Medical expenses incurred due to the treatment of any ailment, surgery, hospitalization, etc. are covered under a health insurance plan. The cost can be reimbursed by the insurance company by submitting supportive required documents or by using the cashless service offered by the insurance company.
Family health insurance plan is a type of health insurance plan (also known as family floater plan), which covers all the members against various diseases and illnesses. Health insurance plan for family covers your family with lowest premium depending on the age of the family members.
Features and Benefits of a Family Health Insurance Plan
Features of Family Health Insurance
Cover family members: You can cover your family members including your spouse, children, parents, in fact, many insurance companies also allow parent in-laws.
Rebate on high sum insured: Many insurance companies offering health insurance plan for family offer rebates on higher sum insured. Increase in the sum insured: A family health insurance plan comes with a no claim bonus, which helps you to increase sum insured every year if there's no claim throughout the policy period.
Cashless claim settlement: You can avail cashless service at the time of claim if the treatment is carried out in a nominated hospital by the company.
Policy term: Health insurance plan for family offers options for policy term. You can opt for 1, 2 or 3 years as the policy term.
Benefits of Family Health Insurance
Save money: You can cover whole family in a single family floater insurance, you save ample of money instead of buying individual health insurance plan for each member.
Tax benefit: You can avail tax benefit on all the premiums paid for family health insurance plan under the Section 80D of the Income Tax Act.
Restore exhausted coverage: Many family health insurance plan providers offer special benefit called as restore benefit, which helps to reinstate full coverage once exhausted during the policy period. However, it is applicable only for unrelated claims.
Medical umbrella for the whole family: Cover whole family under one umbrella to cover the cost of uncalled medical expenses under a single family health insurance.
Easily add new member: You can add children or any other family member easily in the same family floater plan.
Eligibility in Family Health Insurance Plan
Eligibility Criteria for Family Health Insurance Policy is as follows:
Entry Age for the Policyholder/Proposer under Family Health Insurance Plan
In family health insurance, the eldest person becomes the policyholder. The entry age for a policyholder/proposer is from 18 to 65 years, while some insurance company may allow it up to the age of 70 years and above.
Entry Age for Family Members under Family Health Insurance Plan
For Adults: The minimum entry age is 18 years and the maximum 65 years, while some insurance company may allow it up to the age of 70 years and above. For Dependent Children: The minimum age to children under the family health insurance is from 90 days (this may vary, some insurers may allow it from 30 days and some may have different entry age) to 25 years.
Medical Tests under Family Health Insurance Plan
Few insurers ask for medical tests to be carried out at their nominated centers. While few insurers offer family health insurance policy up to certain age, say, 45 years without any medical tests. In some instances, insurers may make medical check-up as mandatory.
Eligibility for Renewal of Family Health Insurance Plan
Almost all the insurance companies offer lifelong renewal. You need to renew your family health insurance policy every year to keep in force and renew before it expires. After the due date of renewal the insurance company gives a grace period of 30 days. If you want to keep the policy in force, you must renew before grace period ends or else the policy terminates.
What is Covered under a Family Health Insurance Plan?
Health insurance plan for family covers in-patient hospitalization, pre-hospitalization, post-hospitalization, day care, health check-up, emergency ambulance service, etc. Let's see each in detail:
In-patient Hospitalization: All the medical expenses due to hospitalization are covered. In case, if any of the insure family member is hospitalized for more than 24 hours, the insurance company will pay the medical expenses.
Pre-hospitalization Expenses: Any medical expenses incurred before hospitalization are termed as pre-hospitalization expenses. For example, X-ray, MRI, blood test, urine tests, sonography results, etc. done before hospitalization are covered.
Post-hospitalization Expenses: Any medical expenses incurred after the discharge from hospital are termed as post-hospitalization expenses. For example, medicines, or any medical tests done after the discharge to check the improvement.
Ambulance Charges: Most of the insurance companies offering family health insurance plan covers emergency ambulance charges. The amount of the emergency ambulance charges varies from insurer to insurer.
Hospital Cash: The insurance company provides daily cash allowance. This hospital cash can be utilized to cover the cost of the transportation or other basic requirements of the person attending the patient.
Restore Benefit: Many health insurance companies offer restore benefit feature under family health insurance plan. This feature helps to reinstate the basic plan cover in case the coverage gets exhausted. However, restore benefit is applicable only for unrelated claims.
Day care treatment: Day care treatments are the treatments that does not require 24 hours of hospitalization. For instance, medical expenses related to cataract which can be treated within few hours.
What is Not Covered in a Family Health Insurance plan?
Here is the list of few exclusions of a family floater health insurance plan
Any claim raised within the 30 days waiting period of the health insurance policy. issuance wouldn’t be covered unless and until it arises due to the accident.
Any sexually transmitted diseases.
Any treatment related to fertility issues.
Any treatment and expenses incurred due to routine medical check-ups.
Any treatment/surgery done for gender reassignments or for gender change.
Artificial life maintenance, including life support machine use, where recovery or restoration of the previous state of health is not possible.
Any treatment undergone due to surgery or a plastic surgery, aesthetic treatment, or any further consequences due to such treatments. Treatment of stress, mental illness or any psychological disorders, or due to the abuse of stimulants or depressants.
Any OPD Treatment.
Any treatment undertaken abroad.
Any Illness or Injury directly or indirectly causing or arising because of breach of any law by the insured who has a criminal intent, war, nuclear, chemical or biological attack or weapons, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.
Illness or Injury caused due to consumption or abuse of tobacco, intoxicating drugs and alcohol or hallucinogens.
Any act of self-inflicted injury, suicide or attempted suicide while sane or insane.
Any treatment related to pregnancy (including voluntary Termination), childbirth, maternity (Including caesarian section), miscarriage (unless due to an Accident), abortion or complications of any of these. However, this Exclusion will not apply to ectopic pregnancy.
That’s the list of few common exclusions of a family health insurance plan. However, one must refer and read policy wordings for the full list of exclusions.
List Of Best Family Floater Health Insurance Plans in India in 2018
Mentioned Below Is The List Of The Best Family Floater Health Insurance Plans in India Year 2019
Religare Care
Being a comprehensive health insurance plan, Religare Care offers coverage for your medical expenses incurred due to an accident, illness or an injury. It also offers coverage for pre and post hospitalization expenses, day-care treatments, health check-up, etc. Some of the best features of Religare Care are daily allowance to meet incidental expenses, flexibility to lower the pre-existing diseases waiting period, non-increment of premium in case of filing a claim, etc.
Star Family Health Optima
Star Family Health Optima Plan offers protection to your entire family simply by making a single premium payment. This plan is trusted by most of the people since it offers a host of benefits such as domiciliary hospitalization expenses for the treatments that exceed 3 days, 100% automatic facility to restore the entire sum insured, coverage for new-born from the 16th day of birth, etc.
Apollo Munich Optima Restore Family
This is a unique and innovative health plan that is tailor-made for a family that includes spouse, dependent children, dependent parents as well as parents-in-law. Some of the unique advantages that this family floater plan includes are Multiplier, Restore and Stay Active. This plan offers a benefit of automatic re-instatement of the sum assured in case the basic sum assured gets exhausted. However, do remember that this can be done only during the policy period. This plan offers a superb benefit of increasing the sum assured by 50% in case of a claim-free year.
HDFC Health Suraksha
HDFC ERGO has customized this plan keeping ‘the medical inflation’ in mind. The motive of this plan is to offer maximum coverage with a continuous and better medical treatment. The HDFC Health Suraksha Plan focuses mainly on ‘no limit for the entry age, no sub-limits on room-rent, option to add critical illness cover as well as the maternity cover. It also offers coverage for around 144 day care procedures. AYUSH benefits and wide range of sum insured are few other benefits that the HDFC Health Suraksha offers.
Oriental Insurance Happy Family Floater Policy
This family floater health insurance plan offers coverage to self, spouse, children, parents as well as parents-in-law. The Oriental Insurance Happy Family Floater Policy can pay for your injury/ ailment/ accident that would require hospitalization, besides, 24 day-care procedures, no claim benefits, organ donor cover, pre & post-hospitalization, restore benefit, etc.
Health Insurance Plan for Family - Eligibility Criteria
The family floater health insurance policy is similar to a individual health insurance policy which has one annual premium payable, the difference being the entire given sum insured that can be utilized by any of the insured family members.
The basic eligibility needs the primary policyholder to be 18-65 years in age. Yet, lifelong renewal of policy is available with most insurance companies in India. The medical tests of the family members are mostly required post 45 years of age. The criteria of eligibility and age vary for the different insurance companies.
All About Mediclaim Policy for family
The rising cost of modern medicine and healthcare treatment has made a mediclaim policy for your entire family a necessity. In case of emergency hospitalization, a mediclaim policy will help you by covering your family’s health care expenses.
A mediclaim policy for family is an insurance (health) plan under which the policyholder and his/her family gets health cover of a certain amount available for the entire family. In case of a medical emergency or accident, the policyholder will receive medical care and the expenses will be deducted/reimbursed from the amount insured, as per the health plan. A mediclaim policy can be taken on an individual or a family floater basis.
Note: Purchasing a mediclaim policy on an individual basis means buying a separate insurance for each member with a defined medical cover. In case of a family floater plan, the mediclaim policy can be utilised by any of the family members.
Value added benefits of Mediclaim Policy for family
The benefits of a mediclaim policy are as follows:
- Provides cover for hospitalization expenses, be it planned or emergency resulting from natural causes or from an accident.
- Provides cover against injury/illness in case of an accident.
- Most of the mediclaim policies offer cashless settlements in network hospitals.
- You can claim an Income Tax Deduction under Section 80D on the premium paid towards a mediclaim policy.
- Can be renewed annually.
Inclusions under a Mediclaim Policy for Family
The inclusions of a mediclaim policy for family are:
Hospital expenses – Expenses incurred due to hospitalization like medicines, oxygen, blood, OT charges, medical tests and diagnosis, chemotherapy, radiotherapy, organ transplantation, etc.
Hospital accommodation expenses – Expenditures towards hospital room, ICUs are either addressed through cashless hospitalisation feature or are reimbursed by the company.
Day-care hospitalization – Expenditures towards tech-driven medical treatments that do not involve 24-hour hospitalization.
Pre and post-hospitalization expenses – Expenses incurred for up to 30-60 days before and till 60-120 days after hospitalization. It may also include medical assistance for emergency services like ambulance, etc.
Charges for medical experts – The fees for medical professionals involved during hospitalization like doctor, surgeon, nurse, etc. are also provided by mediclaim policies.
Note: These are common inclusions of a mediclaim policy for family. The inclusions also vary from one policy to another.
Exclusions under a Mediclaim Policy for Family
The exclusions of a mediclaim policy are:
- Non-medical expenses like administrative charges, service charges, toiletries, diapers, syringes, etc.
- Diseases/ailments contracted within a specific time from the policy purchase.
- Any dental treatment except in case of an accident.
- Sexually Transmitted Diseases and HIV.
- Cosmetic surgery, circumcision or plastic surgery.
- Vaccinations
- Medical condition resulting from the addiction of alcohol, smoking, drug abuse, etc.
- Health conditions arising out of war, nuclear weapons, etc.
Eligibility Criteria - Application for Mediclaim Policy for Family
The eligibility criteria is as follows:
- Entry age for a policyholder (adults) is 18 years to 65 years.
- Entry age for children is 90 days to 18 years.
Documents required to buy mediclaim policy for family
The documents required to purchase a mediclaim plan are:
- KYC - Proof of ID and Address.
- Age Proof.
- Medical Check-up/Report if required.
- 2 Passport-sized photographs.
- Application Form
The details have to be provided for each and every family member.
Documents required for claim under a mediclaim policy for family
- Claim Form/Pre-authorization Request Form.
- Attending physician's statement.
- Attested copies of all medical records.
- NEFT mandate form
For a Death Claim:
- Original policy documents
- Original/attested copy of death certificate issued by the local municipal authority.
- Death claim application form (Form A).
- NEFT mandate form attested by bank authorities along with a cancelled cheque or bank account passbook.
- Nominee's photo identity proof such as copy of Passport, PAN card, Voter identity card, Aadhaar (UID) card, etc.
Medical Natural Death:
- Attending physician's statement (Form 'C').
- Medical records (admission notes, discharge/death summary, test reports, etc.).
Accidental Unnatural Death:
- Copy of the First Information Report (FIR) or Panchanama/Police complaint.
- Copy of Post Mortem report (PMR)/Autopsy and Viscera report.
- Copy of the Final Police Investigation report (FPIR)/Charge sheet.
Top Health Insurance Plans for Family
Religare Care Health Insurance
| FEATURES/ PLAN (SI) | CARE 3 ( 4 LAC ) SUPER SAVER | CARE 4 (5,7,10 LACS) ELITE |
|---|---|---|
| Deductible in policy period | Yes, Rs.10,000 | No deductible |
| In patient hospitalization | Up to Sum Insured | Up to Sum Insured |
| Pre-hospitalization | 30 days | 30 days | Post-hospitalization | 60 days | 60 days |
| Day Care Treatments | Yes | Yes |
| Room Rent | 1% of SI per day | Single Private Room |
| ICU charges | 2% of SI per day | No Limit |
| Ambulance Cover | Rs.1,500/ hospitalization | Rs.2,000/ hospitalization | Daily Allowance | Rs.500/ day up to 5 days | NA |
| Domicilliary hospitalization | Up to 10% of SI | Up to 10% of SI |
| Up to 10% of SI | Yes, all members | Yes, all members |
| Recharge of SI | Yes | Yes |
| No Claim Bonus | Yes | Yes |
| Organ Donor Cover | Rs.50,000 | Rs.100,000 |
| Second opinion | Yes | Yes |
| Alternative Treatments | Up to 15,000 | Up to 20,000 |
Policy Terms
| Min Age | 91 days |
| Max Age | None |
| Renewal | Lifelong Renewability. The Policy can be renewed under the then prevailing Health Insurance Product or its nearest substitute approved by IRDA. | Renewal premium | Premium payable on renewal and on subsequent continuation of cover arc subject to change with prior approval from IRDA. |
| Co-payment | No Co-payment in policy, if age of the eldest member insured with the company at the time of first policy is below 61 years. 20% Co-payment will be applicable in policy, if age of the eldest member insured with the company at the time of first policy is 61 years or above 61 years i.e. you will have to pay 20% of the claim amount under the policy, if any. The company will pay the rest. |
| Waiting period | 30 days for any illness except injury |
| Waiting period for pre-existing illnesses | Four years of continuous coverage |
| Change in sum insured | You can enhance your sum insured under the policy only upon renewal |
| Grace period | 30 days from the date of expiry to renew the policy |
Exclusions
- Any diagnosis of diseases / undergoing of surgery / occurrence of event, whose signs or symptoms first occur within 30 days of Policy Period Start date.
- Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide).
- Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
- Medical expenses incurred for treatment of AIDS.
- Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences.
- Congenital disease.
- Tests and treatment relating to infertility and in vitro fertilization.
- War, riot, strike, nuclear weapons induced hospitalization.
- Under this policy, every time there is a no-claim year, it will lead to an increase in Sum Insured by 10%, up to a maximum of 50% in consecutive 5 years.
- The cover is inclusive of room rent when there is hospitalisation, also pre-hospitalisation charges and post-hospitalisation charges are covered in case of surgery and ambulance expenses, besides a daily cash benefit.
- The policy also offers a cover for the pre-hospitalisation charges of up to a month and post-hospitalisation charges of up to 2 months. - It also gives organ donor cover ranging from INR 50,000 - 5 lakhs.
- The ICU-stay charges are without a limit. This policy offers a single private room facility when there is hospitalisation and also one free medical check-up annually. There are add-ons such as air ambulance coverage and personal accident cover etc.
Apollo Munich Optima Restore Family
| BASIC SUM INSURED PER INSURED PERSON PER POLICY YEAR (RS. IN LAKHS) | 3.00 - 5.00 - 10.00 - 15.00 - 15.00 20.00,25.00,50.00 |
|---|---|
| Inpatient treatment | Covered |
| Pre-hospitalisation | Covered, up to 60 days |
| Post hospitalisation | Covered up to 180 days | Day Care procedures | All Day Care Treatment Covered |
| Domiciliary treatment | Covered |
| Organ donor | Covered |
| Daily cash for Choosing shared accommodation | Rs.800 per day, Maximum Rs.4,800 (Rs.1000 per day, Maximum Rs.4,800) |
| Emergency Ambulance | Up to Rs. 2000 per hospitalisation | E-opinion in respect of critical illnesses | Covered | Emergency Air Ambulance Cover | Not Covered (Covered up to Rs.2.5 Lacs per hospitalization and maximum up to sum insured in an year) |
| Restore Benefit | Equal to 100% of basic sum insured |
| Multiplier Benefit | Bonus of 50% of the Basic Sum Insured for every claim free year, maximum up to 100%. In case of claim, bonus will be reduced by 50% of the basic sum insured. However, this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy. |
| Health Checkup | Not covered (Up to Rs. 2,500, 5,000, 8,000, 10,000) |
| Critical Advantage Rider | Offered (where base Sum Insured is Rs.10 lacs & above) |
| Age | 91 days to 65 years |
Exclusions
- All treatments within the first 30 days of cover except any accidental injury.
- Any pre-existing condition will be covered after a waiting period of 3 years.
- 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
- Expenses arising from HIV or AIDS and related diseases.
- Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments.
- Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
- Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
- Pregnancy, dental treatment, external aids and appliances.
- Items of personal comfort and convenience.
- Experimental, investigative and unproven treatment devices and pharmacological regimens.
- Auto-reinstatement of the sum insured, in case of the basic sum insured getting exhausted. This restoration may happen only once in the policy period.
- For a no-claim year, the basic sum insured is raised by 50%. This policy will include the complete expense when there is a life-threatening disease and there is the feature of daily cash benefit also.
Star Family Health Optima
| Eligibility | ● 18-65 years of age ● 65+ for renewals ● Child from 16th day of birth can be covered as part of the family |
| Pre-Hospitalization expenses | Up to 60 days |
| Post-hospitalisation expenses | Up to 90 days | Lump-sum for Treatment in Preferred Network Hospital | In the event of a medical contingency requiring hospitalization, if the insured seeks advice from the Company, Up to 1% of Basic Sum Insured, subject to maximum of Rs.5000/- per policy is payable as lump sum. |
| Automatic Restoration of Sum Insured | 3 times at 100% each time, during the policy period. |
| Bonus | Following a claim free year bonus of 25% of the expiring basic sum insured in the second year and additional 10% for subsequent years (max.100%) would be allowed. |
Exclusion
- Any hospital admission primarily for investigation diagnostic purpose
- Pregnancy, infertility.
- Domiciliary treatment, treatment outside India.
- Circumcision, sex change surgery, cosmetic surgery and plastic surgery.
- Refractive error correction, hearing impairment correction, corrective and cosmetic dental surgeries.
- Substance abuse, self-inflicted injuries, STDs and HIV/AIDS.
- Hazardous sports, war, terrorism, civil war or breach of law.
- Any kind of service charge, surcharge, admission fees, registration fees levied by the hospital.
- The expenses covered include ambulance expenses, hospital expenses, in-house treatment expenses etc.
- The insurance provider has tie-ups with 6000+ hospital networks. Hence, there are faster pay-outs. They can also maintain online records if you choose.
Max BUPA Health Companion
The sum insured is open for auto-refill when the basic sum insured runs out. Considering there is a premium that is not too expensive for you, the policy delivers a larger daily cash benefit. Besides, in case of a No claims Bonus for 5 consecutive years, the basic sum insured will go up by 100%.
| Sum Assured | ● Rs. 3 Lakhs, Rs. 4 Lakhs, Rs. 5 Lakhs, Rs. 7.5 Lakhs, Rs. 10 Lakhs & Rs. 12.5 Lakhs, Rs. 15 Lakhs, Rs. 20 Lakhs, Rs. 30 Lakhs, Rs. 50 Lakhs & Rs. 1 Crore. ● Top Up with Annual Aggregate Deductible Option of Rs. 1 Lakhs, Rs. 2 Lakhs, Rs. 3 Lakhs, Rs. 4 Lakhs, Rs. 5 Lakhs & Rs. 10 Lakhs. |
| NCB | Increase in Sum Insured @20% of Base Sum Insured subject to the maximum of 100% of Base Sum Insured for each claim free year with no penalization in case of a claim |
| Health Check-up | Avail Heath Checkup for yourself and your family once in two years (for variant 1) or annually (for variant 2 & 3), so that you live a healthier and happier life. | Policy Term | Default policy term for all plans is one year. You can choose a 2 year term as well and thereby avail a discount of 12.5% on the second year’s premium. |
| Refill Benefit | Under this benefit, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year, provided it is for an unrelated illness. |
| AYUSH | Avail In-patient treatment under AYUSH (Ayurveda, Unani, Siddha, and Homeopathy) up to the base sum insured. |
Exclusions
- Ancillary Hospital Charges
- Hazardous Activities
- Artificial life maintenance
- Behavioral, Neurodevelopmental and Neurodegenerative Disorders
- Circumcision
- Complementary & Alternative Medicine
- Conflict & Disaster
- External Congenital Anomaly
- Convalescence & Rehabilitation
- Cosmetic and Reconstructive Surgery
- Dental/oral treatment
- Eyesight & Optical Services
- Experimental/Investigational or Unproven Treatment
- HIV, AIDS, and related complex
- Hospitalization not justified
- Inconsistent, Irrelevant or Incidental Diagnostic procedures
- Mental and Psychiatric Conditions
- Non-Medical Expenses
- OPD treatment
- Obesity and Weight Control Programs
- Off- label drug or treatment
- Puberty and Menopause related Disorders
- Reproductive medicine & other Maternity Expenses: Any assessment or treatment method
- Robotic Assisted Surgery, Light Amplification by Stimulated Emission of Radiation (LASER) & Light based Treatment
- Sexually transmitted Infections & diseases
- Sleep disorders
- Substance related and Addictive Disorders
- Unlawful Activity
- Treatment received outside India
- Unrecognized Physician or Hospital
Documents Required to buy family floater health insurance
KYC - Proof of Address and Proof of Identity for all family members.
Age Proof - Birth Certificate.
Photo - 2x Passport size photographs of each family member.
Medical Report - Medical tests/checkups/report for certain family members above the age of 45 years.
Process To Renew family health insurance Policy
Since the advent of internet banking, all health insurance providers have enabled the online facility of policy renewal. You simply have the visit the official website of the respective insurer and log in with your registered user ID/password. Once logged in, select the option for renewal and make the payment online via net banking/credit/debit card etc.
Top Family Health Insurance Companies in India? What is Incurred Claims Ratio?
Mentioned below is the Incurred Claim Ratio of the top 6 standalone health insurance companies of India. An Incurred Claim Ratio is the number of claims settled by an insurer from the given number of total claims in a single financial year. The higher the Incurred claim ratio, the better the company becomes with respect to settling claims. Therefore, you should always select an insurer with a high claim settlement ratio.
| INSURER | HEALTH (%) |
|---|---|
| ADITYA BIRLA | 89.05 |
| APOLLO MUNICH | 62.47 |
| MANIPAL CIGNA | 46.29 | MAX BUPA | 50.19 |
| RELIGARE | 51.97 |
| STAR HEALTH | 61.76 |
Types of Family Health Insurance Plan
Unfortunate incidents that require timely medical treatment can bring you and your family financially down. The burden of the rising medical expenses takes a toll not only financially but also emotionally. In such a scenario, having a family health insurance plan to support you financially at the time of medical emergencies can be a saviour.
Family health insurance policies are customizable. There are two ways you can cover your family members:
You can opt for individual policies for each family member or opt for a family floater health insurance, wherein you and your family together are covered in a single policy on a shared basis. A family floater health insurance protects your entire family – spouse, parents, and children in a single plan. Itis also commonly called as family floater plan.
Let’s see the difference between the two.
Cover each family member individually having different coverage (sum insured)
| Family Member | Age (years) | Sum Insured (SI) |
|---|---|---|
| You | 28 | Rs.1 lakh |
| Your Spouse | 26 | Rs.1 lakh |
| Your Dad | 55 | Rs.1 lakh |
| Your Mom | 52 | Rs.1 lakh |
| Your Son | 1 | Rs.50,000 |
| Your Daughter | 3 | Rs.50,000 |
| Total SI = Rs.5 lakh |
Cover each family member having one coverage value (sum insured)
| Family Member | Age (years) | Sum Insured (SI) |
|---|---|---|
| You | 28 | Total SI = Rs.5 lakh |
| Your Spouse | 26 | |
| Your Dad | 55 | |
| Your Mom | 52 | |
| Your Son | 1 | |
| Your Daughter | 3 |
The benefit of family floater is that your whole family is covered and sum assured is shared across all the family members. Plus, family health insurance plans also offer to restore benefit, which helps to restore the sum insured to its full coverage value once it gets exhausted.
Here's an example how these health insurance policies work:
God forbid, if something happens to any of the family members, say you yourself get hospitalized and the medical expense sums up to Rs.2.5 lakh.
Case 1: Individual plan:
Suppose, you bought individual health insurance policy for each of the family members. You are covered with a sum insured of Rs.1 lakh. Under such a case, the maximum amount that the health insurance company would pay is Rs.1 lakh, while the rest of the amount you need to pay from your pocket.
Despite having a health policy, you will be paying Rs.1.5 lakh from your pocket.
Case 2: Family floater plan:
Suppose, you bought a family floater health insurance policy having the sum insured of Rs.5 lakh. Under such a case, the health insurance company will pay the full incurred medical expenditure. That means you won't have to pay any extra money from your pocket. Moreover, the rest of the coverage of Rs.2.5 lakh can be utilized by the other insured family members, if the need arises during the policy period.
Thus, the insurance advisor suggests to opt for a family floater insurance plan to cover the whole family instead of having different individual policies.
Family Health Insurance Claim Process
The claim process of Family Health Insurance can be understood as mentioned below.
Cashless Process
- Go to the insurance desk of Network hospital.
- Provide ID card for identification.
- The hospital does verification of identity and demands a pre-authorization form to be filled and submitted.
- The insurer or TPA checks the documents and approves the cashless claim as per the terms and conditions of the coverage.
- The insurer also assigns a field executive who makes the claim process easy for the policy holders.
Reimbursement Claim Process
- When discharged, the policy holder should pay all the hospital bills and collect all original documents.
- The reimbursement claim form needs to be submitted to the claims team of the insurer or TPA along with all the required forms, hospital and medicine bills, medical and consultation reports and bills and any other document as required in original.
- The claim will be validated by the Insurer/TPA and then cleared as per the policy terms and conditions.
Documents Required to Claim family floater health insurance
- Insurance company's claim form, duly filled and signed by you.
- Discharge card.
- Written consultation from the doctor with receipts.
- Your hospital bills, which have to be stamped and signed by the hospital authorities.
- X-ray films and other test results such as blood test, urine test etc.
- Medicine bills.
- Other relevant documents relating to the cause of treatment.
Why is Family Health Insurance Necessary?
Fast-paced life, junk food on the go, pollution taking deeper roots across the country, unfortunate incidents, road accidents, contagious diseases, heart attacks and diabetes in young age, and many more things may result in any kind of medical emergency.
Are you prepared?:
Rising medical inflation can wipe off your lifetime's savings. You don't want that. Since, a medical emergency comes without any prior notice to anyone irrespective of age, gender, and location, it is better to have a health insurance plan. Take care of your loved ones - spouse, parents, and children and cover their medical cost with the help of a family health insurance plan.
Family Health Insurance Premium Calculator
The incorporation of the health insurance premium calculator by most of the health insurance providers on their official portal has digitalized the process of the health insurance premium calculation. Earlier it was unavoidable to make manual errors but today due to the availability of the family floater health insurance premium calculator, life has definitely become hassle-free and easier for insurance companies as well as for the people looking for health insurance.
A family health insurance premium calculator is easy to use. In order to use the simplified health insurance premium calculator page, you can follow the below-mentioned steps:
- All you need to do is select the family members you wish to include in your family floater health insurance policy
- Enter your gender and your area pin-code
- Then the system will prompt you to enter the age of the selected family members
- Enter your mobile number and your email address (optional)
- The different competitive quotes will reflect on your screen
Is There Any Waiting Period in a Family Health Insurance plan?
An Initial Waiting Period: This refers to the waiting period of 30 days but may vary from insurer to insurer and may have even 90 days of waiting period from the date of policy issuance. However, any medical expenses arising due to an accident will be covered from day one.
Check for Specific Waiting Period: Every family floater insurance provider specifies a list of specified illnesses for which any claim shall not be admissible during the first 1 or 2 years, which is called specific waiting period. For example, arthritis, benign ear, nose, and throat disorders, cataract, hernia, kidney stone, etc.
Pre-existing waiting period: If any of the family member insured under a family floater plan is suffering from any pre-existing diseases such as hypertension, diabetes, any heart ailments or any other ailment at the time of purchase of family health insurance plan is not covered for a specific time period. The treatment for a pre-existing disease is covered after the waiting period. The pre-existing waiting period may vary from 1 year to 4 years depending on the insurer. But, mostly the waiting period for pre-existing diseases under a family floater plan is 4 years.
Frequently Asked Questions
Q. How to buy new family floater health insurance Plan?
Ans: The best way to buy a family health insurance plan is to log onto Coverfox, compare all the available options, select the best plan and fill in the required details, select sum insured, pay the premium. Your policy conveniently arrives in your mail box. However, here are a few factors which you need to keep in mind when deciding on an insurance company.
Reputation: The company’s reputation plays an important role in deciding your investment. It is a good idea to go for a company with claim settlement ratio and a good brand image.
Quick Process for Claim Settlement: Consumers purchase insurance policies for their future emergencies and no doubt, you should be able to make claim on time.
Feedback from Customers: Before purchase, one must spot customer ratings and user opinions for the insurance company.
Q. How to renew family floater health insurance plan?
Ans: You can simply login to the insurer's website and fill in your family health insurance policy details, and pay the premium. Once the premium is paid, you will receive digitally copy of renewed family floater policy.
Q. What is the best health insurance plan for a middle-class family?
Ans: The best health insurance plans for a middle class family are
- Max Bupa Health companion individual Plan
- Royal Sundaram Health Lifeline supreme Plan
- Aditya Birla Health Diamond Plan
- Religare Health NCB super premium Plan
- Star Health Family Health Optima Plan
- ManipalCigna Health Prohealth Plus Plan
- Apollo Munich Health Optima Restore Plan
- HDFC ERGO Health Suraksha Gold Regain Plan
- Universal Sompo Health Privilege Plan
- Star Health Senior Citizen Red Carpet Plan
Q. Why Buy a New Family Health Plan online?
Ans:
- The best thing about purchasing a family plan online is that it gives the option to compare the charges of all the plans sold in market together with analysis opportunity of their policy features and benefits. Thus, online transactions ensure complete transparency in paying the right amount.
- Besides, an online Health Insurance Plan is always cheaper when compared to offline plans since the agent’s role is removed leading to the removal of commission payment. The insurer is able to save on the commission and administration charges and therefore, low premium is offered to the customers.
- Also, transations done online mean complete transparency of payment of the correct amount.
Q. Does family health insurance plans cover against OPD Treatment?
Ans: Most often under a health insurance plan treatment expense is covered for Day Care Treatments or in-patient hospitalisation which means that the policyholder needs to be hospitalised beyond one day. However, Certain Insurance companies have started to offer benefits for OPD treatments also such as Apollo Munich, ICICI Lombard, Bajaj Allianz and ManipalCigna.
Q. What Are Some Popular Individual Insurance Plans for Family?
Ans: Below are few plans offered on individual sum insured basis that can be taken into account.
Religare Care No Claim Super: With attractive features like 100% Recharge Benefit, No Claim Bonus unto 150% and a complementary annual health checkup, Religare's No Claim Super plan is definitely worth considering.
Apollo Munich Optima Restore: With the maximum individual sum insured of Rs.15 lakhs, Apollo Munich Optima Restore offers benefits like coverage of domiciliary treatment, pre-post hospitalization for 60 and 180 days respectively, Organ Donor and Restore Benefit.
L&T Medisure Classic: Strongly backed by a powerful brand like L&T, the Medisure Classic plan should be on your consideration list with features totally worth paying for. With maternity & new born cover along with hospital cash, ambulance charges and cover for Ayurvedic treatment, it also offers options like room rent waiver and double sum insured for critical illness at an additional premium.
Star Medi Classic: Automatic Restoration of Sum Insured and cover for non-allopathic treatments are just few of the many benefits offered by the plan. The premium pricing is also quite cost-effective in comparison to other plans offering similar benefits.
Q. How much is a family health insurance plan?
Ans: Different insurers provide family health plans at various quotes. It is advisable to check the exact price from the official website of the insurance company.
Q. How much does family health insurance cost per month?
Ans: The average cost of health insurance per family (4 members) comes up to Rs. 6000 to Rs. 8000 per month, and for an individual, it comes up to Rs. 2000 per month.
Q. What is the average cost of health insurance for a married couple?
Ans: The average cost of health insurance for a married couple stands at around Rs. 8,000 per year.
Q. Why is health insurance plan for family so expensive?
Ans: Since it covers more than one person and every family member has different requirements in terms of health and age, family health insurance is more expensive than regular health insurance.
