Employer Group Health Insurance: What's Covered and What's Not

Most salaried employees think employer group health covers everything. It doesn't. Group health has sub-limits, waiting periods waived at joining but pre-existing at GROUP level, not individual. It covers only while employed. The day you resign or are laid off: cover stops at midnight. You need an individual policy ALONGSIDE group cover.

What group health typically covers: In-patient hospitalisation (24-hour admission). Pre-existing diseases (usually from Day 1, waiting period waived in group). Maternity (1-2 year waiting period typically retained even in group). Day-care procedures (100+ procedures requiring less than 24-hour admission). Ambulance charges (typically ₹1,000-2,000 sub-limit). Pre and post hospitalisation expenses (typically 30-60 days before/after). What group health typically does NOT cover: OPD (outpatient consultation, diagnostic tests, medicines, unless employer buys OPD rider). Dental and vision (separate rider). Cosmetic treatment. Fertility treatment and IVF. Organ donor expenses. Experimental treatment. Mental health (in some older policies, newer IRDAI mandates now include it). Specific sub-limits: room rent (often ₹3,000-5,000/day), ICU (₹5,000-8,000/day), cataract (₹25,000/eye).