Difference Between GMC Insurance and GPA Insurance Policy

Group policies are generally insurance policies provided by an organization to its employees. GMC (Group medical coverage) and GPA (group personal accident) insurance policy are two popular group insurance policies in the market.  In this article, we are decoding what these two policies are and which is better for your employees.

What is group medical coverage?

A group medical coverage (GMC) also called group health insurance (GHI) covers all hospitalization-related expenses made by the employees. In fact, accidental hospitalizations are also covered in GMC. Group health insurance is a highly customizable insurance policy. Employers/HRs can choose what they want to add to the policy to best suit the employees. For example, you can choose what can be the maternity cover, if dependents need to be added, ICU and room rent limits and more.

What’s covered in a GMC policy

1. All pre, during and post hospitalization expenses are covered.
2. All pre-existing diseases are covered with zero waiting period
3. All hospitalization is covered including accidents.
4. Coverage for maternity insurance and new-born if included in the policy
5. Covid-19 treatment is covered

What is group personal accident insurance?

Group personal accident policy covers all expenses incurred by an individual due to an accident. This policy protects employees from financial strains after accidental injuries. This policy takes claims only related to accidents. GPA policies are generally worldwide in nature.

What’s covered in a GPA policy

1. Hospitalization due to accident
2. 100% sum insured to the nominee in case of death
3. 100% sum insured in case of total disablement
4. 2 to 60% of the sum insured in case of partial disablement or loss of vital organs.
5. A percentage of the sum insured can be put towards the education of two dependent children based on the policy
6. Ambulance charges are covered
7. Expenses incurred in the transportation of mortal remains are covered

Difference between GMC and GPA insurance policy

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How is the insured notified if a claim is denied?

When a claim is denied, the insured receives a detailed refusal letter as official notification. This letter is thoroughly communicated, not just to the insured, but also to various stakeholders involved in the claim process. Specifically, the point of contact managing the claim, any beneficiaries, and the organization's human resources department are also informed. This ensures that all relevant parties are aware of the decision and can take any necessary follow-up actions.

How to Claim Group Personal Accident Insurance

Navigating the process of claiming group personal accident insurance can be straightforward if you follow the right steps. Here's a breakdown of what to do:

Step 1: Initiate the Claim

• Notify Your HR Department: The first action is to report the accident to your company’s HR department. They will coordinate with the insurance company or advisor to initiate the claim process.

Step 2: Claim Documentation

• Receive Claim Form: Once notified, the insurer will send you a claim form and a detailed list of required documents. It's essential to gather all pertinent paperwork promptly.
• Coordinate with a Surveyor: If needed, a surveyor may assess the situation to ensure all due diligence is completed.

Step 3: Submission and Processing

• Submit Required Documents: Ensure all documents and the completed claim form are returned to the insurer. The insurance team will then evaluate your claim based on the policy’s terms.

Step 4: Claim Settlement

• Receive Notification: Once successfully processed, a check will be issued to the insured. If any issues arise, such as a claim denial, you’ll receive a formal notification explaining the reasons.

By adhering to these steps and providing the necessary information when requested, you can facilitate a smooth claim process for your group personal accident insurance.‍

What steps are involved in the claim settlement process for group personal accident insurance?‍

Steps Involved in the Claim Settlement Process for Group Personal Accident Insurance

When filing a claim under group personal accident insurance, several steps need to be followed to ensure a smooth settlement process. Here's a breakdown of those steps:

1. Documentation Submission:
   • Gather all necessary documentation, including medical reports, accident details, and a filled-out claim form.
   • Submit these documents to the insurance provider for processing.
2. Claim Processing:
   • Once all pertinent documents and forms are received, the insurance company evaluates the claim.
   • The insurer reviews the details to determine eligibility and assess the claim's validity.
3. Issuing a Settlement:
   • If the claim is approved, the insurance company creates a settlement check.
   • This check is then issued to the insured party entitled to receive the benefits.
4. Notification of Denial:
   • In instances where a claim is denied, the claimant and other relevant parties, such as the point of contact or HR department, are informed.
   • A formal refusal letter is sent, detailing the reasons for the denial.

By following these steps, claimants can navigate the intricacies of the settlement process effectively. Understanding these procedures helps manage expectations and ensures that all parties are adequately informed along the way.

What is the Process for Claim Assurance in Group Personal Accident Insurance?

1. Initial Notification:Begin the claim assurance process by informing the company's HR department about the incident. The HR team will then coordinate with the insurance provider, ensuring they are aware of the situation.
2. Recording the Claim:Once notified, the insurance company logs the claim into their system to begin the evaluation process.
3. Filing the Claim:After recording, the insurer will provide the necessary claim form to the policyholder. This package typically includes a detailed list of required documents, ensuring you have everything needed for the next steps.
4. Evaluation and Survey:Often, a surveyor may be appointed to assess the situation. They will carry out due diligence to verify the details of the incident. This step is crucial to prevent any discrepancies.
5. Documentation and Approval:Submitting all required paperwork is key. Once the insurance company receives the complete documentation, the claim will be reviewed according to the policy's terms and conditions.
6. Final Processing:After a thorough evaluation and approval, the insurance company processes the claim, leading to a resolution in line with the policy's benefits and coverage.

By following these steps, policyholders can ensure a smoother and more efficient claim assurance experience in group personal accident insurance.

Which is better? GMC or GPA insurance policy?

GMC is a more comprehensive cover whereas GPA covers only accidents. GPA can be bought as a rider (add-on) to your GMC. This way, you can include coverage for disability and death due to accidents in your GMC as hospitalization is already covered.

Overall, if you are deciding between GMC and GPA, your best bet is GMC as it provides more value to your employees.

Read: Why including parents in group health insurance policy is important

Pazcare for group insurance

Pazcare offers all types of group insurance for the best prices in the market. We are IRDAI certified broker and work with all the insurers in India to get you the best policy. Along with this, you also get the Pazcare admin/HR dashboard to manage your employee benefits insurance easily. You can make endorsements, get reports, check usage CD balance, etc. without depending on the TPA or insurer.

As a cherry on top, with group health insurance from Pazcare, there is also a super top-up option. Super top-up in health insurance allows employees to increase their cover and add dependents to their policy by paying a premium.