Group health insurance is a single health insurance policy that an employer buys for all its employees, and often for their families too. Group health platforms let a start-up or a small company buy this policy online, add and remove employees, and help employees use the cover.
For the employee, group cover has clear advantages. Usually there is no medical check. Illnesses that the employee already has are often covered from the first day. And the employer pays the premium. For a small company, however, buying it the old way is slow. A broker collects quotes on paper, each new joiner is added by email, and employees do not know how to make a claim. A group health platform puts all of this online.
Take, for example, a design start-up in Gurugram with 45 employees. The founder enters the company's details on a group health platform and compares quotes from several insurers. She picks a policy with ₹5 lakh of cover for each employee, their spouse and two children, for about ₹2.9 lakh a year in total. The platform connects to the company's HR and payroll system. When a new designer joins on a Monday, she is added to the policy the same day, and her insurance card appears in the platform's app. When an employee leaves, the platform removes them. The insurer's insurance core system records each addition and removal.
Platforms add services around the policy. Many include doctor consultations through a telemedicine app, and some employ their own primary-care doctors. When an employee is admitted to hospital, the platform helps with the cashless claim, in which the insurer pays the hospital directly. The claim itself is checked by the insurer or by its third-party administrator (TPA), a company that processes claims for insurers. This checking is called claims adjudication. In India, more of these claims now travel through the National Health Claims Exchange (NHCX).
Group health insurance is one part of employee benefits. Larger companies manage all their benefits, such as insurance, meal cards and retirement savings, through benefits administration software. In America, employer cover is the main way most working people get health insurance.