Secure your employees' well-being with
Group Hospital Cash Insurance coverage.

With Sanyog Insurance Brokers

Benefits of Group Hospital Cash Insurance

Uniform Coverage for All Members

Ensures that every individual in the group receives the same daily cash benefit, simplifying policy management and providing equitable support.

Financial Flexibility

Allows members to use the cash benefit for various non-medical expenses, such as travel and accommodation, which are not typically covered by standard health insurance.

Customizable Options

Policies can be tailored to suit the needs of the group, including adjusting daily benefit amounts and coverage terms based on specific requirements.

Reduces Financial Burden

Helps alleviate the financial impact of hospitalization by providing a predictable cash benefit, which can be especially useful for managing unexpected out-of-pocket costs.

Reference for Group Hospital Cash Insurance

Definition

A Group Hospital Cash Insurance Policy offers a daily cash benefit to insured members during their hospital stay, providing additional financial support beyond regular health insurance coverage. This benefit helps cover non-medical expenses, such as food, travel, or other incidental costs that may arise while hospitalized.

Designed for organizations, employers, or groups, this policy provides a fixed daily amount for each day of hospitalization, making it easier to manage out-of-pocket expenses. It can be customized based on the group’s needs, offering a flexible solution to support members financially during their time in the hospital.

How Does EDLI Operate?

  1. Enrollment

    • Automatic or Voluntary Enrollment: Employees or members are enrolled in the Group Hospital Cash Insurance policy either automatically by their employer or organization or by choosing to opt-in during an open enrollment period. This policy is usually part of a broader employee benefits package and is offered to groups such as employees of a company, members of associations, or large organizations.
    • Eligibility: Once enrolled, participants gain immediate or scheduled access to the daily cash benefits upon hospitalization, depending on the terms of the policy.

  2. Fixed Daily Cash Benefit

    • Pre-Defined Cash Payout: The insurance plan provides a fixed, predetermined amount of cash for each day the insured individual is hospitalized. For instance, the daily benefit could range from ₹500 to ₹5,000 or more, depending on the chosen policy.
    • Benefit Duration: The benefit is typically payable for a set maximum number of days per hospitalization or per policy year. For example, the policy may limit coverage to 30, 60, or even 100 days of hospitalization in a given year.
    • ICU Coverage: If the insured is admitted to the Intensive Care Unit (ICU), some policies may offer an enhanced benefit, such as a doubled payout amount. This additional benefit helps cover the higher costs and risks associated with ICU stays.

  3. No Link to Actual Medical Expenses

    • Independent of Hospital Bills: One of the unique aspects of Group Hospital Cash Insurance is that the payout is not tied to the actual medical expenses incurred during hospitalization. This means that the insured will receive the fixed daily benefit regardless of the total hospital bill, even if the medical expenses are fully covered by another health insurance policy.
    • Flexible Use of Cash: The benefit can be used by the insured for any purpose, providing flexibility beyond medical bills. For example, the cash payout can be used to cover additional expenses such as:
      • Loss of income during hospitalization.
      • Travel and accommodation for family members.
      • Non-covered medical costs, such as specialized treatments or medicines.
      • Any other incidental costs that may arise during the hospital stay.

  4. Multiple Claims

    • Recurrent Claims: If the insured individual is hospitalized multiple times within the coverage period, they may make several claims under the policy, as long as it remains within the specified limits of the daily cash benefit and the total number of claimable days.
    • Seamless Claim Process: Once the insured provides the necessary documentation (such as medical reports and proof of hospitalization), the insurance provider disburses the daily cash amount without needing to verify the hospital’s charges, making the process quick and hassle-free.

By offering a guaranteed daily cash benefit independent of actual medical expenses, Group Hospital Cash Insurance provides financial security and flexibility during hospitalization, ensuring that employees or members are not financially strained by unexpected incidents.

Key Features:

  • Daily Cash Benefit: Provides a fixed sum for each day of hospitalization, generally ranging from ₹500 to ₹5,000 or more per day.
  • Extended Coverage: Available for hospitalization due to accidents, illnesses, or surgeries.
  • ICU Benefits: Some policies offer a higher payout if the insured is admitted to the Intensive Care Unit (ICU).
  • Affordable Premiums: Group policies typically offer lower premiums due to the collective nature of coverage.

How to Make a Claim?

  1. Notify the Insurance Provider

    • Inform the insurance provider about the hospitalization as soon as possible. Some policies may require notification within a specified time frame, such as 24 or 48 hours after admission.
    • If the policy is offered through an employer, notify the HR department, as they may assist with the claim process.

  2. Collect Required Documents

    • Hospital Admission Records: Obtain the admission and discharge summaries from the hospital, confirming the dates of hospitalization.
    • Medical Reports: Ensure you have detailed medical reports from the treating doctor, explaining the diagnosis, treatment, and length of stay.
    • Daily Hospital Records: Some insurers may ask for daily treatment records to validate the claim duration.

  3. Complete the Claim Form

    • Fill out the claim form provided by the insurance company. This can often be downloaded from the insurer’s website or obtained through your employer.
    • Ensure that all sections are completed accurately to avoid delays in processing.

  4. Submit the Claim

    • Submit the claim form along with the required documents to the insurance provider or employer, depending on the policy administration process.
    • Attach additional documents such as identity proof (Aadhar, passport, etc.) and a canceled cheque or bank details for the payout.

  5. Review and Approval

    • Once the insurance company receives the claim, they will review the documentation. Since the claim is independent of actual medical costs, they will verify the duration of hospitalization rather than the total hospital bill.
    • Claims are usually processed within a few days to a few weeks, depending on the insurance company and the complexity of the claim.

  6. Receive Payout

    • Upon approval, the insurer will disburse the fixed daily cash benefit directly into your bank account.
    • The payout will be based on the number of days spent in the hospital, up to the maximum limit specified in the policy.

  7. Follow Up if Needed

    • If there is any delay or additional information is required, follow up with the insurance company to ensure that all required documents have been submitted and the claim is progressing.

By following these steps and ensuring all required documents are in order, you can smoothly claim your Group Hospital Cash Insurance benefits. Always check with your insurance provider for any specific terms or additional documentation needed for your policy.

Eligibility for Group Hospital Cash Insurance:

  1. Employment Status

    • Full-Time Employees: Group Hospital Cash Insurance is primarily available to full-time employees who are officially enrolled in the company’s employee benefits program. These employees are automatically covered under the policy as long as they meet any other eligibility criteria.
    • Part-Time Employees: Some policies extend coverage to part-time employees, though this is less common. Coverage for part-time employees may depend on the specifics of the policy or additional premiums paid by the employer or employee.
    • Dependents: Coverage may also be available for dependents of employees, such as spouses and children. This typically depends on the policy terms and the employer’s benefits package. In some cases, employers may offer additional options for family coverage at an extra cost.

  2. Group Size

    • Minimum Group Size: Group Hospital Cash Insurance policies are generally available for groups of 10 or more individuals. Insurers set this minimum to ensure that the risk is spread across a sufficient number of participants, making the policy more cost-effective and manageable.
    • Large Groups: For larger groups, such as organizations with hundreds of employees or clubs with many members, insurers may offer customized plans with enhanced benefits or lower premiums. The larger the group, the more cost-effective the coverage becomes due to the pooling of risk.
    • Special Arrangements: Some insurers might offer policies for smaller groups if they are part of a larger association or network, or if they meet specific criteria set by the insurer.

  3. Pre-existing Conditions

    • Exclusions: Many Group Hospital Cash Insurance policies may exclude coverage for pre-existing conditions. This means that if an employee has a medical condition that existed before the start of the insurance coverage, claims related to that condition may not be eligible for benefits.
    • Waiting Periods: Some policies impose a waiting period for coverage of pre-existing conditions. During this period, which can range from 6 months to 2 years, claims related to pre-existing conditions are not covered. After the waiting period, coverage for such conditions may become available.
    • Disclosure Requirements: Employees may need to disclose any pre-existing conditions when enrolling in the policy. Full transparency ensures that all parties are aware of coverage limitations and avoids disputes during the claims process.

  4. Additional Eligibility Criteria

    • Age Limits: Some policies may have age limits, either for the insured individuals or their dependents. For example, coverage might be limited to individuals under a certain age or extend to dependents up to a specific age.
    • Employment Tenure: Certain policies may require a minimum length of service before eligibility kicks in. For example, employees might need to complete a probationary period or work for a certain number of months before becoming eligible for coverage.
    • Geographic Location: Coverage may vary based on geographic location, particularly for groups with members in different regions or countries. Insurers may have specific terms for domestic versus international travel or coverage.

By understanding these eligibility criteria, employers and employees can better navigate the options for Group Hospital Cash Insurance and ensure that they meet the requirements for comprehensive coverage.

Documents Required For a Claim under the Group (EDLI) scheme:

  1. Claim Form

    • A completed and signed claim form provided by the insurance company. Ensure all sections are filled out accurately and completely.

  2. Hospital Admission Records

    • Admission and discharge summaries from the hospital confirming the dates of hospitalization.
    • Copies of hospital bills or receipts, if applicable, although the cash benefit is not dependent on the actual costs.

  3. Medical Reports

    • Detailed medical reports from the treating physician outlining the diagnosis, treatment received, and the duration of hospitalization.
    • Discharge summary or medical certificate from the hospital confirming the treatment and recovery status.

  4. Daily Hospital Records

    • Records or statements from the hospital that detail the daily treatment and care provided during the hospital stay.

  5. Identity Proof

    • Valid identification documents for both the insured and the claimant, such as a passport, Aadhar card, or driver’s license.

  6. Proof of Employment

    • Employment verification documents or certificates from the employer confirming the insured’s status and coverage under the group policy.

  7. Bank Details

    • Bank account details of the claimant for the direct transfer of the cash benefit amount. This may include a canceled cheque or bank statement.

  8. Proof of Hospital Stay

    • Any additional documents that may support the claim, such as visitor passes or room booking confirmations from the hospital.

  9. Additional Documentation

    • If applicable, any other documents requested by the insurer or required under specific circumstances, such as:
      • Police reports for claims related to accidents.
      • Reports or statements if there were multiple hospitalizations during the policy period.

Ensure all documents are correctly prepared and submitted to facilitate a smooth claims process. Always check with your insurance provider for any additional or specific documentation required for your policy.

FAQ'S

Additional members can usually be added to the policy, but terms and conditions may apply. Contact the insurer for specific details.

The policy pays the daily cash benefit for the duration of the hospitalization up to the maximum number of days specified in the policy.

The benefit amount is pre-determined and set according to the policy terms. It can often be customized based on the group’s needs.

Exclusions may include certain high-risk activities, pre-existing conditions, or specific non-covered expenses. Review the policy for detailed exclusions.

Ready to Buy Insurance?

We Are Here...

Our experts are here to help you get the right business insurance.

Please enable JavaScript in your browser to complete this form.
Email