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Medical expenses incurred towards the treatment of any ailment, surgery, hospitalization, etc. are covered under a health insurance plan. The cost borne may be reimbursed up to the eligible sum insured via the insurer by providing supportive documents or by using the cashless facility offered at the listed network hospital.
Family medical insurance plan is a type of health insurance plan (also referred to as family floater plan), which covers all the family members against medical expenses arising out of diseases and illnesses or accident. Health insurance plans for family covers your entire family at lowest possible premium. The premium depends on the sum insured, number of members included, age of the oldest family member.
| Covers family member: You can cover your family members which includes your spouse, children, parents, in fact, many family floater plans also allow the in-laws to be included in the plan. |
| Rebate on higher sum insured: Many insurers are also offering rebates on their health insurance plans on opting for a higher sum insured. |
| Increase in the sum insured: A family floater medical insurance plan comes with a no claim bonus feature, this feature increases the sum insured if there is no claim for the duration of the policy period. |
| Cashless claim settlement option: You can avail cashless facility at listed network hospitals. |
| Policy term: Health insurance plan for family also offers options in coverage term. You can choose 1, 2 or 3 years as a coverage term. |
| Save money: You can cover your whole family under a family floater insurance plan. You will save ample money as opposed to buying a single medical health insurance plan for every member. |
| Tax benefit: You can avail tax benefit on all the premiums towards a medical health insurance plan as per Section 80D of the Income Tax Act, 1961. |
| Restore exhausted coverage: Many family floater medical insurance plans offer special benefits referred to as restore benefit, which facilitates to reinstate full insurance for unrelated medical expenses as soon as the sum insured is exhausted during the policy period. |
| Medical umbrella for the whole family: You can cover the whole family underneath one umbrella plan (under a single health plan). |
| Easily add a new member: You can add kids or any other family member easily in the same family floater plan. |
| Best Health Insurance Plans for Family | Minimum Entry Age | Maximum Age | Renewability | Sum insured |
|---|---|---|---|---|
| Care Health Plan | 91 days | No Age Bar | Lifelong Renewability | NA |
| HDFC ERGO Optima Restore Family | 91 days | 65 years | Lifelong Renewability | NA |
| HDFC ERGO - my: Health Suraksha | Any age | Any age | Lifelong Renewability | Rs. 3 lakhs to Rs. 75 lakhs |
| Oriental Happy Family Floater Mediclaim Plan | NA | 65 years | Lifelong Renewability | Rs. 2 lakhs to Rs.20 lakhs |
| Bajaj Allianz Health Guard Family Floater Plan | 18 years | 65 years | Lifelong Renewability | 3 Lakh to 50 Lakh |
| Star Family Health Optima Plan | 18 years | 65 years | Lifelong Renewability | 1 Lakh to 25 Lakh |
| SBI General Retail Health Insurance | Age of 3 months | 18 years | Lifelong Renewability | 2 Lakh |
| United India Family Medicare Policy | 18 Years | 80 years | Lifelong Renewability | Rs. 2 lakhs to Rs. 10 lakhs | New India Family Floater Mediclaim Policy | 18 years | 65 years | Lifelong Renewability | Rs. 2 Lakh to 15 Lakh |
| National Insurance National Mediclaim Policy | 18 years | 65 years | Lifelong Renewability | Rs. 50,000 to Rs. 5 lakhs |
Eligibility Criteria for Family Health Insurance Policy is as follows:
Entry Age for the Policyholder/Proposer under Family Health Insurance: 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: 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.
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.
Here is the list of few exclusions of a family floater health insurance plan
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.
| Best Health Insurance Companies | Claim Ratio (%) |
|---|---|
| Aditya Birla Health Insurance | 59% |
| HDFC ERGO Health Insurance previously Apollo Munich Health Insurance | 63% |
| ManipalCigna Health Insurance | 62% | Max Bupa Health Insurance | 54% |
| Care Health Insurance (formerly Religare) | 55% |
| Star Health Insurance | 63% |
Documents Required to Buy Health Insurance Plans For Family
| 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.
The claim process of Family Health Insurance can be understood as mentioned below
| Cashless Claim Process | Reimbursement Claim Process |
|---|---|
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:
Is There Any Waiting Period in a Family Health Insurance?
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. 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.
