Every April, HR managers across Mumbai go through the same exercise. Renewal quotes land in their inbox. Premiums have gone up again. The coverage hasn’t changed. Nobody’s quite sure whether the policy the company is paying for is actually adequate for the team they now have.

It’s a familiar cycle, and it usually happens because the original decision group health or individual mediclaim was made without a structured review. The result is a policy that may not fit the workforce it’s supposed to protect.

Let’s fix that.

Group Health Insurance: What It Is and Who It’s For

A group health insurance policy also called a group mediclaim policy covers a defined group of people under a single master policy. For businesses, that typically means employees, and often their immediate families. The employer pays the premium, the insurer covers hospitalisation expenses up to the defined sum insured, and the HR team manages the policy with the insurer.

Group health is generally the right choice for businesses with five or more employees. Why? Because at group size, insurers offer more favourable underwriting pre-existing conditions are typically covered from day one (subject to waiting period waivers), there’s no individual medical examination required, and the per-member premium is usually more competitive than what an individual would pay for equivalent cover.

For a company with 30 employees in Andheri, a well-structured group mediclaim policy covering each member and their family for ₹5 lakhs is both affordable and meaningful. It’s also a retention tool the talent market is competitive, and health cover is one of the benefits employees explicitly factor into their employment decisions.

Individual Mediclaim: Where It Still Makes Sense

Individual mediclaim policies bought by the employee themselves, outside of any employer arrangement still have a place. They’re particularly relevant in three situations: for self-employed professionals and business owners who don’t have a group to insure, as top-up cover for senior employees whose exposure exceeds the group policy’s sum insured, or as a personal portable policy that isn’t linked to employment status.

The portability point matters. Group cover disappears when the employee leaves the company. An individual policy stays with the person. Employees who’ve been on group health for years and then change jobs sometimes discover they have no personal cover to fall back on and may face exclusions for pre-existing conditions on a new individual policy.

Good HR practice is to explain this clearly so employees understand what they actually have.

The Numbers That Should Inform Your Decision

Health insurance in India is growing fast. Health insurance gross direct premium income reached ₹37,528 crore in March 2025, up significantly from the previous year. Medical inflation is running well above general inflation healthcare costs at Mumbai’s private hospitals have risen sharply over the past five years.

That context matters when you’re setting sum insured levels. A ₹3 lakh sum insured was adequate five years ago. It may not cover a single hospitalisation today at a premium private facility. We routinely see clients renewing policies with sum insured levels that haven’t been revised in years, which creates a false sense of security.

The group health conversation should include: What is the per-member sum insured? Does it cover dependants? Is there a family floater or individual cover structure? Are there sub-limits on room rent or specific treatments that could dramatically reduce a claim payout?

Top-Up and Super Top-Up Plans: The Middle Ground

For businesses that want to offer meaningful cover without dramatically increasing premium spend, top-up plans are worth understanding. A top-up policy kicks in after the base policy’s sum insured is exhausted it’s a cost-effective way to extend protection for employees whose healthcare needs are higher, or for senior staff who want more comprehensive cover without the employer funding a significantly higher base policy.

Super top-up plans go further, aggregating multiple claims within a year before applying the deductible. For companies with a good claims history and a mixed workforce, this is often an efficient structure.

What Most Businesses Get Wrong at Renewal

The most common mistake is treating renewal as an administrative exercise. The right approach is to review claims data from the expiring year, reassess the workforce composition, check whether the sum insured still reflects actual medical costs in your employees’ region, and compare the market for better terms.

That’s not a 20-minute job it’s a structured review. Which is exactly what a broker should be doing for you, not just sending the renewal papers and waiting for your signature.