Group Medical Insurance refers to a type of Health Insurance. It covers a group of people, such as employees of a company, members of an organisation, or members of a community. Understanding the terminologies associated with it can help you check your coverage and make informed decisions. So, here are key terms of Group Medical Insurance explained in simple ways:

• Group

A group is a collection of people who are eligible for coverage under the same Insurance Policy. This could be employees of a company, members of a club, or participants in a programme.

• Coverages

Coverages are the medical services and expenses that are included in the Insurance Policy. This can vary depending on the plan chosen by the employer.

• Premiums

The premium is the amount paid to the Insurance company to buy the Insurance Policy. It is usually paid by the employer on behalf of the group members. You can calculate this amount through a Health Insurance premium calculator based on your policy details.

• Deductibles

A deductible is the amount that the insured individual or group must pay out of pocket. It should be paid before the Insurance company starts covering expenses.

• Co-payment

A co-payment is a fixed amount that the insured individual or group must pay for certain medical services or prescriptions. For example, a co-pay of Rs. 5,000 may be required for a doctor's office visit or a prescription medication.

• Network

Networks include doctors, hospitals, clinics, and other healthcare providers that agree to offer facilities to members of the Insurance Plan at negotiated rates. It is important to use providers within the network to maximise coverage and minimise out-of-pocket costs.

• Pre-existing conditions

Pre-existing conditions are health issues you had before the start of the Insurance coverage. Group Medical Insurance plans may have limitations or waiting periods for coverage of pre-existing conditions.

• Exclusions

Exclusions are specific medical services, treatments, or conditions that are not covered by the Insurance Policy. You need to carefully review the policy documents to understand what is and not covered.

• Renewals

Renewal is the process of extending the coverage of the Insurance Policy for another term, usually annually. The group should review the terms of the policy at each renewal to ensure it still meets their needs.

• Claims

Claims are requests for payment to the Insurance company by the insured individual or healthcare provider. It is meant for medical services or expenses covered under the Group Medical Insurance. The Insurance company checks the claim and reimburses the appropriate amount according to the policy terms.

Conclusion

These basic terminologies can help you understand your Group Medical Insurance coverage more effectively. That way, you can make informed decisions about their healthcare needs.