Best Health Insurance for a Family

Which Health Insurance Is Best for a Family: Retail or Group

Health Insurance
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Are you confused about deciding the best health insurance policy for your family?

Are you finding it difficult to decide between group health insurance and retail health insurance policy for your family?

Then this article throws some light on the best health insurance policy for your family.

Health insurance is a type of insurance policy in which the insurance company agrees to reimburse or pay the hospitalization expenses of the insured customer in case of hospitalization due to any illness, disease, or accident in return for a nominal amount known as a health insurance policy premium.

Health insurance covers the hospitalization cost of the insured due to illnesses, disease, or an accident. Health insurance can be classified into two types:-

Retail Health insurance and Group health insurance.

Retail health insurance is a policy that can be taken by an individual or a family,

While the Group Health insurance policy can be taken by an employer for employees working in an organization.

Since the onset of the Covid-19 pandemic, there has been a huge demand for health insurance due to the increased health care costs. Many people flocked to purchase health insurance and only the health insurance premium has skyrocketed while other insurance products were on the declining trend.

To increase the penetration of health insurance in India, the Insurance Regulatory and Development Authority of India has even asked the insurance companies to introduce covid specific health insurance plans such as Corona Rakshak and Corona Kavach which provide health insurance coverage to the people infected with the coronavirus.

The products have been a huge hit in the market due to the affordable pricing as well as the understandable terms mentioned under the policy.

Read more: Top 10 Best Family Health Insurance Plans

Let us understand which is the best health insurance policy for a family- Retail health insurance or Group Health insurance.

Description Retail Health Insurance Group Health insurance
What is it? Retail health insurance is a type of health insurance policy that covers individuals and/or family members under the same policy. A group health insurance policy is a type of health insurance policy that covers the employees and/or their families under a single master health insurance policy.
Inpatient hospitalization Covered up to the sum insured limit Covered up to the sum insured limit
Pre & Post Hospitalization Maximum of 90 days pre-hospitalization and 120 days post hospitalization Maximum of 90 days pre-hospitalization and 120 days post hospitalization

 

Alternative Treatments Alternative treatments such as Ayush covered up to a certain percentage of the sum insured only in registered hospitals. Alternative treatments such as Ayush covered up to a certain percentage of the sum insured only in registered hospitals
Room rent Room rent is covered as per the limit mentioned under the policy.  Room rent can be a certain percentage of the sum insured or a single A/C private room as per the option exercised by the insured customer.
Daycare treatment Daycare treatment covered up to the maximum sum insured under the policy. Daycare treatment is covered as per the terms and conditions mentioned under the policy.
Sum insured The minimum sum insured is ₹50k while the maximum sum insured can go up to ₹1 Crore for pre underwritten products. The minimum sum insured is ₹50k and the maximum sum insured is ₹10 Lacs in most group health insurance policies.
Premium based on The premium under the retail health insurance policy depends on the age of the elder person in the family and the sum insured chosen by the customer. The premium under the group health insurance the premium to be paid depends on the previous claim experience, age of the members, sum insured, etc.
Premium paid by? Insured customers will pay the premium under the retail health insurance policy. The employer or the organization for which you are working will pay the premium under the group health insurance policy.
Additions/ Deletions Additions and deletions can be made at any point the time during the policy period on payment of additional premium. The addition of family members due to marriage, childbirth, etc. is possible on payment of an additional premium. Deletion of a family member can be done with a refund of the premium. Additions and deletions in a group health insurance policy would be done only with the approval of the employer/ organization on payment of additional premium by the employer to the insurance company. In case of deletions, the premium would be refunded to the customer. Additions would be done in case of childbirth or marriage. Deletions would be done if the employee leaves the organization or on superannuation or death of the employee.
Endorsements Endorsements in a retail health insurance policy would be done after proper intimation to the insurance company. Endorsements in group health insurance policy can be raised from the Corporate portals provided to the organizations. All the endorsement-related activities can be done in the same portal with ease.
Cashless Claim settlement A cashless claim settlement facility is available to the retail health insurance policyholders in any of the network hospitals tied up with the insurance company. Cashless claim settlement can be availed in any of the network hospitals tied up with the insurance company under the group health insurance policy.
Reimbursement claim settlement Reimbursement claim settlement can be availed in case of non-availability of network hospital. All the claim-related documents should be submitted to the insurance company. Reimbursement claim settlement can be availed in case of non-availability of network hospital. All the necessary documents would be submitted by HR of the organization to the insurance company to process the claim.
Renewal Retail health insurance policies can be renewed before the expiry to prevent the lapsation with the same insurance company. Group health insurance policies can be renewed with the same insurance company or with a different insurance company as per the wish of the organization.
Lifelong renewability Retail health insurance policies have the option of lifelong renewability. There is no such option for group health insurance policies as the insurance company may deny renewing the policy stating a high claim ratio.
Maternity Maternity cover would be available under the retail health insurance policies and the sum insured for this would be the base sum insured. A separate sum insured would be available for group health insurance policies which are in addition to the base sum insured.
No claim bonus No claim bonus up to 150% of the base sum insured is available for every claim-free year. The no-claim bonus would be in the form of an extra sum insured. No claim bonus is not available.
Add-ons Add-ons can be opted as per the wish of the insured in retail health insurance. The organization would decide the add-ons to be taken under the group insurance.
Eligibility Criteria Minimum age- 3 months, Maximum age -80 years Employees of an organization are only eligible for group insurance.
Tax Benefits Tax benefits can be availed under section 80D of the Income-tax act. No tax benefit is available for group insurance.
Waiting period There would be an initial waiting period, pre-existing disease waiting period, and specific disease waiting period under retail health insurance. There is no waiting period for group health insurance. Claims can be availed from day 1.
Dependency There would be no dependency on anyone to purchase/ renew the retail health insurance policy. The insured customer can renew the policy on his own. Group health insurance is employer dependent which means the employees are dependent on the employer to renew or purchase the group insurance policy.
Premedical checkups Pre-medical check-ups would be required in certain conditions. No pre-medical check-ups are required.

Read more: Top 10 Best Health Insurance Plans In India

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