✓ Pre-hospitalisation expenses (30 days) | ✗ Spectacles / contact lenses |
| ✓ Post-hospitalisation expenses (90 days) | ✗ War, nuclear or experimental treatment |
| ✓ Mental health & teleconsultation | ✗ OPD (unless add-on purchased) |
| ✓ Road accident emergency | ✗ Obesity / weight-loss treatment |
Frequently Asked Questions
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