GMC vs. GPA Insurance Policy: Explained
GPA (Group Personal Accident) and GMC (Group Medical Coverage) are two popular types of insurance policies often offered by employers. Although they have similarities, they are not the same. Whether, you are an employer choosing the best coverage for your employees or an employee wanting to understand your employer-provided insurance policy. The following sections will clarify these options and help you make an informed choice.
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What is GMC Policy?
GMC insurance, or Group Medical Coverage, provides health insurance to a group, usually employees. It covers many medical expenses, including inpatient and outpatient care, pre-existing conditions, and maternity. GMC also offers cashless services at certain network hospitals and doctors.
What is GPA Policy?
GPA insurance, also known as Group Personal Accident insurance, covers accidental injuries or death. It's often provided to groups such as employees. GPA insurance policy offers worldwide protection, death benefits, and additional features like hospitalization and reimbursement for medical expenses.
GMC vs. GPA
Here is a table comparing GMC and GPA based on key parameters. Please note that the exact details can vary between insurers and individual policies.
Difference between GMC and GPA
| Parameters | GMC Insurance | GPA Insurance |
| Full Form | GMC full form is Group medical coverage | GPA full form is Group personal accident |
| Other Names | This policy is also known as Corporate Insurance, Group Health Insurance and Employer-Employee Insurance. | This policy is also referred to as Personal Accident Cover for Employees and 24-Hour Worldwide Accident Policy. |
| People covered | Group medical coverage is suitable for a diverse range of employer-employee setups, regardless of industry or job type. In some cases, dependent family members such as spouse, children and parents. | Group personal accident insurance is better suited for industries where employees face a higher risk of accidents, such as construction, oil and gas, travel, and others. |
| Scope | This policy covers medical issues and emergencies faced by the insured employees. It typically includes pre-hospitalization, post-hospitalization expenses, and coverage for daycare treatments in most cases. | This policy covers accidents experienced by the insured employees. Whether these accidents are covered only during duty hours or both during duty and off-duty hours depends on the terms and conditions of the policy. |
| Range of Coverage | GMC offers broader coverage compared to GPA. Additionally, GPA can be added as an extra cover within a GMC policy. | GPA offers limited coverage as it only covers accident-related incidents. |
| Coverage Type (Sum Insured) | In most cases, GMC coverage operates on an indemnity basis. This means that the expenses of the insured employee will be reimbursed based on the actual expenses incurred, as long as they fall within the sum insured limit. For instance, if the sum insured is Rs. 6 lakhs and the hospital bill amounts to Rs. 1.5 lakhs, the entire bill will be covered according to the policy terms, as it is within the sum insured limit. | In most cases, GPA coverage operates on a benefit basis. This means that the insured employee receives a lump sum amount based on the severity of the injury, according to the policy's terms and conditions. For example, if the policy has a sum insured of Rs. 40 lakhs and the insured employee suffers permanent total disability due to an accident, they would receive 100% of the sum insured amount. |
| Customisation | GMC can be customised by the employer. | Usually the features, coverage and services are not customisable by the employer offering policy or the insured employee |
| Inclusion | The specific inclusions vary based on the chosen policy coverage, additional options selected, and the terms and conditions. Common inclusions in GMC typically encompass hospitalization expenses (pre, during, and post), maternity coverage, daycare expenses, and outpatient department (OPD) expenses (either included or available as an add-on). | The specific inclusions vary based on the policy coverage, optional add-ons (if selected), and the terms and conditions. Here are typical inclusions in GPA coverage: accidental death, permanent total disability, permanent partial disability, temporary total disability, child education cover, and repatriation of mortal remains. |
| Exclusion | Here are common exclusions typically found in GMC policies. The specific details will be outlined in the Policy Wordings: treatments not covered by the policy, drug and alcohol abuse, and self-inflicted injuries. | Here are typical exclusions often found in GPA policies. Specific details will be specified in the Policy Wordings: attempted suicide, participation in adventure sports, and engagement in illegal activities. |
Conclusion
Both GMC and GPA insurance policies are essential for providing financial protection and peace of mind. GMC insurance offers comprehensive coverage for a wide range of medical expenses, making it ideal for overall health care needs. On the other hand, GPA insurance focuses primarily on covering accidental injuries and death. When choosing the right policy for yourself or your organization, it's important to consider your specific needs, budget, and the coverage benefits offered by each type of insurance.
Frequently Asked Questions
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Q1: What does "off duty GPA" mean?
Ans: GPA coverage can be tailored to cover only on-duty incidents or expanded to include off-duty situations. Under on-duty coverage, employees are protected only for accidents occurring while they are working. Conversely, with on-duty + off-duty coverage, there are no such restrictions—the employee is covered at all times according to the policy's terms and conditions.
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Q2: Can part-time employees be covered under a GMC or GPA?
Ans: Typically, only full-time employees are covered under a GMC or GPA policy. However, part-time or contract-based employees may also be included, depending on the negotiations between the insurer and the employer.
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Q3: Is it mandatory to insure employees under group personal accident insurance?
Ans: It is not mandatory to cover employees under group personal accident insurance. However, combining a GMC policy with a GPA add-on can be a valuable perk for employees.
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Q4: What determines the payable premium for a GMC and GPA cover, and who makes the payment?
Ans: The payable premium is determined by the chosen coverage and the insurer. Typically, the employer pays the premium. However, in some cases, the employer may require employees to contribute towards the premium. If employees choose to enhance the policy with add-ons, they are responsible for paying the premium for those enhancements.
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