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Difference Between Group Health Insurance and Individual Health Insurance Coverage

Posted on 10 Apr, 2024
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Choosing the best health insurance can sometimes feel like unravelling a code. A health insurance policy can be of different types, and one should choose a plan that suits his/her needs the best. The two popular types of health insurance categories are Individual Healthcare Plans and Group Health Insurance Policies. Let’s look at the distinctions between group health insurance and individual health insurance coverage. Whether you’re a business owner or someone exploring your healthcare options, this guide aims to bring clarity.

group health insurance policy

Group Health Insurance

A group health insurance policy is like a safety blanket for your crew. It’s a policy that caters to a collective of individual employees within an organisation. Here’s the breakdown of how it can be beneficial for organisations, especially small businesses.

  • The Employer Takes Charge: In most instances, employers are responsible for procuring and predominantly funding group health insurance for their workforce.
  • Negotiating Power: Group Health Insurance Policy covers a large number of individuals and, therefore, comes with lower premiums compared to individual plans.
  • One Plan, Many People: Typically, all members covered under a group health insurance plan receive the benefits. But remember that flexibility and customisation options are usually restricted in such plans.
  • Group Health Insurance for Small Business: A group health insurance policy isn’t limited to large organisations only. Even small businesses can provide this perk to attract and retain employees.
  • Employer Benefits: Employer benefits can be significantly enhanced through the utilisation of a group health insurance policy. This valuable tool not only helps in attracting and retaining talent but also plays a crucial role in boosting employee morale and potentially reducing absenteeism caused by health-related issues.
  • Cost Sharing: Employers often bear a large portion of the premiums, thereby lessening the burden on employees.
  • Eligibility Criteria: Typically, full-time employees and sometimes their dependents are eligible for group health insurance coverage.

Employers recognise that a workforce’s well-being directly impacts productivity and happiness. A group health insurance policy provides support to employees in maintaining their health while alleviating their worries.

Individual Health Insurance

An individual health insurance policy revolves around your preferences. From selecting coverage options that align with your needs to paying premiums that suit your budget, this is a more flexible and customisable option for those considering investing in a healthcare plan that is not employer-sponsored.

  • Customisation: Individual health insurance plans offer a broad range of coverage choices tailored to your healthcare requirements.
  • Your plan, Your choices: In contrast to group health insurance plans, individual insurance policies grant you autonomy over decision-making aspects, such as selecting healthcare providers, the sum insured, add-on covers according to your needs and preferences, and more. Take a look at the options available, including the clauses related to deductibles, co-pays, and scope of coverage.
  • Pricing: Individual plans may cost more than group health insurance policies since you’re responsible for paying the entire premium without any employer contributions.
  • Portable: When you switch jobs, group health insurance typically ends. On the contrary, an individual healthcare policy remains with you, regardless of whether you switch jobs/employers. You can also port your individual healthcare plan to another insurer.
  • Easy modification: An individual healthcare plan gives the policyholder the freedom to adjust the scope of coverage based on his/her changing needs; this is not the case when it comes to an employer-sponsored group health insurance policy. With an individual health insurance policy, you have the flexibility to select doctors and hospitals within the insurer’s network.

Which One is the Best?

When it comes to choosing between group and individual health insurance plans, each has its advantages. Consider opting for group health insurance if you’re an employer, as it builds your firm’s reputation as an employee-friendly organisation. Also, this helps you cut costs as a group healthcare plan is cheaper than investing in individual health insurance plans for each employee.

However, if you prefer an insurance plan with more flexibility, an individual healthcare policy might be the way to go. This option is ideal for those who are self-employed or don’t have access to employer-provided coverage. It offers flexibility in tailoring a plan that meets your needs and budget, offering the continuity of health coverage even if your job situation changes.

When it comes to pre-existing health conditions, group health insurance policies score higher than individual healthcare plans as there are no waiting periods involved or health check-ups required to receive coverage. Moreover, the coverage offered by a group health insurance plan can be extended to include an employee’s family (i.e., spouse, children and sometimes parents). This cannot be done if one opts for an individual healthcare plan.

Another vital aspect of a group healthcare plan for employers is tax benefits associated with premiums. This is particularly beneficial for employers who opt for group health insurance for small businesses. An employer can avail of deductions for premiums under Section 80D of the Income Tax Act. An employee can also avail of a tax rebate under Section 80D only if he/she makes a contribution to the payment of premiums. Those opting for an individual healthcare plan can avail of a tax rebate under Section 80D as they pay the entire premium.

Summing Up

Selecting health insurance is undoubtedly a good decision. While there’s no one-size-fits-all solution, this guide serves as a starting point in navigating through the options to secure suitable coverage for your workforce or yourself. Consider if you’re looking to provide insurance as a perk for your team while keeping expenses down or if having authority over your coverage and the option to remain covered when switching jobs is more critical.

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This contains only an indication of the cover offered. For complete details on risk factors, terms, conditions, coverages and exclusions, please read the sales brochure carefully before concluding a sale.ICICI trade logo displayed above belongs to ICICI Bank and is used by ICICI Lombard GIC Ltd. under license and Lombard logo belongs to ICICI Lombard GIC Ltd. ICICI Lombard General Insurance Company Limited, ICICI Lombard House, 414, Veer Savarkar Marg, Prabhadevi, Mumbai – 400025. . IRDA Reg.No.115. Toll Free 1800 2666. Fax No – 022 61961323. CIN (L67200MH2000PLC129408). customersupport@iciclombard.com. www.icicilombard.com. (Group Health Insurance,4016 , ICIHLGP21381V052021)