As a corporate employee and even otherwise you would definitely have heard of the terms Group Medical Coverage (GMC) and Group Personal Accident (GPA). What is GMC and GPA in health insurance? These terms and policies are to some extent similar but definitely not the same. It is important that you understand the differences between these two types of health insurance policies and GMP (Group Medical Policy) policy benefits as well as GPA policy benefits. Pore over this article to understand what Group Mediclaim Coverage and Group Personal Accident policies mean and also the difference between them.
Before you read about the difference between Group Medical Coverage (GMC) and Group Personal Accident (GPA) policies, let us explain what is GMC and GPA in health insurance?
Group Medical Coverage (GMC) is a health insurance policy that provides insurance coverage to a group of people who have something in common. Examples of such groups are:
Although a Group Medical Coverage (GMC) policy may be applicable for the different groups as mentioned above, the most popular one is that which is subscribed by an employer for its employees.
As per the Annual Report of the Insurance Regulatory and Development Authority of India (IRDAI) for the year 2022 – 23, the following numbers relate to group health policies in 2022 – 23:
You may fathom the popularity of Group Medical Coverage (GMC) health insurance policies in India by looking at these numbers.
The key features of a GMC policy are as:
1. A Group Medical Coverage (GMC) policy requires renewal on an annual basis. The premium is usually paid by the employer as it is a prerequisite received by you as the employee of the company.
2. The sum insured, referred to as a ‘cover’ for each employee may be in the range of Rs 3 lakh and more depending on the seniority of the employees and the type of master policy that your company has subscribed to. *These numbers are provided as an example only. The individual coverage provided is the sole choice of your employer.
3. The total premium paid by your company depends on the following factors:
4. Group Medical Coverage (GMC) plans come with either cashless claim or reimbursement claim options.
5. Your claim as an individual employee has no impact whatsoever on the coverage for all or any of the other employees.
6. Your employer is eligible to claim the expense incurred on the total premium in the profit and loss account of the company as per the Income Tax Act, of 1961. e Any additional premium paid by you as an employee, if your company’s master policy so allows, allows you to claim tax deduction under section 80D of the Income Tax Act, 1961.
Group Personal Accident (GPA) policy is a type of health insurance policy that protects a group of people, again having something in common, financially against the loss of income or the capacity to earn due to death or disablement caused by an accident. Although coverage under a Group Personal Accident (GPA) policy may be provided to all employees in all types of commercial establishments, it is more prevalent for employees engaged in potentially hazardous work and conditions in industrial establishments and sites.
The GPA insurance premium also is paid by your company and is also eligible to be shown as a company expense in the profit and loss account as provided by the Income Tax Act, 1961.
Now that you have read about what Group Medical Coverage (GMC) and Group Personal Accident (GPA) policies mean, let us go over the differences they have:
| Parameters | Group Medical Coverage (GMC) | Group Personal Accident (GPA) |
|---|---|---|
| Other names referred to by |
This policy is also known as Corporate Insurance Employer- Employee Insurance Employer – Offered Insurance |
This policy is also known as Personal Accident Cover for Employees 24–Hour Worldwide Accident Policy |
| Scope of policy |
This policy covers the hospitalisation expenses of the covered employees incurred due to planned medical procedures or medical emergencies. Usually, such policies cover the pre-hospitalisation and post-hospitalisation expenses and also include expenses incurred on day-care treatments. |
The objective of this policy is to protect the employees and their families from the financial implications of loss of income or the ability to earn a living due to death or disablement caused by an accident. The terms and conditions of the particular policy determine whether it covers the employees against accidents during duty only or also includes accidents off duty. |
| Type of Coverage | Group Medical Coverage (GMC) is an indemnity policy. This means that you can claim for the expenses incurred for you within the sum insured amount or the coverage. You may not claim for an amount greater than the sum total of all your admissible medical expenses subject to the limit of your sum insured. | Group Personal Accident (GPA) is on a benefit basis. This means that the employee will receive a lump sum amount based on the nature of the injury. The percentage of the sum insured paid depends and differs on the degree of disability suffered or in case of death of the policyholder and is defined in the terms and conditions of the policy. |
| Who does the policy cover? | Group Medical Coverage (GMC) covers the employee concerned and often their family members depend on them, like their spouse, children or parents, depending on the type of master policy subscribed by the employer. | A Group Personal Accident (GPA) normally provides coverage to the employee only and does not include the family members of the employee. |
| Gamut of coverage | Group Medical Coverage (GMC) has a wider gamut of coverage and may include Group Personal Accident (GPA) coverage within itself as an add–on rider if so desired by the employer. | A Group Personal Accident (GPA) policy is comparatively non-extensive coverage subject to policy terms and conditions. |
| Option for customisation | A Group Medical Coverage (GMC) policy may offer you the option to customise it to some extent if the terms and conditions of the master policy so allow. As an employee, you may be allowed to purchase an additional sum insured or coverage for your in–laws by paying the premium for such customisation yourself. | A Group Personal Accident (GPA) policy normally does not have any provision for customisation. |
| Policy Inclusions |
The terms and conditions of the master policy as chosen by your employer determine the exact inclusions in the policy. Common inclusions in a Group Medical Coverage (GMC) are as:
|
The terms and conditions of the master policy as chosen by your employer determine the exact inclusions and add–on benefits, if any, in the policy. Common inclusions in a Group Personal Accident (GPA) policy are as: 1. Accidental death 2. Total Disability:
3. Child education cover 4. Repatriation of mortal remains in case of death and where the place of death is other than the home town of the deceased employee. |
| Policy Exclusions |
The terms and conditions of the master policy as chosen by your employer determine the exact exclusions in the policy. Common exclusions in a Group Medical Coverage (GMC) are:
|
The terms and conditions of the master policy as chosen by your employer determine the exact exclusions and add–on benefits, if any, in the policy. Common exclusions in a Group Personal Accident (GPA) policy are :
|
| Ideal workspace conditions for policy | A Group Medical Coverage (GMC) policy is for any establishment regardless of the industry and nature of the work carried out by the establishment. |
A Group Personal Accident (GPA) policy is mostly provided in cases where the employees are engaged in daily work which exposes them to the risk of accidents. Examples of such workplaces are oil and gas extraction sites and refineries, mining sites, construction, etc. |
With Care Health Insurance, you have the options of providing customised Group Medical Coverage (GMC) as well as Group Personal Accident (GPA) plans to your employees. Connect with our experts for information about these plans.
You have just read about both Group Medical Coverage (GMC) and Group Personal Accident (GPA) plans and do realise that although there are certain common factors in them, these are basically policies having different purposes. As such the comparison between these two types of policies is not one between like products and declaring any one of them as the best is neither fair nor correct.
The employer providing the cover needs to make a decision based on several internal factors. However, it is safe to say that a Group Medical Coverage (GMC) policy with an add–on Group Personal Accident (GPA) plan is an option providing your employees with comprehensive coverage, safeguarding them from both medical expenses as well as financial uncertainty in the unfortunate occurrence of accidents.
Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
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