Frequently Asked Questions

  • all hospitalization costs are covered from day 1 of the policy. There’s a 30 day cooling off period  – except if admitted after being in an accident
  • over 527 day care procedures also are covered, these procedures don’t require hopsitalization due to advancements in surgery and care and are fully cashless if the patient takes pre-approval from Aditya Birla Health Insurance
  • the policy also includes all costs arising 30 days prior and 60 days from being discharged in the case of hospitalization. If there are MRI’s, medicines, tests etc.. it will get reimbursed once claimed
  • 2 years waiting for listed diseases you can view the list of diseases here
  • if hospitalized due to any diseases that exists from before this policy is issued, like diabetes, hypertension etc.., the hospitalization shall not be covered until 4 years from date of issuance

Yes, according the circular issued by the IRDA on 4th March 2020

A pre-existing disease is an ailment present before the inception of the insurance policy. For instance, many of the cardiovascular diseases or diabetes is classified under pre-existing diseases. Basically, any condition, ailment, or injury for which you had signs or symptoms, or were diagnosed, and received medical treatment, within specified period before taking insurance policy.

Premium of group health insurance is based on several factors including size of group, average age of group, type of occupation, type of coverage and benefits opted, and lastly the employer’s claim history. In cases where it is a fresh policy it becomes more important that the right insurer is chosen. We strive to offer more insurers to be able to offer the best possible experience at the most affordable price for a small business. Feel free to ask us for any specific information you have, we are very transparent.

Yes, they affect the premium a great deal, especially if this is the first policy you’re offering to your employees! We have seen including coverage for pre-existing medical ailments the costs tend to increase by ~ 65% on some plans. Young teams that are healthy need not worry much about this condition but it is recommended to get this coverage as it becomes a key element of group health insurance.

Yes. Cashless claims service will be available at all network hospitals of the respective insurer. Typically, each insurer has more than 5,000 hospitals on their network across the country. You can download the network hospital list for any insurer from our download section. To avail the cashless facility, you need to show your insurance cashless card at the TPA helpdesk in any of network hospital. Or follow the instructions in your account.

Yes, under group health insurance policy, insurance company reimburses expenses even if the insured member does not use the network hospital. To get your reimbursement, you need to submit your medical bills along with other documents as specified by the insurance company. After submission of all the documents, insurance company typically takes 30 days to review the documents and transfer the claim amount. It maybe also advisable to get pre-approvals from the insurer by following the process outlined in your account.

While buying group health insurance policy for employees, employer select the specific plan to offer their employees. Individual firms may customize the benefits for group insurance plans. Tenure of the plan is 1 year and premiums are paid upfront. If an employee leaves the firm or joins in new, the same is endorsed under the policy by charging or refunding the premium on pro-rata basis.

Indian insurance regulator, IRDA, in an exposure draft issued on January 19, 2016, specified that the minimum number of employees in the group should be 20 for the purpose of a group health insurance policy. However, micro insurance policies can be issued to a group with as small as 5 members. Essentially, companies of various size from small startups to large MNCs can cover their employees under group health insurance.

The employers can enjoy tax benefits for the premiums paid under group insurance. The premium paid by the employer is considered as privileges in the hands of the employee, and hence the employer can claim tax rebate under the income tax act. As the premium is considered as a part of business expenses, it is tax exempted