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.
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.
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 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)|
|Your Spouse||26||Rs.1 lakh|
|Your Dad||55||Rs.1 lakh|
|Your Mom||52||Rs.1 lakh|
|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|
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.
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.
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 family health insurance 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: Family health insurance plan 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.
What is Covered under a Family Health Insurance Plan?
Family health insurance 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.
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.