Group Medical Insurance Fundamentals

Managing a corporate medical scheme requires a working understanding of how group insurance is structured, funded, and administered. This program covers the fundamentals an HR professional needs to manage and explain employee medical cover.

Participants build the vocabulary and concepts behind plan types, coverage tiers, funding, and the parties involved, so they can manage the scheme and communicate it accurately to employees.

By the end of this course, participants will be able to:

– Explain how group medical insurance works
– Distinguish between common plan types and structures
– Describe coverage tiers, limits, and exclusions
– Outline how group plans are funded and priced
– Interpret a policy schedule and its key terms
– Describe the roles of insurer, broker, and TPA
– Communicate scheme details clearly to employees

1- How Group Medical Insurance Works
2- The Insurance Market and Players
3- Insurable Risk and Pooling
4- Plan Types and Structures
5- Coverage Tiers and Networks
6- Limits, Exclusions and Pre-Existing Conditions
7- Funding and Pricing Concepts
8- Reading a Policy Schedule and Wording
9- Roles of Insurer, Broker and TPA
10- Compliance and Regulation Basics
11- Wellness and Added Benefits
12- Communicating Cover to Employees

HR practitioners and benefits administrators responsible for employee medical insurance.

The program uses worked examples, sample policy documents, and short exercises. Participants interpret real schedule structures and practice explaining cover in plain terms, finishing with a scheme walkthrough.

Participants leave able to understand and manage a group medical scheme and to communicate it accurately to the workforce.