Who Is Eligible for Group Health Insurance? Employer & Employee Rules

Group health insurance eligibility isn't a single rule — it's a set of conditions that apply differently to employers, employees, and dependants. Here's a breakdown of who qualifies and under what circumstances.

Employer Eligibility

To purchase a group health insurance policy in India, an organisation must meet a few basic conditions:

• Be a registered legal entity. This includes private limited companies, LLPs, partnerships, sole proprietorships, NGOs, trusts, and societies.
• Meet the minimum group size. Most traditional insurers require seven or more employees.
• Have a defined employer-employee relationship. Insurers will ask for proof such as a payroll register, salary slips, or PF contribution records.
• Provide statutory documentation. GSTIN, PAN, and incorporation documents are typically required during onboarding.

Employee Eligibility

Once the policy is in place, the question becomes which employees are covered. The plan design determines this, but common categories include:

• Full-time, permanent employees. Almost always covered from Day 1 of employment.
• Probationary employees. Usually covered, though some companies wait until probation ends.
• Contract employees. Coverage depends on the policy. Many companies extend cover; some don't.
• Interns and trainees. Covered only if explicitly included in the plan.
• Domestic helps and gig workers. Generally not covered under standard group policies, though some plans now extend to them.

Dependent Eligibility

Group policies typically allow employees to add family members, with eligibility defined as:

• Spouse: Legally married partner; same-sex partners are increasingly covered as insurers update plan terms.
• Children: Usually up to age 25 if unmarried and financially dependent.
• Parents: Optional add-on; most plans cover parents up to age 80.
• Parents-in-law: Often covered as an alternative or addition to parents, depending on plan design.
• Siblings: Rarely covered under standard plans.

Age-Based Limits

Most group policies have an upper entry age between 65 and 80 for parents. Children are typically covered until age 25. Spouses have no age limit as long as they are married to a covered employee.

What Disqualifies Coverage

Even within an eligible group, certain situations can affect coverage: undeclared dependants who later try to claim, employees added after the policy renewal cut-off date, or family members beyond the dependant tier the company has paid for.

How Plum Handles Eligibility

Plum offers group health insurance for Indian companies starting at two employees, with flexible eligibility for full-time, probationary, and contract staff. Dependant tiers can be configured to include spouse, children, parents, and parents-in-law. Onboarding takes a few days from quote to policy issuance.

Frequently Asked Questions

Are part-time employees eligible for group health insurance?

It depends on plan design. Most policies cover full-time staff by default; part-time inclusion is optional.

Can employees add live-in partners as dependants?

This varies by insurer. Some progressive plans now recognise long-term partners; most still require legal marriage.