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What is Group Personal Accident Insurance?

A Group Personal Accident (GPA) Insurance policy helps protect you and your family financially in case you suffer an accident that results in death or disability. It compensates policyholders in events such as accidental death, loss of limbs or eyes, permanent partial disability, and permanent total disability. Whether your group is large or small, customizable GPA policies can meet the needs of all members. Additionally, discounts are available based on the group's size.

Features of Group Personal Accident Insurance:
  • Small to large organizations can avail themselves of GPA Insurance for their employees and board members.
  • Coverage includes medical expenses, hospitalization costs, disability benefits, and death.
  • In cases of permanent disability or death, an educational fund may be available for dependent children.
  • Policy tenures generally last one year.

Why do you need Group Personal Accident Insurance?
Accidents are unfortunate events that can financially strain families, especially if the primary breadwinner is involved. GPA insurance provides financial support in such scenarios. It can deliver a lump-sum payment or income replacement, helping cover medical bills, lost wages, or other expenses resulting from the accident. For employers, offering this insurance underlines your commitment to employee well-being and financial security.

What will a Group Health Insurance Policy cover?

Here are some incidents covered under the policy :

Accidental Death

If the insured person dies in an accident, the insurer pays the sum insured to the nominee.

Permanent Partial Disability

An employee who becomes partially disabled due to an injury will receive a sum assured, usually ranging from 2% to 60%, depending on the policy terms and conditions.

Permanent Total Disability

If an employee suffers an accident resulting in permanent disability, or a disability lasting at least a month, the employee is entitled to compensation from the insurer. This compensation can be up to the sum insured.

Educational Benefits

Should an employee suffer permanent disability or death, the insurance company will cover the educational expenses for his/her dependent children.

Ambulance Charges

These cover the expenses associated with transporting the injured employee from the accident scene to a medical facility.

Weekly Benefits

A company pays weekly compensation if an employee is fully disabled due to an accident.

Transport of Mortal Remains

The policy reimburses the cost of transporting the deceased from the accident site to a hospital, residence, or crematory.

Bone Fractures

A lump sum payment is made for incidents involving bone fractures. The policy clearly states which types of broken bones are covered.

What's not covered?

Generally, GPA insurance does not cover :
  • Natural death
  • Injuries caused by alcohol or drugs
  • Acts of law violation
  • War and nuclear perils
  • Pregnancy or childbirth
  • Ionizing radiation or radioactivity

Who needs a Group Personal Accident Insurance Policy?

Registered entities such as companies, associations, educational institutions, and government agencies should have GPA insurance for their employees.

  • Even small startup teams can purchase GPA insurance, an effective tool for attracting and retaining top talent.
  • As your company expands, managing insurance and employee benefits becomes increasingly complex. GPA insurance helps you offer excellent medical coverage to your employees.
  • Large organizations commonly provide GPA insurance to their employees. BimaKavach offers various benefits for such organizations, covering all members uniformly, regardless of age, gender, or position.

FAQs

What is the difference between group mediclaim and retail health insurance?
The primary distinction between group health insurance and individual health insurance is that the former provides coverage shared among a group of individuals connected under specific conditions. In contrast, individual health insurance exclusively covers the individual policyholder.
How does claim admissibility vary by room type?
For group mediclaim policies, claim admissibility might differ based on the room type selected by the insured during hospitalization. Sub-limits (specific percentages of the sum insured amount) often apply to various hospital expenses, like room rent. Therefore, policyholders are advised to adhere to the room rent limit to ensure hassle-free claim admissibility.
What is group insurance room rent capping?
Group mediclaim policies often establish sub-limits or caps for diverse hospital expenses, including room rent. Claim admissibility might differ based on the room type an insured selects during hospitalization. Policyholders are advised to adhere to the room rent limit to facilitate smooth claim admissibility.
Do we require a pre-existing disease waiver?
A pre-existing disease waiver within group health insurance can be invaluable. It ensures coverage for treatments and costs related to pre-existing conditions from the policy's outset, devoid of specific waiting periods or exclusions. Such a waiver guarantees immediate medical treatment and services access for any pre-existing conditions.
How do you file a cashless claim for Group Health Insurance?
To initiate a cashless claim in group health insurance, adhere to the steps below:
  • Complete a pre-authorization form at the TPA counter during admission and notify your insurance company beforehand for ultimate approval.
  • Present necessary documents at the TPA counter, such as the cashless healthcare card from your insurer and KYC document copies for verification.
  • The insurance company, upon reviewing these documents, provides cashless approval for your hospitalization and retains all treatment-related documentation.
  • It's prudent to procure a personal copy of these documents for your records. Retain all medical reports, test outcomes, discharge summaries, etc., as they are pivotal for seamless claim processing and future referencing.
  • Cashless hospitalization enables the insurer to bear your treatment costs, with the policyholder accountable for any charges not covered per insurance guidelines.