Honestly, just like you and your friend may not like the same cuisine of food, similarly a plan ideal for your friend may not be the best for you. It completely depends on your family and your individual requirements, financial needs and dependencies. Here are some points to help each one of you to choose the best plan for you:
Sum insured
In order to select the right sum insured value for your family, consider your family size. Choose a sum insured such that even if more than one family member is hospitalized there is some amount of sum insured left for other members too
Risk factors
Having a medical history of heart attack, medical history of gestational diabetes, chain smoking habit, etc. which are likely to increase health expenses too, are considered as risk factors while determining the premium. Presence any of these factors in even one of your family members covered under the floater will increase your premium (also known as premium loading*). Also, there are possibilities that the person with such risk factors will use up a larger part of sum insured in a policy year with little or no amount left for others in the floater.
Thus, it is advisable to buy a floater for individuals with no such risk factor and an individual policy for individuals with such risks.
In a family of 4 members A, B, C and D family member A has a history of heart attack then, there would be premium loading or increase in the premium cost. Besides affecting waiting periods on certain diseases for all the members there would remain a high possibility that the member A uses up the maximum sum insured value. Thus, it is advisable to cover A in a separate individual plan.
Premium loading is the increase in the premium value on account of the condition that the individual covered in the floater has pre-existing health condition or history of some serious illness.
Age
Older individuals are usually considered to be at higher risk for illnesses when compared to younger individuals. So, when you choose a family floater plan involving much older individual (above age 60 years) compared to other members (up to age 35 years) then there are possibilities that a larger part of sum insured would be used up by this elder member. Thus, it is advisable to buy a separate plan for this member. However, all the other members in a similar, younger age group should be covered in the floater plan.
Example: In a family of 4 members is covered under a floater where:
- A is 12 years old
- B is 10 years old
- C is 60 years old
- D is 35 years old
There is a high possibility that member C who is 60 years old will use up the entire sum insured in a policy year. Thus, buy a separate individual policy for C and a floater plan for the rest of the family.
Policy Terms
Some of the important policy terms that should be considered in a family floater plan are:
Network hospital list
All the health insurance companies are associated with certain hospitals where they offer cashless treatment. These are known as network hospitals.
Thus, while you look out a health insurance plan, check if the network hospital list of the company includes name of your preferred hospital.
Cashless treatment is when the insurance company settles all the hospital bills directly by coordinating with the hospital so you don’t have to pay anything at the time of treatment.
Co-payment
Co-payment or co-pay is the percentage of claimable hospital expenses you have to pay out of your pocket. Although, this option lowers the premium amount, it is advisable to avoid it if you do not want to make higher out-of-pocket expenses during each claim.
Consider if you have a plan with sum insured Rs. 1,00,000 and 10% co-pay. Your claimable hospital expenses are Rs. 1,00,000 then you have to pay Rs. 10,000 only after which your expenses would be covered up to sum insured. A co-pay option does not reduce your coverage amount.
Deductible
Some plans have an agreed deductible value which is nothing but fixed amount that you have to pay out of your pocket before claiming for insurance. These plans with deductible are also known as top-up plans as you can opt for these plans in addition to your regular health plan. The premium amount for these plans is very low.
Since, more than one member is covered under a family floater, the chances of sum insured getting exhausted are higher thus top-up plans provide extra security to your family.
Additional information on top-up plans: The top-up plans have two variants a regular top-up and a super top-up. The only difference between the two is the threshold value or compulsory deductible. This value states the amount above which the top-up plan would be activated.
In a regular top-up plan you have to exhaust the deductible value in a single hospitalization. However, with a super top-up plan you can exhaust the deductible value in multiple installments.
If an individual has health insurance family floater plan of Rs. 2,00,000 he can additionally have a top up plan of Rs. 4,00,000 with deductible Rs. 2,00,000. After the family floater of Rs. 2,00,000 is exhausted one can use the top-up plan to overcome the expenses.
Room Expenses
Some of the plans have defined limit (also known as capping amount) up to which your room rent per day would be covered while some others companies define the room type for which your expenses would be covered. Both these plans are considered to have room expense limit. If you opt for a plan that limits your room expense, and by some chance if you exceed those limits then, you have to pay for this exceeded amount from your own pocket.
Once your plan has a room expense limit then even if your claim amount does not exceed the sum assured, you still have to bear additional exceeded room cost. This exceed cost will not just be the room rent but also the additional doctor fees, nurse expenses, etc. which increases with the increase in room expense.
In the course of treatment there is a possibility that you exceed the room expense limit due to unavoidable circumstances such as non availability of rooms within your room limit. To understand this better please refer to this link.
It is advisable to avoid plans with limit on room expenses.
Example of a plan with limit on room expenses:
Example 1: You opt for a plan which states room expenses for only general ward will be paid and following are the charges:
| Room type | General ward | Private |
|---|
| Room charges (INR) | 1,000 | 2,500 |
| Heart surgery (INR) | 60,000 | 1,00,000 |
Consider that you opt for this plan which pays only for general ward. Then, if you opt for treatment in shared ward which has higher expenses then, the difference in expenses is something that you will have to pay out of your pocket. So, precisely you will have to pay Rs. 1,500 (exceeded room rent) and Rs. 40,000 (exceeded surgeries charges because of room change).
Example 2: Your policy states room rent limit of Rs. 3,000 for sum insured of Rs. 3,00,000 and following are the charges:
| Room type | General Ward | Shared | Private Deluxe |
|---|
| Room charges (INR) | 1000 | 2500 | 4000 |
| Heart surgery cost (INR) | 60,000 | 1,25,000 | 2,00,000 |
Consider that you opt for treatment in a private deluxe room with room rent on Rs. 4,000. Then, the difference in expenses is something that you will have to pay out of your pocket. So, precisely you will have to pay Rs. 1,000 (exceeded room rent) and Rs. 75,000 (exceeded surgeries charges because of room change).
Rewards/Bonus policy on renewal
Some companies reward you for no-claim by offering a no-claim bonus for a particular year. This bonus is percentage increase in sum insured value at renewal. With conditions such as you should not change the type of policy.
After claim, this bonus amount reduces to basic which is your original sum insured. Please refer to the policy document for the details of these values for your policy.
Some companies also offer a discount on the premium amount that you need to pay during renewal. In this case too after claiming for a particular year the discount offered would not be valid. Please refer to the policy document for the details of these values for your policy.
It is better to have at least one of these rewarding features on no-claim.
If you have a floater plan of Rs. 3,00,000 with no-claim bonus of 5% then at renewal your sum insured value increases to Rs. 3,15,000. However, after claim the sum insured will reduce to basic of Rs. 3,00,000.
The premium discount also works on similar lines.
Restore Benefit
This benefit ensures that after entire sum insured is exhausted, the basic sum insured (does not include the bonus unless specified in the policy document) is automatically restored for re-utilization.
Since, all the members of the family have shared sum insured value it is advisable to have plans with restore benefit. Please refer to the policy document for the details of these values for your policy.
Consider family members A, B and C are covered under a family floater with restore benefit and the entire sum insured is utilized by member C for hospitalization against malaria. Then, in this case, the sum insured will be restored to basic.
Condition: This restored amount will be available only for member A and member B. However, C would be covered for any condition other than malaria.
Please wait... 
