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- What is a Group Medical Coverage Policy (GMC)?
- Benefits of Group Medical Coverage Policy
- What is a Group Personal Accident Policy (GPA)?
- What is a GMC insurance policy, and what is covered in the policy?
- What is a GPA insurance policy, and what is covered in the policy?
- What is the difference between GMC and GPA insurance policies?
- How is the premium for the GMC policy calculated?
An organisation's productivity depends on several factors, and one of the critical factors is employee satisfaction. It has a significant impact on the way business thrives and remains competitive. To keep the employees happy and engaged, the employers offer various benefits, like privileged leaves and insurance.There are different insurance policies under which the employers cover their employees, and the two most popular ones are – Group Medical Coverage (GMC) and Group Personal Accident Policy (GPA). These policies help employers take care of the expenses they must incur due to unfortunate incidents at the workplace. Both these policies provide medical and financial coverage to the employees and ensure their welfare.
What is a Group Medical Coverage Policy (GMC)?
An organisation offers a group medical coverage policy to its group of employees. All the members covered under the policy enjoy the same benefits. One of the GMC healthcare policy's significant features is that it allows the employers to customise it as per their organisation's specific needs. Also, since the risk is spread to many individuals, such policies' premium is much lesser than individual Mediclaim policies.Typically, the insurance companies calculate the premium for GMC policy based on the following factors:
- Number of employees covered under the policy
- The demographic factors like age of the members, occupation, and income
- Add-on purchased (if any)
Benefits of Group Medical Coverage Policy
- Covers hospitalisation expenses, including diagnostic tests as per the policy terms
- Offers reimbursement for daycare procedures (for specific illness as mentioned in the policy documents)
- Female employees get maternity coverage
- You can avail the cashless facility at network hospitals
- Many organisations extend the medical coverage to employees' families, including spouse and dependant parents
What is a Group Personal Accident Policy (GPA)?
GPA insurance policy is a group health insurance plan that provides financial protection to the employees against unexpected events like injuries, accidental death, disability. Whether the employee meets with an accident while on duty or not and whether the incident occurs in the country or abroad, GPA policy covers the hospitalisation expenses. Owing to its extensive coverage, the GPA insurance plan is also known as a 24-hour worldwide accident policy.Benefits of Group Personal Accident Policy (GPA)
- If the employee meets with an accident that leads to disability or dismemberment of any body part, the insured member gets complete compensation to cover treatment cost as per the policy terms
- Accidental death due to sudden or unexpected incidents is covered under the policy.
- The policy covers the cost of carrying the deceased person and the funeral charges
- Ambulance charges
- In the event of insured employees' death, it offers compensation for the education of the dependent children
Final Word The terms and conditions of GMC and GPA insurance policy may vary from insurer to insurer, and as an employee, you must be aware of the policy terms and wordings to get the most out of the coverage.
What is a GMC insurance policy, and what is covered in the policy?
A sort of health insurance policy called a Group Medical Cover, which is famously known as GMC, is provided to a group of people, like the staff of a single company. This also extends to their dependents, such as spouses, kids, and parents.Typically, an employer provides such a policy as a perk and pays the premium. The costs for this type of health insurance are kept cheap since the risk is shared among a large group of already covered people.
Here are the things that are covered in the GMC insurance policy:
Hospitalisation Expenses:
If you stay in the hospital for more than 24 hours, then your hospitalisation costs are covered.Pre and Post-Hospitalisation Expenditures:Pre as well as post-hospitalisation expenses, such as those for medical reports, prescription medications, X-rays, and other similar costs, are covered by the policy.
Pre-Existing Conditions:
This type of insurance policy provides immediate coverage for pre-existing conditions , including diabetes, hypertension, etc.
Maternity plus Newborn Coverage:
Available as an add-on, this coverage also includes maternity costs and newborn baby medical costs.
Ability to avail of Add-Ons:
GMC covers may also offer the option to select add-ons for a modest additional fee. Maternity insurance, personal accident insurance , and AYUSH treatment insurance are popular add-ons.
Critical Illness Coverage:
The policy may include coverage for critical illnesses, including cancer, cardiovascular conditions, etc.
Additional Advantages:
Daycare procedures, as well as outpatient medical treatments, are typically covered by this policy.
What is a GPA insurance policy, and what is covered in the policy?
A type of insurance called group personal accident insurance covers a group of people financially in the event of unanticipated incidents that cause death, serious injury, or disability.Accidents can happen at any time and have unanticipated negative effects on your health. Therefore, a GPA policy has some built-in provisions to protect employees in the event that an accident results in their death or disability, which may have an impact on their ability to earn a living. It offers them or their families some level of financial security.Similar to a GMC, an employee's salary or the employer will pay the premium for a GPA.
Here are the things that are covered in the GPA insurance policy:
Whole or Partial Disability:
It offers financial protection in the event that an accident results in partial, total, or permanent disability, such as the loss of limbs or vision.
Accidental Death:
It offers dependents financial security in times of untimely demise.
Ambulance and Transportation Expenses:
Ambulance and transportation costs are also offered as optional benefits.
Hospitalisation Expenses:
When hospitalisation costs are related to an accident, it covers things like room rent as well as daycare visits.
Benefits for Children:
In the event of death or permanent disability , it pays for specific benefits for dependent children, like college tuition or wedding expenditures.
What is the difference between GMC and GPA insurance policies?
Take a look at the difference between Group Medical Cover and Group Personal Accident Cover insurance policies:
| Factors | Group Medical Cover | Group Personal Accident Cover |
| Other names for the insurance policy | Corporate Insurance policy, Employer-Employee Insurance policy & Employer-Offered Insurance policy | 24-hour Global Accident policy & Employee Personal Accident Insurance policy |
| The capacity of the insurance policy | This policy covers pre-hospitalisation, post-hospitalisation, and daycare costs for covered employees' medical difficulties and crises. | This policy covers incidents involving covered personnel while they are at work or when they are working and off-duty. |
| Coverage offered by the insurance policy | The GMC plan's coverage is determined using an indemnity system. This indicates that just the sum insured limit may be used to reimburse the covered employee's expenditures. For example, if the sum insured by the policy is Rs. 5 Lakhs and the hospital bill is Rs. 3 Lakhs, then the bill will be covered entirely by the policy. | Coverage under the GPA plan is determined based on benefits. This indicates that in accordance with the terms of the policy, a lump sum payment for the damage shall be made to the insured employee. For instance, if the accident leads to the covered employee's permanent total disability and the policy's sum insured is Rs. Fifty lakhs, then they will receive 100% of the policy's sum insured amount. |
| The extent of the insurance policy | GMC provides coverage for both the employee and any dependent family members, including a spouse, kids, or parents. | There is no cover offered to the dependent family members under the GPA plan; only employees are covered. |
| Range of the insurance policy | GMC can add GPA to the policy as an add-on because of its greater coverage area. | Only a small portion of accident scenarios are covered by GPA for covered personnel. |
| The ability to customise the insurance policy | The employer might alter certain features of the GMC insurance coverage. | GPA insurance policy doesn't allow any customizability. |
| The premium of the insurance policy | The premium for GMC coverage is often on the cheaper side. | GPA insurance has a somewhat higher-than-average premium. |
| Inclusions for the insurance policy | Pre, during, and post-hospitalisation costs, maternity insurance, daycare costs, outpatient department costs, pre-existing conditions, critical illness insurance, and routine physicals are all included in a GMC policy. | An accidental death benefit, permanent partial disability benefit, permanent total disability benefit, temporary total disability benefit, repatriation of mortal remains, child education benefit, ambulance fees, and hospitalisation costs like room rent in the event of an accident are all included in a GPA policy. |
| Exclusions for the insurance policy | Self-inflicted injuries and drug and alcohol addiction are excluded from coverage under a GMC policy. | Suicide attempts, participation in extreme sports, as well as participation in illicit activities are all excluded from the GPA policy. |
| Who should opt for the insurance policy? | The GMC policy is ideal for several organisations. | GPA policy is more appropriate for workers in dangerous industries like construction, oil and gas, or transportation. |
How is the premium for the GMC policy calculated?
A group of people can purchase a customised health insurance plan called a "Group Medical Policy", in which the benefits are the same for all group members. Employers adopt this policy and alter it to suit the company's requirements. The cost of the policy is far less than private medical insurance policies because the risk is shared among many people inside a business.The amount and perks supplied to employees are the same regardless of their health risk factors within the company. While some organisations charge a set amount from the employee's income, many organisations cover the entire cost of the premiums.The following variables are used in the calculation of the GMC policy's premium:
- Age, income, occupation, and other demographic factors of the members.
- Riders and Add-ons that are selected under the policy.
- Size of the group.
DISCLAIMER
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
