How Does A Separate Health Cover Affect Your Group Mediclaim Benefits?

Most of the salaried class today have group health plans offered by their company. It is a perk that corporates provide to their employees. At the same time, these people, more likely than not, also have individual health insurance. This can create a bit of doubtfor many, as to which one to use for their claims and whether you can use both.


To be fair, it is a logical to ask: “Is it useful at all to incur expense on something that is being provided on a platter?”

Before we answer this question, it would be helpful to understand the differences between group mediclaimand individual health policies.

Group mediclaim and individual health insurance – how do they differ from each other?

While you might think that, both offer essentially the same benefits, the fact is that there are some pronounced differences between the two. Group health insurance is an insurance package that a company buys for the benefit of its employees. Individual insurance is insurance that youcan buy for yourself, or for your family. Yes, it is important to know that even though we call it “individual insurance,” it is not necessary that an individual insurance policy should cover only one person.

• The first and foremost difference between group and individual policies is that group insurance costs less, and can be availed at very low, or no cost at all. Unless you opt for additional benefits, you do not have to pay anything. If at all you opt for other benefits, then your premium will be deducted from your salary. But in the case of individual insurance, you have to pay the premium separately, either at one go or in a staggered manner, whatever be the case.
• In the case of group health insurance, you need not go through a medical check-up, but for an individual policy, your health parameters would be checked. It is, thus, much easier to obtain group insurance.
• Group insurance does not give you any control over the terms and conditions, but in the case of an individual policy, you have the flexibility to decide on various issues.
• Group insurance can be withdrawn at the discretion of your employer, but an individual policy will continue for its entire term as long as you pay the premium.
• In the case of group insurance, even if you do not make a claim throughout the tenure of the policy, you will not get any bonus. But in the case of an individual policy, you will get a no-claim bonus.

So, now that you know the differences between these two types of health cover, what should you do? Is group insurance enough for you, or should you have your own individual cover as well? Let us examine a few scenarios to answer this question.

Case 1: You Need a Day-Care Treatment

Suppose you need to undergo dialysis or cataract removal. You will need to go to a hospital, but you need not stay overnight as some procedures can now be completed in just a few hours, thanks to advances in medical science. Hence, some insurance companies now provide day care plans as well. These plans cover costs of those procedures that can be completed in a matter of hours, giventhe newer and faster treatment.

In this scenario, your individual health insurance will be better suited, because you get to decide what all the policy covers right at the time of buying the plan. You would know whether you have opted for day care treatment or not. You may not know whether your group health cover offers this facility or not.

Case 2: You Need Hospitalization, But the Expense Will Be Minor

Consider a situation where you need to be hospitalized for some minor procedure. You know that the expense will not be much. In this situation, it is better to utilize your group mediclaim plan. This is because using your individual policy for a minor expense will mean you will forego the no-claim bonus. You will, anyway, not get any no-claim bonus on your employer-provided insurance. So, why waste your bonus on making a small claim?

Case 3: You Need Hospitalization, and It Will Be a Significant Expense

In a scenario where you need to be hospitalized for a major procedure, where the costs will be substantial, you can take recourse to either your group insurance or your individual plan. Both will be equally useful. Do check sub-limits. You might have exclusions on either your group cover or your own plan. Check what you are eligible for, and then go for whichever policy you feel is better suited. As said earlier, both will be equally handy.


It is, thus, clear that having an individual plan does not negatively impact your group cover. In fact, an individual policy complements your employer-provided insurance and enhances your overall cover. So, even as you enjoy the benefits of group cover, make sure you have an individual health insurance policy as well.

There are more than 20 insurers that specialize in providing group mediclaim insurance. It may not always be possible for everyone to compare and research about all of them and figure out the best. Online insurance advisors such as SecureNow fill this gap very efficiently. They can help buyers in analysing their needs, decide the right cover amount and manage the policies after buying.

About the Author

Raj Kumar Mishra
Entrepreneur..been there done that.