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GMC and GPA Policies in Health Insurance

A health insurance is one of the most important benefits that any employer can provide their employees. It’s the best way to protect employees and when they are less burdened by financial stress, it is likely to boost everything from attendance and productivity, to even company profits!

When it comes to employee health insurance, Group Medical Covers (GMC) and Group Personal Accident (GPA) Insurance are two common options to choose from. But they are very different policies with distinct features and benefits.

Let’s take a look at both policies, so that you can better understand them and choose whichever is best for your company and your employees:

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What is a GMC Insurance Policy?

A Group Medical Cover, or GMC, is a type of health insurance that is offered to a group of people, such as the employees of the same organization. Their dependents, including spouse, children, and parents, can also be covered under this.

Generally, such a policy is offered as a benefit by an employer, who bears the cost of the premium. As the risk of this kind of health insurance is spread across a pool of insured individuals, the premiums are kept low.

What is Covered in a GMC Policy?

Hospitalization Expenses – Hospitalization expenses are covered in case of admission of more than 24 hours.
Pre and Post Hospitalization Charges – It covers expenses that are incurred before and after hospitalization, including medical reports, cost of medicines, X-rays, etc.
Pre-Existing Diseases – This covers pre-existing illnesses such as diabetes, hypertension, etc. from day one, without any waiting period
Critical Illness Cover – Critical illnesses such as cancer, cardiovascular diseases, etc., can be covered in the policy.
Maternity and Newborn Coverage – There is also coverage for maternity expenses and medical expenses for the newborn baby as an add-on.
Other Add-Ons Available – GMC covers also might come with the option to choose add-on covers at a small additional premium. Common add-ons include Maternity cover, Personal Accident cover, or AYUSH treatment cover.
Other Benefits – A GMC also often includes coverage for daycare procedures and outpatient medical treatments.

What is a GPA Insurance Policy?

A Group Personal Accident Insurance (GPA) is a type of insurance that protects a group of people financially in the case of any unforeseen accidents that result in death, fatal injury, or disability.

Accidents can occur at any time, and can have unexpected health consequences. Thus, a GPA policy comes with certain in-built features to cover employees in case an accident leads to their death or disability which can affect their income. It provides a measure of financial protection for them or their dependents.

Like a GMC, the premium of a GPA is also borne by the employer, or it is contributed to from an employee’s salary.

What is Covered in a GPA Policy?

Total or Partial Disablement – If an accident causes partial, total, or permanent disabilities (like loss of sight or limbs) it provides financial coverage.
Accidental Death – In the worst case of accidental death, it provides financial protection for dependents.
Ambulance and Transportation Expenses– There is also optional coverage for ambulance charges and transportation expenses.
Hospitalization Expenses– It provides coverage for hospitalization expenses like room rent and daycare procedures when they are due to an accident.
Benefits for Children – In case of permanent disablement or death, it covers certain benefits for dependent children, such as costs of education or marriage expenses.

The Difference Between GMC and GPA Insurance Policies

To get a better understanding of how these two policies compare, let’s take a look at the difference between Group Medical Cover and Group Personal Accident:

Parameters	Group Medical Cover	Group Personal Accident Cover
What is it?	It covers hospitalization expenses and illnesses faced by employees and their dependents.	It covers expenses resulting from accidents that lead to injury, disability, or death.
What is covered?	The policy covers hospitalization, pre-existing illnesses, pre-and post-hospitalization expenses, daycare procedures, maternity expenses, newborn baby cover, and more.	The policy provides financial coverage against death and disabilities caused by an accident.
What is excluded?	Generally, this policy excludes medical expenses that are a result of suicide, self-injury, cosmetic treatments, alcohol or drug abuse, or HIV/AIDS.	This policy generally excludes expenses relating to natural deaths, accidents resulting from illegal activities, self-injury, suicide attempts, pre-existing diseases, and alcohol abuse.
What is the scope?	Since it covers a wide range of hospitalization expenses and illnesses, it has a broader scope. Additionally, a personal accident cover can also be included as an add-on.	This kind of policy only covers expenses resulting from accidents, so it has a comparatively smaller scope.
Who is covered?	It covers employees and their dependents, i.e., spouse, children, and parents.	It generally only covers employees of the organization.
Can it be customized?	Yes, it can be customized by the employer based on employee needs.	This cover is non-customizable.
Who should get this policy?	Group medical cover is suitable and necessary for all organizations, irrespective of the nature of business.	GPA is an important component and suitable for businesses that involve risk of accidents, for example, construction and travel businesses.

Both Group Medical Cover (GMC) and Group Personal Accident (GPA) Insurance can do a great deal to help with employee satisfaction and talent retention, so it is important to know what they are and make the right choice.

So whether you’re an employee looking to understand what’s out there, or an employer making a choice for your employees, hopefully now you can make a more informed decision.

Frequently asked questions

All

Can part-time employees be covered under a GMC or GPA?

Usually, it is only full-time employees who are covered under a GMC or a GPA policy. But depending on the agreement between the insurer and the employer, part-time or contract-based employees can also be included.

What determines the premium for a GMC and GPA cover?

For both a GMC and a GPA policy, premiums are dependent on various factors such as group size, coverage, features and add-ons included, and demographics like age, income, and the nature of the job.

Who pays the premium for either GMC and GPA cover?

In most cases, the premiums for the GMC or GPA policy are paid by the employer. However, in some cases, employees may be asked to contribute towards the premium payment, especially if they are opting for any added benefits at an individual level.

Who all can be covered in a GMC policy?

Under a GMC policy, all employees above 18 years and up to 70-95 years (depending on the insurer) who are employed with an organization are covered; they can also add their spouse, parents, and dependent children aged between 3 months to 25 years.

When should you get a GMC policy for your employees?

If your company has at least 10 employees, then you should think about getting a group health insurance to protect them all. You can conduct a survey to decide what coverage to offer, and if they would prefer a GMC or GPA policy.

If you already have a GMC policy from your employer, should you get an individual health insurance policy too?

This depends on the type of corporate health insurance plan you have. However, since this plan is tied to your employment, opting for an additional Individual Health Insurance will help you stay covered even if you leave. Additionally, you will also have more coverage and get personal tax savings.

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Disclaimer #1: *Customer can choose options at the time of availing insurance. Premium amount may vary accordingly. Insured is required to disclose any pre-existing condition or on going treatment before policy issuance in the proposal form.

Disclaimer #2: This information is added only for informative purposes and collected from different sources across the Internet. Digit Insurance is not promoting or recommending anything here. Please verify the information before making any decisions.

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