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Group Health Insurance VS Individual Health Insurance

Posted by Royal Sundaram on 03 Oct 2018


We all need to take care of our health. Yes, keeping a fit body and mind is essential but on the chance that your body falters, it is health insurance that comes to your aid.


A health insurance policy is a type of insurance that fully or partially covers your medical expenses. Thus, buying a health insurance is important as it helps in removing the burden of expenditures during your tough times. This insurance policy ensures yours and your family’s financial stability and well-being. Thus, it has become a necessity for every individual.


There are several health insurance plans available in the market. Although, choosing a health insurance plan that best suits your needs is quite a task. So which one do you go with? The group health insurance your company offers you or an individual health insurance, here’s the lowdown on them so that you can make an informed decision.

What is it?


Group health insurance:

It is a health insurance package a company offers to its employees. The company can either design its own package or select one from the many packages that the insurance companies sell. In simple terms, this is a type of insurance especially designed to cover the employees and their family members, which includes spouse and their two dependent children. Group health insurance policies provide their members/employees the optimum cover they require.


A few key benefits –


  1. * It offers hospitalization cover: Employees under this policy are covered for all in-patient hospitalization expenses in case of any accident or illness. Employee’s hospital stay should be for more than 48 hours.
  2. * It provides out-patient care: It covers out-patient treatment expenses under certain medical conditions such as eye surgery, kidney stone removal, tonsillectomy, eye surgery, etc.
  3. * It covers pre and post hospitalization expenses: It covers all medical expenses incurred 30 days prior to hospitalization and 60 days after hospitalization.


What’s not covered under the policy?


Here’re the things that are not covered under the policy –

  • * Drug abuse, alcoholism, and AIDS
  • * All injuries, diseases, and illnesses existing at the time of proposing the insurance
  • * Dental treatment or surgery
  • * Contact lenses and hearing aids
  • * Homeopathy, Ayurvedic, Naturopathy and other types of local medication
  • * Diseases such as cataract, piles, hernia, sinusitis etc., are excluded


Individual health insurance:

Individual health insurance is a safeguard plan that covers all sorts of medical emergencies at all stages of life. You approach an insurance company, select one of their plans, set the premium, pay. And you renew it next This plan’s benefit is only for you who is the policyholder.


Here’re the following key benefits of having an individual health insurance policy –

  • * Family expenses are covered under a single plan
  • * It offers tax benefits under section 80C of the Income Tax Act
  • * Maternity cover
  • * It provides all-day care
  • * It covers pre and post hospitalization expenses
  • * You can get cumulative bonus for every claim free year
  • * In case of hospitalization due to an illness or accident, your cover expands up to an additional 50% of sum assured
  • * Cashless claims across network hospitals
  • * It provides cover from day one of the member joining the group


What’s not covered under the plan?


  • * Pre-existing diseases are not covered under this plan
  • * Congenital external diseases and diseases that occur due to the use of drugs
  • * Naturopathy is excluded
  • * Cost of preliminary diagnosis and cost of vitamins and tonics are excluded from this treatment
  • * Dental treatment is excluded
  • * Acquired Immune deficiency syndrome



Group Insurance: Most employers buy group plans in bulk because they offer it to every employee. Thus, they incur low costs. And if the employee decides to avail additional benefits, it is deducted from his or her salary.

Individual insurance: This one depends on several factors. Some of them include age and health levels of the policyholder, any pre-existing diseases, location, smoking or drinking habits.


Pre-Existing Disease & NCB

Group insurance: When it comes to group health plans, most accept claims that even arise from pre-existing diseases which is an advantage. However, NCB benefits do not apply here. You get what the company offers and if you have to shell out a certain amount for it, then do so.

Individual insurance: When it comes to pre-existing diseases, individual health plans do not cover them until two or three years post policy purchase. However, NCB benefits apply here. You can avail premium discounts during policy renewal.



Group insurance: This one is simple. Till the moment you are employed with a company, you are eligible under the group insurance plan. However, the moment you leave the company, the insurance plan ceases to exist.

Individual insurance: An individual health plan is usually valid for one year. After this, you need to renew it. If you miss the deadline, you get a grace period to do so. In case, you miss that too, you will then have to purchase a brand new policy.

Which one is better – Group or Individual Health Insurance?

No doubt, group health insurance goes a long way in addressing concerns over the medical issues. But, your group health insurance won’t be of any use after your retirement. And then you will have to buy a health insurance policy at an extra cost. For that reason, it is good to go with an individual health insurance for you and your family. The benefit of having an individual health insurance is that you can keep renewing it by paying affordable premiums. This insurance policy will act as a safeguard and will protect you and your family against all financial challenges and difficulties arising due to medical crisis.

Buy online –

You can buy group health insurance or individual health insurance online without any documentation. All it takes is just a few clicks, little bit of your time and you are all set. Royal Sundaram is an online insurance company that offers affordable health plans with a wide range of benefits to take good care of you and your family.

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