Group insurance: What is it? What types are there? What coverage does it offer?

What is it? What types are there? What coverage does it offer?

In today's world, there are numerous organizations and employers with employees, staff, and personnel within their ranks. Group insurance is considered one of the excellent benefits for employees. Apart from providing protection to employees, it also benefits the organization in terms of cost-effectiveness, credibility, and the relationship between the organization and its employees.

In this article, Pacific Care Hua Hin will guide you to a better understanding of group insurance. We'll delve into what group insurance is, what types exist, what coverage it provides, and explore the benefits it offers to both employees and employers.

Group Insurance: What is it?

Group insurance refers to insuring multiple individuals under a single policy, with the employer or legal entity being the policyholder. The document received is called the master policy, and employees or members within the organization are the insured parties. They receive a certificate of insurance or insurance card.

Types of Group Insurance:

Group Life Insurance:
Provides coverage for death in all cases, with the insurance company paying the insurance benefits to beneficiaries or recipients specified by the employer.

For more details on this insurance, you can click on this link (.............).

Accidental Death and Dismemberment Benefits:
Provides coverage in case of death or loss of various body parts (e.g., arms, hands, feet, eyes) resulting from accidents. In some cases, compensation for medical expenses arising from accidents or injuries may be provided, depending on the conditions of the insurance.

For more details on this insurance, you can click on this link (.............).

Group Permanent Disability Insurance:
Provides coverage in case the insured party becomes permanently disabled due to illness or accidents.

For more details on this insurance, you can click on this link (.............).

Group Medical Insurance:
Covers compensation and medical expenses arising from illness or injury, covering both inpatient (IPD) and offering additional coverage options such as outpatient (OPD) coverage, dental care, maternity care, treatment of congenital diseases, etc.

For more details on this insurance, you can click on this link (.............).

Group Travel Insurance:
Covers accidents or illnesses that occur during travel, both domestically and internationally. Some companies also cover issues like lost documents or lost luggage.

For more details on this insurance, you can click on this link (.............).

Businesses commonly encountered with group insurance include:

- Companies, shops, small and medium-sized enterprises (SMEs)
- Financial institutions
- Industrial estates
- Savings cooperatives
- Hotel business groups
- Educational institutions at all levels

What does group insurance mostly cover?

Mostly, it covers medical treatment for both illness and accidents, including inpatient (IPD) and outpatient (OPD) treatments. The coverage and benefits depend on the type of insurance selected and the terms of the policy.

How many members are required to obtain group insurance?

It depends on the type of insurance and the coverage chosen.

- Small businesses: 3-5 members and above
- Medium to large businesses: 20-30 members and above

Benefits employers receive from group insurance:

Enhances the organization's image by providing good welfare benefits to employees, demonstrating care for their well-being. This builds trust both internally and externally.
Efficiently takes care of employees. When providing group insurance, regardless of the type, employees receive protection as per the chosen plan. They can access medical treatment without worrying about expenses, leading to improved quality of life and increased productivity.

Fosters good employer-employee relationships. Group insurance provides a better quality of life for employees, making them more comfortable and secure in their work.
Low cost with high benefits compared to individual insurance, and helps reduce financial claims when employees experience death, injury, or disability.
Aids in financial planning with predictable insurance premiums, allowing organizations or employers to plan ahead and accurately forecast annual costs.
Utilizes tax benefits. Companies can use insurance premiums to reduce corporate income tax liabilities, thereby reducing the financial burden of the company.
Attracts talent to expanding businesses or companies. Having good welfare benefits or group insurance is a crucial factor that makes many people choose to work with a particular organization or company, making it more attractive and able to attract talented personnel.

Benefits employees will receive from having group insurance:

Provides a solid sense of security from insurance companies with stable coverage.
Receives protection from the insurance plan chosen by the employer, leading to increased happiness and peace of mind in the workplace.
Improved quality of life, as many may opt to self-treat or wait for illness to pass rather than seek immediate medical attention due to the expenses involved. Group insurance allows employees to access medical treatment promptly, reducing the risk of worsening health conditions and serious illnesses.

Reduces financial burden, especially with group accident insurance, group health insurance, or other plans covering illness or injury. Employees do not have to worry about medical expenses in the event of accidents or illnesses and are not responsible for covering full treatment costs themselves.
In the event of employee death, family members or beneficiaries will receive compensation, alleviating potential financial difficulties.

Factors considered for group insurance acceptance and premiums:

Insurance acceptance is typically based on the average risk of individuals in the group, considering factors such as occupational levels, age ranges, gender, job duties, and the insured amount. Premium rates are calculated as a single rate and apply to everyone in the group, resulting in lower insurance costs compared to individual life insurance. Employees must be permanent employees aged between 15-65 years, depending on the chosen group insurance, and there may be additional conditions beyond those mentioned.

Common documents required for enrollment:

Completed application form with employer's signature and stamp (if applicable)
Copy of the company's business registration certificate as a legal entity
Copy of employee's identification card
Employee details summary, including age and position

Responsibility for paying insurance premiums typically falls on the employer, organization, or entrepreneur.

Additional information:

During the insurance acceptance process, it is generally necessary to assess the risk level of the business. There are typically four risk levels as follows, with most insurance companies accepting up to level 3:

Occupational Level 1: These are businesses with low or minimal risk, such as office-based professions, service-oriented roles, management, computer services, or skilled manual work not involving machinery (office workers, managers, graphic designers, golf caddies, ticketing officers, administrative staff, teachers, professors, etc.).

Occupational Level 2: These are businesses with moderate risk, often requiring expertise or working in exposed conditions, such as indoor and outdoor professions, sales, small-scale industrial work (engineers, gardeners, stonecutters, laundry workers, tour guides, air conditioning installers, automobile or motorcycle mechanics, marketing personnel, photographers, architects, carpenters, small business owners, agents, etc.).

Occupational Level 3: These are businesses with relatively high risk, involving machinery or regular work outside the office, and some companies may increase insurance premiums or not provide coverage at all (cement production, pipe installation, warehousing, cold storage, automobile manufacturing, etc.).

Occupational Level 4: These are businesses with the highest risk of accidents, often requiring high insurance premiums or exclusion from coverage altogether (stunt performers, construction workers, skyscraper window cleaners, firefighters, gas or oil pipeline workers, chemical handlers, aircraft pilots or crew members, safety officers, chemical cooking services, etc.).

Most insurance companies do not cover high-risk businesses located offshore, at high elevations, underground, outside river or sea shores, involved with explosive materials or flammable chemicals, dealing with oil and gas, heavy machinery, dangerous animals, tall building installation and repairs, high-voltage electricity, munitions factories, oil drilling, charcoal production, etc.

Network Hospitals

Another important aspect to consider before purchasing various group insurance plans is checking the list of hospitals that participate in the insurance network. In the event of an accident, the most crucial thing is that the injured party can receive treatment at nearby hospitals and see a doctor promptly.

Employee Age

The age range for employees is typically between 15 and 65 years old.

Additional Coverage: Group Dread Disease Plan 48 (ALLIANZ)

Apart from the aforementioned group insurance plans, there is another interesting option for employers, namely the Group Dread Disease Plan 48.

The top 5 deadliest diseases affecting Thais are cancer, heart disease and stroke, high blood pressure and cholesterol-related heart disease, tuberculosis, lung cancer, respiratory system diseases, diabetes, thyroid disorders, and liver cancer due to alcohol consumption.

Note: If the insured person falls ill with a dread disease, the insurance will pay out benefits (for only one disease), and once benefits are paid, this additional coverage will immediately cease to be in effect.

Common Exclusions

In terms of life insurance group coverage, insurance companies will not pay benefits under the policy if:

- A member commits suicide (intentionally) within 1 year of joining the insurance.
- A beneficiary kills the insured person intentionally.
- The insured person ceases to be an employee.

Accident Group Insurance with Optional Coverage Plans

Businesses related to hospitals, medical facilities, or clinics with personnel involved in medical professions such as nurses, doctors, or similar occupations will have specific coverage plans. These plans fall under the category of group accident insurance without medical expense coverage (Without ME).

 Auther : Pla