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Health insurance provides financial aid against the medical emergencies to the insured.
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.
Eligibility Criteria for Family Health Insurance Policy is as follows:
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.
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.
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.
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.
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:
Here is the list of few exclusions of a family floater health insurance plan
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.
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.
| 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
| 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
| 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
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
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.
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 |
| CIGNATTK | 46.29 | MAX BUPA | 50.19 |
| RELIGARE | 51.97 |
| STAR HEALTH | 61.76 |
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.
The claim process of Family Health Insurance can be understood as mentioned below.
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.
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.
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.
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.
How to buy new family floater health insurance Plan?
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.
How to renew family floater health insurance plan?
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.
Which health insurance plan covers the policy holder and dependents?
A family floater health insurance plan covers the policyholder and dependents like spouse, children and parents.
What is the best health insurance plan for a middle-class family?
The best health insurance plans for a middle class family are
How do group health insurance plan work?
Employer-backed health insurance is a policy chosen and bought by the employer and offered to eligible employees and their dependents. These are also called group plans. The employer will share or pay the entire amount of your premium. They work on the same lines of a normal health insurance or mediclaim plan, here you can either get yourself or covered members treated first and then raise a reimbursement request, or go for the cashless facility provided by the insurer.
Why Buy a New Family Health Plan online?
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.
What are the eligibility criteria for purchasing the Family Health insurance policy?
As a basic criterion, any person who is 18-65 years of age can become the primary policyholder., Lifelong renewal of health policy is provided by most insurance companies. The medical tests of the enrolling members are required after 45 years of age.
Do these health policies offer any tax exemptions?
Yes. The Section 80D of Income Tax Act, 1961 permits one to avail tax deductions on the premiums paid up to INR 25,000 for medical insurance of your family. This includes self, spouse and dependent children.
For instance, if there is a senior citizen without a health insurance and is dependent upon their children, then the person who pays premium will be allowed tax deduction of up to INR 50,000.
What is covered under the AYUSH Benefit?
AYUSH Benefit covers treatment under alternative treatments like Ayurveda, Unani, Sidha or Homeopathy. The expenses of these alternative treatments are covered up to the specified limit of the sum insured, mostly up to a percentage of the sum insured that ranges between 7% to 25% of the plan.
Does family health insurance plans cover against OPD Treatment?
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 Cigna TTK.
What are the benefits of a Health Card?
A Health Card is an ID card, that identifies the person insured by the health insurance plan. The health card supplements access to the hospitals. The health card tags along the policy document.
Benefit of health card:
Allows cashless treatment in network hospitals.
Makes you eligible to avail medical treatments in the network hospital without having paying any cash.
Is a family floater health insurance plan required for those who are already covered under the corporate coverage?
Yes. The insurance provided by the employer can become insufficient as the primary holder grows old with a bigger family, more dependents and increasing healthcare costs which will require reconsideration of employer provided health insurance coverage.
Can a hospital be changed during the treatment?
Yes. It’s feasible to shift to another hospital, if you need better medical procedure. This move is generally evaluated by the TPA on the basis of merits and policy regulations.
What Are Some Popular Individual Insurance Plans for Family?
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.
How much does family health insurance cost per month?
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.
How much is a family health insurance plan?
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.
What is the average cost of health insurance for a married couple?
The average cost of health insurance for a married couple stands at around Rs. 8,000 per year.
Why is health insurance plan for family so expensive?
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.
