It’s an oldie but goodie - employees are an organization's biggest and greatest asset. Whether or not you like to admit it, the pandemic has had an impact on different facets of your life, including employee benefits like GMC and GPA insurance.
Now, retaining employees is not a sprint, but a marathon. There’s a shift from a desire for handsome salary packages to valuable benefits and perks. Take a moment and look at top organizations like Google, Apple, or Facebook, you will notice that they understand this, and that’s why they offer different benefits to keep their employees happy.
And employee health ranks high up in the rung; showing you care for them and their loved ones. Here’s where GMC and GPA insurance come into the picture.
What Is GMC Insurance?
GMC insurance full form is group medical cover. It falls under the group health insurance plans category and is offered to a group of people like employers to their employees. Typically, such policies are a benefit that employers provide. In the insurance world, GMC stands for Group Mediclaim Coverage.
As the name suggests, the plan covers medical expenses and other additional expenses that an organization opts for. GMC plans are customizable and often specifically tailored to suit a corporation’s needs and requirements.
The GMC medical insurance policy is contingent on three primary components:
- The size of the group of employees (the more number of employees the lower the costs)
- Demography of the employees (occupation, income, average age, etc.)
- Riders you’ve selected or any other additional benefits you opt for
A few significant features of GMC policy include pre and post-hospitalization expenses, daycare procedure expenses, maternity and infant health, OPD expenses, and more. This is what GMC policy means. You can jump to the following section that covers more on this.
With GMC policies, it spreads the risks over a group of people and so; the premiums are comparatively less in comparison with individual health insurance. Most often, your employer bears the total costs. Rarely do employees pay for GMC.
What Is Covered in a GMC Policy?
Especially with the pandemic, one of the biggest worries on people’s minds is the bills in case of any health situation. With the steep increase in healthcare costs, meeting such expenses is challenging.
Here’s the solution: an employer-provided GMC policy.
GMC health insurance is much cheaper compared to individual insurance. At this lower cost, it also gives you nearly the same insurance benefits. Let’s skim through what is covered.
- Hospitalization expenses - this covers costs during hospitalization, provided the hospitalization is more than 24 hours. Then the bills for the following expenses are covered - medical practitioner, nursing, room rent, consumables, medication, operation theatre costs, oxygen, blood, anesthesia, etc.
- Pre and post hospitalization expenses - Covers expenses that incur before and after hospitalization, normally within a 30 days’ time frame like X-rays, blood tests, cost of medicines, medical reports, etc.
- Pre-existing diseases - Pre-existing illness is anything you’ve been facing before the purchase of the group health insurance plan. Unlike individual health plans, GMC covers pre-existing diseases. You get coverage for conditions such as hypertension, diabetes, asthma, thyroid, etc. from day 1, with no waiting period. In the event you are diagnosed with anything related to such conditions, you can claim from the first day.
- Daycare procedures - There are certain procedures that take less than 24-hours. For such instances, if you are hospitalized for under 24-hours, you can make a claim. Go through the policy details carefully and you’ll find out the names of such procedures.
- Domiciliary hospitalization bills - Domiciliary hospitalization refers to any treatment for any illness, disease, or injury that you undertake at home. You are considered to be hospitalized, even when at home. And expenses for this are covered by GMC.
- Maternity and newborn cover - Depending on the insurer, you can even opt for maternity and newborn cover.
- Cover for critical illness - There is a set of critical illnesses, like cardiovascular disease or cancer, that is covered under GMC.
- Extra cover - Beyond the listed, you can opt for add-ons like dental, vision, family cover, etc. This way you’ll get comprehensive cover. Here are the benefits of comprehensive insurance.
What Are The Exclusions Under The GMC Insurance Policy?
Just like what’s covered in a GMC policy, there are certain exclusions. Reading through the list of exclusions will give you a better idea of what you get coverage for. Based on this information, you can opt for added coverage if you need it for you and your family. However, if you’re solely dependent on group health insurance, you must be extra vigilant about your choice.
- Engaging in criminal or unlawful activities
- Experimental treatments
- Any alternative treatment that’s not specified in the insurance policy
- Self-inflicted injuries
- Illness or distress caused by alcohol or drug abuse
- Cosmetic treatment not given in the policy
- Injuries caused due to military action, mutiny, war, etc.
What Is GPA Insurance?
GPA or group personal accident policy is a part of the group health insurance offered by most employers in India.
A GPA coverage provides financial protection against any unforeseen or unexpected circumstances that result in disability, fatal injury, or death. Essentially, the in-built features of a group personal accident (GPA) policy are a means of financial protection for your employees and their dependents.
Similar to Group medical coverage (GMC), premiums are lower. Typically, employers can bear the costs of the premiums of GPA. However, sometimes, it’s a part of an employee’s salary.
A prominent part about GPA policies is that you get coverage even when you’re not on duty.
What Does A GPA Policy Cover?
Accidents are unforeseen. That doesn’t mean you don’t stay prepared, so you have a one-up when something does come about.
The answer: GPA policy
However, to make an informed decision, you must take into account what’s covered.
- Permanent, partial, or total disablement - Under the GPA policy, if an accident results in partial or total disablement of your limbs or organs, then you get compensation. If it’s temporary total disablement, you get covered only if the accident prevents you from getting back to work for more than 104 weeks.
- Accidental death - The GPA policy provides financial support during unexpected, sudden, or unintended death. Based on the sum assured, you also get coverage for medical expenses to treat your injury.
- Dismemberment - You get coverage for any dismemberment or incapacitation with this policy.
- Additional benefits - With a GPA policy, you also get the following benefits: coverage for the cost of an ambulance, the cost of damages in the accident, after the death of the insured the children get educational support, and certain funeral charges.
- Add-on covers - By making a small additional payment, you can get these add-ons - an allowance of Rs. 500 (depends on the insurer), for 30 days if you’re hospitalized due to an accident. Secondly, medical expenses incurred up to actual expenses or 40% personal accident claims, whichever is lesser.
What Are The Exclusions Under The GPA Insurance Policy?
During an emergency, it helps if you’re aware of what your policy excludes. This way, deciding how to tread forward is clearer. Besides, you will know exactly what to do without wasting much time or having to read through fine lines when you’re stressed or have other things on your mind. Staying prepared lets you focus on yourself, your family’s health.
- Injury or death because of attempted suicide, self-injury, STDs or adventure sports
- Taking part in any mutiny action, revolution, war, illegal or criminal acts
- Death related to childbirth or pregnancy-related
- Fraudulent claims
- Death due to natural causes
- Payments made after making the claims
- Injury or death caused by illegal drugs or alcohol
What Is The Difference Between GMC And GPA?
Now that you’re aware of what GMC and GPA insurance policies are, let’s quickly go over the key differences.
1. Other names:
- Group medical cover - Also goes by other names such as employer-offered insurance, group health insurance, employer-employee insurance, and corporate insurance.
- Group personal accident cover - GPA is also known as a 24-hour worldwide accident policy or personal accident cover for employees.
2. What is it?
- Group medical cover - It’s like a health insurance policy that covers medical issues and emergencies that employees and their dependents face.
- Group personal accident cover - This is essentially a policy that’s related to accidents employees face on or off duty and covers the same.
- Group medical cover - A GMC policy offers a sum insured and the insured can claim for any amount up to that limit. Typically, costs of hospitalization, pre and post-hospitalization, daycare expenses, maternity care, and more are covered.
- Group personal accident cover - A GPA policy offers a lump sum amount when the insured faces an injury or accident. Coverage for this includes permanent, partial, or total disablement, accidental death, additional benefits, etc.
- Group medical cover - The scope is much wider as it covers a range of offerings. Plus, GPA can be included as an add-on with GMC.
- Group personal accident cover - Comparatively, the scope of GPA is limited as it covers expenses resulting from accidents.
5. Who is covered?
- Group medical cover - The GMC policy provided by GMC insurance brokers covers employees and sometimes even family members like parents, children, and spouses.
- Group personal accident cover - GPA policies usually cover only employees and the coverage does not extend to family members.
- Group medical cover - Customization is possible based on employers' needs. This is something you should discuss with GMC Insurance Agency.
- Group personal accident cover - This is a non-customizable cover.
7. Suitable for:
- Group medical cover - After the pandemic, GMC has been made mandatory for all businesses, irrespective of the nature and size.
- Group personal accident cover - GPA is important for organizations that involve accidents or risk factors like construction, travel, gas, oil, etc.
Which Is The Better Among GMC and GPA Policies?
The above information should make the differences between both GMC and group personal accident cover.
But if you’re looking to pick either one, it entirely depends on your needs. Both serve different purposes and whichever fulfills your needs, you can choose that. Here, the decision is not which one is better, rather, what is your requirement and which policy matches that. Either way, both policies help employees boost morale and satisfaction.
In short, you’ve got a lowdown on GMC and GPA insurance. This will help you get out of the dark and make an informed decision when it comes to picking the right cover for you.
For more help on group health insurance along with a host of added benefits, you can reach out to team Loop.
Loop health is your answer if you’re looking for the best GMC insurance company to take care of your team better and boost your bottom line!