Key Individuals Covered
- Employees (Full-time and Part-time): The primary beneficiaries of a group health plan are the organization’s employees. By default, all regular employees are covered under the policy. This typically includes full-time salaried staff and, depending on the employer’s choice, can also include part-time or contract workers. As one insurer explains, group health insurance “primarily covers employees” and may include “both full-time and part-time employees”. In fact, group plans often cover salaried staff across various roles. Some policies even extend to long-term contract workers, apprentices, or interns. (Temporary freelancers or consultants usually are covered only if explicitly allowed by the insurer.)
- Spouse and Children: Most group policies allow employees to add their immediate family members. In practice, an employee’s spouse and dependent children can be included in the same group plan. Tata AIG notes that a group medical insurance policy can cover an employee’s “spouses, children, [and] parents”. Similarly, insurers point out that group plans frequently cover the employee’s family – for example, a Plum (employer) insurance article states that plans cover “family members, such as spouses, children, and sometimes dependent parents”. Most insurers even allow including young and older children under 18 as dependents. In short, if you opt for family coverage, the policy will typically insure your spouse and kids at no additional underwriting cost.
- Parents and In-Laws: Depending on the policy, employees may also include their parents or parents-in-law. Many companies offer a coverage tier called ESKP (Employee, Spouse, Kids, Parents). For example, Pazcare confirms that group plans can extend to “parents/in-laws” under the same policy. Tata AIG likewise mentions that employees can sometimes add parents to their group policy for extra premium. (Coverage of older parents may have age limits; check the insurer’s terms.) Including parents gives employees added security, and it’s often offered at a subsidized rate since costs are shared across the group.
- Common-Interest Groups and Associations: A group is not limited to just a company’s employees. According to IRDAI rules, a group can be an employer-employee group or a non-employer group of people with a common purpose. This means registered clubs, societies, or associations can also get group health insurance. For example, sports clubs, NGOs, professional bodies, or even customer/member associations can form a group plan for their members. Onsurity notes that “registered societies and associations can also avail the benefits of group health insurance”. In practice, any organized group of 20+ individuals (see below) sharing an interest may purchase a group plan and cover all its members.
- Other Eligible Members: In some cases, companies extend group coverage beyond employees. For instance, business partners or consultants working long-term may be added if the policy allows. Startups sometimes include co-founders or part-owner directors. However, these are up to the employer and insurer to agree. Importantly, group health insurance generally does not cover people outside the defined group – for example, unrelated freelancers or clients.
Eligibility and Group Requirements
Group health cover is subject to certain rules and
minimum sizes. In India, IRDAI’s standard requirement is a minimum of 20 lives
(employees and/or their dependents) to form a valid group. (That means an
employer plus dependents can count together to meet the 20-person rule.)
However, many insurers now offer small-group plans for startups and
SMEs: some accept as few as 5–7 members. For example, IRDAI guidelines allow
micro-insurance schemes for just 5+ employees, and providers like Pazcare and
Onsurity sell group plans to teams of 3 or more.
It’s also important to note who cannot be covered. A one-person
business (solopreneur) with no other employees is not eligible for a group
policy. Likewise, a private family where all members are related (with no
outside employees) typically cannot form a group per IRDA rules. In such cases,
individuals must seek separate (individual or family floater) policies.
In summary, to buy a group policy you need an
eligible group (usually a business or registered association) and meeting the
minimum membership criteria. Once in force, the policy can insure all employees in that group, plus any
dependents or members the employer chooses to include.
Conclusion
Group health plans are a powerful way for employers
to provide healthcare to entire teams. They routinely insure the organization’s
staff and often their dependents, so understanding eligibility is key. As seen
above, a typical group health insurance policy covers all eligible employees
and can be extended to spouses, children, and even parents. Business owners and
HR professionals should review their group health insurance policy closely
to confirm which individuals are included. When properly set up, the group
health insurance policy ensures comprehensive coverage for employees and their
loved ones – boosting peace of mind, retention, and productivity in the
workplace.
