This document summarizes the key details of the group insurance policy provided to students at TISS. It finds that while 73% of students are aware of the insurance, only 7.5% have utilized it. The policy is provided by Oriental Insurance Company with a coverage of Rs. 1 lakh for hospitalization and Rs. 5000 for OPD expenses. Claims can be filed either as cashless at network hospitals or reimbursement at non-network ones. The OSA noted that most students are unaware of the full scope of coverage available under the policy.

1. Group
Insurance-
tiss
Alisha Parida
Rishab Darnal
Dr. Suyash Khubchandani
Under the guidance of Dr Ravi Chandra Raju sir

2. CONTENT
1. Introduction
2. Features of Group Insurance
3. Eligibility
4. Why Group Insurance
5. Awareness Levels - Survey Results
6. About the Group Insurance of TISS
7. Student Group Insurance Details
8. Features
9. Conclusion

3. Health Insurance:
Health Insurance provides extensive coverage for various health condition. It is a type
of insurance coverage that provides financial support in the event of a health crisis. It
aims to provide 360-degree and all-round coverage for any illness, accident or injury.
Group Insurance:
Group insurance is a type of insurance plan that covers a number of people in the
same contract. Such a plan provides the same level of insurance coverage to all
members of a group irrespective of their age, gender, occupation or socio-economic
status.
The Insurance Regulatory and Development Authority of India (IRDAI) defines “group”
as an employer-employee group or non-employer-employee group
introduction

4. Features ofgroup insurance
Provides
standardized
coverage at
competitive
premium rates. This
means that the
coverage is the
same for all
members of a
group.
Insured
members to
this contract are
not given
individual
policies
02
Group insurance
acts as a master
contract- A
contract between
the insurer and the
group
policyholder – the
employer.
03 04
The employee pertakes
in the premium by
paying a nominal
amount.Dependent
coverage is optional
and requires additional
premium
01

5. ELIGIBILITY-group insurance
1
FULL TIME EMPLOYEES
3
ORGANISATIONS AND GROUPS
WITH MORE THAN 20 EMPLOYEES
AND MICRO INSURANCE PLANS
CAN BE AVAILED BY GROUP OF 5
PEOPLE- IRDAI
2
PART TIME EMPLOYEES
WITHOUT ANY OTHER
COVERAGE
4
PROBATION PERIOD HAS TO
BE SATISFIED BY NEW
MEMBERS IN A GROUP ( 1 to
6 months waiting period)

6. WHYGROUPINSURANCE?
1. A group insurance policy gives you advantages of standardised coverage and very
competitive premium rates. One can avail of group insurance policies that a group you belong
to takes. One is entitled to get a certificate of insurance if you participate in a non employer-
employee group policy for your records.This certificate should contain:
○ the schedule of benefits
○ premium charged and
○ terms and conditions of the cover
2. Group life insurance can be beneficial because it features: Income tax-free death benefit.
Minimal or no medical underwriting. The potential to add additional coverage for dependents.
3. A major advantage of the Group Insurance Scheme for Employees is that it covers maternity-
related expenses (delivery and related medical treatment). Similarly, the new-born baby is
also covered for up to 90 days.
4. The Group Insurance Policy for Employees allows you to add family members to the cover. For
example, you can opt for your spouse and parents to be covered by the policy in case of a
medical emergency.

7. ● A sole entrepreneur with no employees is not eligible for
group cover.
● In a family business, the spouse is not considered as an
employee and hence does not qualify as a group cover
● Eligible dependants are considered to be a part but the
employer has to pay extra premium for covering the
dependent’s insurance.
● Group disability income plans do not have dependent’s
coverage.
Whoarenoteligibleforagroupinsurancepolicy?

8. DISADVANTAGES OF A GROUP
INSURANCE SCHEME
1 2 3 4 5
Unreliable for
Personal Financial
Planning
Employee-dependent
Cover
Inadequate
Coverage
No TAX benefit
Fear of
Discontinuation

9. UNDERSTANDING
THEPROBLEM
Findings from our preliminary
survey assessing the awareness
levels of the TISS Group
Insurance Policy for Students

10. AWARENESS OFTHEEXISTINGPOLICY

11. Theincidents ofavailing the
insurance

12. Awareness about thetotal coverage amount

13. THE RESPONSES ABOUTTHE ESTIMATED AMOUNTOFCOVERAGE PROVIDED

14. Awareness about thenetwork hospitals

15. Awareness about howtoavail theinsurance

16. Awareness about whomtocontact

17. PERCENTAGES
The conclusion from the above study that 73% of the
sample population is aware about the insurance
But only 7.5% have availed it

18. TISSGROUPINSURANCE POLICY
1 2 3 4 5
Network
Claims and
Coverage
Basic Details Emergency
Contact
Procedure

19. SUMMARYOFPOLICYDETAILS
ORIENTAL
INSURANCE
COMPANY
Name of Company
- Oriental
Insurance
Company Ltd
TPA - Health India
Policy No -
131901/48/2022/61
CASHLESS
MEDICLAIM
For >24 hours of
hospitalization =>
1 Lac Rupee Cover
in a year
Reimbursed
hospitalization
In case of
emergency/accide
nt or non cashless
network hospital -
coverage of
1 Lac Rupee in a
year
OPDCLAIM
Rs 5000 coverage
provided in a year
for dental cover
(subject to
conditions)

21. HOSPITALIZATIONS
CASHLESS -
Facility in the network hospitals,
list shared with students.
Hospitals across the country,
valid even during online classes
period.
Planned admission prior
intimation 48 hours earlier, while
for emergency - within 24 hours.
Contact TPA desk at hospital, and
email OSA and Emerg. Contact
within 24 hours.
REIMBURSEMENTS -
Hospitalization Period must
be >24 Hours;
If admitted to a non
network hospital, then
claim upto 1 Lac rupee still
valid. But inform OSA and
emerg. Contact within 24
hours.

22. Key points -
- OPD reimbursement can be claimed upto Rs. 5000/- within policy
period.
- Exclusions mentioned such as dental care not covered.
- Consumables used during minor OPD procedures may not be
covered depending upon the list shared by the insurance coverage.
- To intimate - Contact #18001801104 is shared, to be filled with a
form.
OPDCOVERAGE

23. CLAIMPROCEDURe
1
Intimate as per need
- Planned Cashless
- Emergency Cashless
- Reimbursement
- OPD
3
CLAIM FORM along with
DOCUMENTS REQUIRED TO
BE SUBMITTED IN ORIGINAL
(next slide)
2
REIMBURSEMENT CLAIM
to be sent within 20 days
to OSA
4
Generally, claim amount is received in
2-3 weeks if no added documentation
deficiency is detected

25. PRe- and post -HOSPITALIZATIONS
Pre- and post-
hospitalization expenses
are also covered -
30 days prior as well as
60 days post
hospitalization. But a
timeline for pre and
hospitalization has to be
submitted within 7 days of
treatment completion or
60 days from date of
discharge for claim.
Documentation for this -
- Copy of Discharge Card
Copy of Detailed
- Discharge Summary (should
specify summary of diagnosis,
period of admission and line
of treatment )
- Original Prescriptions
Original Investigation Report
& bills Original Medicine Bills

26. CONCLUSION
At a premium of Rs 1500 per year (every 2 semesters), this
insurance policy provides moderate healthcare coverage
only to the students during the term of their education.
No dependents are covered but using the Insurance card
on the SMS portal, cashless/reimbursement from network
or non-network hospitals can be availed successfully.
The OSA POC added that “Most students are not aware
about the scope of coverage; their expenses can easy be
covered including the campus health clinic expenses if
they apply for a claim with documents.”

27. THANKYOU