Personal v/s Group Health Insurance

Insurance is a commitment that spans a number of years, if not decades. Owning an insurance policy that caters to your needs is kind of a rainy day fund - it is a financial cushion that shields you against expenses that may seem to touch the skies. Especially health insurance. You don’t want to deal with the hefty bills that are a hand-in-glove companion to the mental stress of hospitalisation for a treatment.

There are a number of health insurance plans in the market and it’s up to you to choose the one that’s right for you. Your insurance should cater to your specific set of needs and requirements, so you can extract the most out of it when necessary.

In this article, we talk about two types of health insurance plans - personal health and group health insurance, so you can make an informed choice.

  • Personal Health Insurance

    A personal health insurance plan is basically a retail product. Its features, benefits, and prices are filed with the IRDAI by the insurance company. They are available for individuals and families. Anyone who falls within the age criteria of the plan can purchase it and the insurance company has the right to either accept or reject your proposal, based on their underwriting regulations.

  • Group Health Insurance

    A group health insurance plan is exclusive. It only covers the members of a particular group. For example, office employees, society members, account holders of a particular bank, registered users of a mobile app, etc.

    So what essentially happens is that the insurance company issues a master group policy in the name of the group administrator. This may be your employer, the company you’re working at, the bank, or other micro-platforms like online travel agents, cab providers, etc. All eligible group members get a certificate of insurance.

    For example, ABC Private Ltd. has a policy of offering an insurance cover under its group health insurance plan to all employees who have been a part of the organisation for more than 6 months. Pranjali joined a year ago and Nikhil joined About 4 months ago. Pranjali is entitled to be covered under the plan, whereas Nikhil will be covered when he completes 6 months at the company.

    The IRDAI states that no group should be formed solely for the purpose of insurance. Group covers can be given to members of an existing group only.

    These plans are beneficial for people who can’t easily get a personal health cover. For example, people with pre-existing medical conditions or senior citizens.

    Let’s have a look at a few aspects of group health insurance plans -

  • You can generally enrol under a group health insurance plan through the website or app of the group administrator.
  • The policy can generally be bought by giving consent and a satisfactory health declaration. Usually, there aren’t any pre-policy medical tests.
  • These plans can be paid for by both the group administrator or the member -
  • Usually, when it comes to corporate organisations and employers, they are paid for by the group administrator. However, employees may be asked to pay, mostly in cases where the coverage extends to their family members or if they opt for a sum insured beyond the defined threshold.
  • When it comes to other sources like banks, travel agents, etc. - the member pays. However, they may offer the members complimentary offers on the premiums, policy tenure, etc.
  • Distinguishing Between Personal Health Insurance And Group Health Insurance

    This table highlights the differences between these two plans -

Personal Health Insurance Group Health Insurance
Control over the insurance You, the policyholder, have full control over the policy you purchase. You can choose the features, benefits, add-ons that you want. The group administrator has control over the policy. You will have little or no control.
Proposal Forms & Declarations You need to fill our detailed forms and give detailed declarations All you need is consent and a satisfactory health declaration.
Medical Tests Often required, especially for -
  • people aged more than 45 years
  • a sum insured above INR 25 lakhs,
  • medical conditions declared in the proposal form
Some insurance companies may also request telemedical tests.
No tests needed.
Premiums Dependent on underwriting. Generally more expensive than group plans. Generally cheaper when compared to personal plans.
Issuance The policy is issued after you fill out the detailed proposal form and undergo the required tests. A soft copy of the policy document can be immediately downloaded. The hard copy gets delivered to you within the span of one week. The policy is in effect as soon as you enrol for it. The policy document is delivered to your mailbox within 48 hours.
Coverage It continues as long as you renew the policy by its due date. It continues till you are a member of the group. For example, your employer covers you under a group insurance plan. If you quit your job, you are no longer covered.
Pre-existing Diseases Covered after the specified waiting period. Usually covered from the first day.
Policy Cancellation This decision entirely rests on your wishes. Depends on the group administrator.
Tax Benefits You can avail tax benefits under Section 80 of the Income Tax Act. Since the group administrator is the policyholder, you aren’t eligible for tax benefits. But, if you pay the premiums, you can enjoy the benefits provided under Section 80D of the Income Tax Act.

So, personal health insurance plans and group health insurance plans have their own sets of features and benefits. Choosing the type of plan depends on what you need. While group insurance plans are cheaper and seem easier to obtain, personal health plans are overall a beneficial choice as they are customised to your unique situation and not the group’s. Group plans should ideally be opted for if you can’t easily purchase a personal plan. No matter your choice, we hope this article helped you navigate through these confusing waters and zero in on the plan best suited to you.

exclusion of health insurance plans
Not Covered In Health Insurance
  1. Pre-existing disease for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

Calculate Your Health Insurance Premium

Partners - We Are Proud To Have

We have over 30+ insurance partners on our back. Rest assured, you won't be short of choices.

Why Customers Love Us

Why Customers Love Us?

  1. We provide quick claim assistance.
  2. We are easily approachable through phone, email, and text.
  3. We are transparent operations with no hidden cost.
  4. We pursue your claims till the very end.
  5. We understand your needs, and advise most suitable insurance products.

Our Customers' Stories

Sharing the experience of happy and satisfied customers with you.

Sameer Yadav

I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More

Dheeraj Bhatia

I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More

Jyoti Sharma

We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More

Sumit Khanna

Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More

Kishor Kumar Bijlani

My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More

Megha Singhal

I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More