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How Group Health Insurance Covers Pre-Existing Conditions

Posted on 07 Jan, 2025

In today’s times, when medical conditions and healthcare costs are increasing by the day, staying covered under adequate health insurance will ease your worries and out-of-pocket expenses. This insurance product will cover your medical bills and help you concentrate on the treatment and recovery.

Insurance companies in India offer a range of health plans to meet different customer requirements and pocket, and group health insurance is one of them. As the name suggests, this policy covers the medical bills of a group of people, such as the employees or members of an organisation. While a group health insurance policy offers wide coverage and many benefits to policyholders, coverage against pre-existing conditions is an important benefit it offers. Let’s talk about this in detail.

group health insurance

What is group health insurance?

Group health insurance is a comprehensive healthcare policy that covers a group of people, such as employees or members of an organisation, under one policy. The features of a group health insurance policy are —

  • Coverage: The policy covers the hospital bills, pre- and post-hospitalisation expenses, daycare treatments, home healthcare, alternative treatments, road ambulance bills, organ donor expenses, etc., of the insured.
  • Premiums: In most cases, employers pay the entire premium of a group health insurance policy. However, there can be instances when the employees are liable to pay a part of the premium amount.
  • Coverage for family: Some employers allow employees to add their immediate family members under a group health insurance policy. However, this entirely depends on the employers or the organisation. Also, while some employers cover family members for free, others cover them for an additional premium.
  • Cashless treatment: Policyholders can opt for cashless treatment at any network hospital of the insurer. This saves them from the hassles of paying the bills from their pocket and filing a reimbursement claim later.
  • No medical screening: Insurance companies cover employees or members of an organisation under group health insurance without a pre-policy health check-up or medical screening.
  • Complimentary health check-ups: A group health insurance policy may also offer complimentary health check-ups to employees. The frequency of these health check-ups depends on the insurance provider.

What is a pre-existing condition?

A pre-existing condition is an illness or injury you were diagnosed with 48 months before buying health insurance. Some examples of pre-existing conditions are diabetes, asthma, cancer, hypertension, heart disease, chronic obstructive pulmonary disease, etc.

How do group health insurance policies cover pre-existing conditions?

A group health insurance policy covers pre-existing conditions from day one. Other health insurance products, like individual health insurance, family floater, or a senior citizen’s healthcare plan, cover pre-existing conditions after a waiting period of 1 to 3 years.

For example, suppose you got diagnosed with a heart disease some 5 years ago. You join a new organisation, and your employer covers you under a group health insurance policy. In this case, the insurer will cover the medical expenses related to the pre-existing condition from day one. The coverage will be limited to the sum insured by your group health insurance policy.

Hence, there is no waiting period for pre-existing conditions under a group health plan. However, if you are covered under this health plan, get in touch with the company’s human resources team for details regarding pre-existing conditions and policy coverage to avoid associated hassles later.

What is pre-existing conditions waiver in group health insurance?

Some insurers may not cover pre-existing conditions for group health insurance policies. In this case, employers or organisations can opt for a pre-existing conditions waiver by paying additional premiums every year. This will ensure better coverage to employees against pre-existing conditions.

A health plan covering pre-existing conditions will help employees opt for timely healthcare without worrying about the bills. This will help reduce absenteeism, increase productivity, and benefit the organisation in the long run.

Conclusion

To sum up, if you are covered under a group health insurance policy, the insurer will cover you against pre-existing health issues from day one. This benefit will help you opt for quality healthcare without paying huge bills from your pocket. However, even if you are covered under group health insurance, it is wise to keep an individual health insurance policy or family floater handy. A personal health plan will help you cover your medical bills when you are in between jobs and save you from financial setbacks.

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This contains only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale.ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025. . IRDA Reg.No.115. Toll Free 1800 2666. Fax No – 022 61961323. CIN (L67200MH2000PLC129408). customersupport@iciclombard.com. www.icicilombard.com. (Marine Insurance, 4010 , IRDAN115P0010V01200607)