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Investing in a Good Health Insurance Plan Over and Above Your Group Mediclaim

By Vikas Chandra Das
21 July 2022, 11:46 AM
why opt for health insurance plan despite group mediclaim

An individual health insurance plan is a standard health insurance product that offers cover for the medical expenses incurred in the case of a single person. Stress, inadequate work-life balance, unhealthy diet habits, etc. have made lifestyle diseases such as hypertension, diabetes, asthma, etc. a common occurrence in every household. Along with that, the cost of medical facilities has been continuously rising in India and these reasons make individual health insurance plans a must-have to face any medical emergencies in the future. 

A group health insurance policy is a package that is offered by an organization to its employees. The organization can either design its package or select from the various health insurance packages which are being sold by the insurance providers. Group medical insurance would provide the members with the optimum cover they need. They are usually designed for providing cover to the employees and their families.

However, many people usually get confused about making their choice between an individual health insurance plan and Group health insurance plans. Group Insurance Plans are extremely beneficial for the employee and his family and there is no element of doubt in that. But whether or not you should buy additional health insurance coverage for yourself and your family over and above your existing group health coverage is what we will address.

So, let us understand the merits and demerits of both plans.

Advantages of Group Mediclaim

  1. No Pre-entrance medical check-up:
    No medical checkup is usually required for a group health insurance policy. This is true for all coverage amounts and any age, unlike individual health plans.
  2. Premium paid by the employer:
    Group health insurance plans are less expensive than individual health insurance plans. Generally, group mediclaim would cost around one-third of the cost of individual health insurance policies. But this cost is usually borne by the employer. So, a group mediclaim is usually an “additional” benefit for the employee.
  3. Maternity and other associated benefits:
    Group health insurance policy would provide benefits like maternity benefits which is difficult to obtain in individual health insurance policies, but up to a certain specified limit. Individual health plans with maternity benefits are available but usually very expensive.
  4. PED coverage:
    Group health insurance plans would also cover pre-existing diseases which are usually not covered under individual health insurance plans. Individual health plans usually have a waiting period for the pre-existing health insurance ailments, which is typically not there in group plans.
  5. No waiting period:
    Policyholders can claim within 30 days of obtaining a group mediclaim whereas this is feasible in individual health insurance policy only in case of medical emergencies or accidents,
  6. Dependent and parental coverage:
    Moreover, policyholders also get coverage for their dependents and even parents. If the Group Health Plan allows parental coverage, they would be included in the same with their pre-existing disease coverage from day 1 in a Group mediclaim.

Disadvantages of Group Mediclaim

  1. Group health insurance plans cannot be customized to cater to the requirements of the policyholders. The employers might not offer good insurance products since the cost needs to be borne by them.
  2. Some Group health insurance plans might also only provide coverage for the employees only while other plans extend their benefits to their immediate family including their spouse and children and might exclude the employee's parents from the list.
  3. In group health insurance plans, there is a common fear that employers might withdraw the benefits of the insurance whenever necessary. There is no guarantee of continuity in a group health plan.
  4. The employers might ask the employees to pay the premium of a group mediclaim plan or share the cost of the same.
  5. Higher payouts can also cause the insurance providers and group administrators to introduce co-pay and other restrictions, especially for senior citizens.
  6. The most important disadvantage of a group health plan is that the coverage is available ONLY as long as you are associated with the group or employed with the company. Usually, the coverage ceases to exist post-retirement or you leaving the company at any point in time!

This is where the importance of individual health insurance coverage steps in.

Why Should Policyholders Opt for Individual Health Insurance Plans Despite Having Group Health Insurance?

Despite having group mediclaim, many policyholders should opt for individual health insurance policies due to the below-mentioned reasons.

1. Customization

An individual health insurance policy can be customized easily and conveniently. You can include add-on covers to enhance the coverage or co-pay to reduce the health insurance premium. Moreover, the policyholders would have complete control over the insurance policy and thus, can add or remove family members into/from the policy easily. 

2. Cumulative Bonus Benefit

A corporate health insurance plan will not let you carry forward the benefits which you have accumulated over many years of employment when a policyholder is joining a new organization. Benefits like No Claim Bonus (NCB) or Cumulative Bonus Benefit are not available in group health insurance plans for not making any health insurance claims

3. Post-retirement issues and Lifelong Renewability

A policyholder might rely on the group health insurance plans but after retirement, there are very few chances of these policyholders obtaining a good individual health insurance plan at a minimal premium. Most insurance providers would charge a higher premium or would exclude many ailments once a policyholder is into a specific age bracket. So, it is wiser to not rely on corporate health insurance cover for the lifetime.  

4. Portability

Policyholders might not be satisfied with the coverage and benefits provided by the health insurance and might think about switching from one health insurance provider to another. This is feasible in the case of individual health insurance policies and policyholders can carry forward their benefits accumulated so far too.  


Hence, group health insurance policies would be a cost-effective option but rather than keeping only the premium factor in mind the policyholders must consider the other factors too. So, a policyholder needs to have an individual health insurance policy for protecting himself and his family members during medical emergencies.

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