Group Health Insurance Vs Individual Health Insurance

There are various types of health insurance policies, and you should select the one that best meets your needs. Group health insurance and individual health insurance are two popular types of health insurance. The coverage provided by these policies may be similar, but who is eligible to receive it is what distinguishes them. Let’s take a closer look at the distinctions between Corporate Group Health Insurance and Individual Health Insurance:

Group Health Insurance Vs Individual Health Insurance

The following table compares Employee Group Health Insurance and Individual Health Insurance Plans:

Content Group Health Insurance Individual Health Insurance
General Meaning A group health insurance plan provides health insurance to a group of people. Individual health insurance policies provide coverage to policyholders.

 

Who is insured? The insured person and any dependent family members. Only one person, the policyholder.
Who is the purchaser? An employer typically purchases group health insurance (or the main member of the family for the Family Floater Insurance plan). Individual health insurance is purchased by the policyholder.
What level of influence does the insured have over the plan? Control is restricted (The employer or the purchaser has control over the coverage and add-ons of the plan). Complete command (The policyholder can control the coverage and add-ons of the plan).
Option to buy Add-ons None or very few Any of the available add-ons can be purchased by the policyholder.
Claims Typically, claims are made through a third-party administrator. Claims can be filed with the insurance company directly.
Available Sum Insured When compared to individual health insurance, the cost is low. It could range between Rs. 5 and Rs. from 10 lakh. When compared to a group health policy, you have the option of selecting a higher sum insured. It could range between Rs. 5 and Rs. 15 lakh.
Eligibility Criteria

 

Should be a full-time employee of a company. For Eligibility Criteria, you have to be at least 18 years old.
Criteria for exit When an employee leaves the company or retires, the insurance plan ends. The policyholder turns 65. (Insurance has an age limit.)
Tax Benefits No Yes
Pre-existing disease coverage Mostly from the first day. Following the end of the waiting period.
Maternity Benefits Covered Must be purchased as an add-on.
No Claim Bonus Inapplicable Applicable
Pre-purchase medical examinations It is not required. Required
Coverage for Critical Illness No If the policyholder so desires.

Group Health Insurance

Pros:

  • Better coverage at a lower cost
  • It is now easier to obtain coverage for pre-existing conditions.
  • Some brokers provide additional administration and claims assistance to corporate clients.

Cons:

  • Benefits and limits are determined by the employer, not the individual.
  • Not all group plans are portable, so you will lose coverage if you quit your job.
  • The plan is owned by the employer, not the employee.

Individual Health Insurance

Pros:

  • More coverage customization options
  • Increased control over co-pays, deductibles, and benefit caps
  • Choose your preferred insurer.
  • It is portable; it is not dependent on your employment status.

Cons:

  • Increased premiums
  • Additional fees or no coverage for pre-existing conditions
  • Some insurers and brokers are involved in the plan’s use.

In conclusion, Individual and group health insurance plans provide distinct benefits and serve distinct functions. To ensure adequate financial support in times of need, one should always purchase health insurance as needed.

The new rules can cover a person with multiple health insurance policies. As a result, it is strongly recommended that you build a solid health insurance portfolio to avoid any unwanted financial risks in the event of a medical emergency. An individual plan, a group plan from the employer (if applicable), a family health insurance plan, and critical illness coverage are all recommended.

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