What is Family Health Insurance Plan?

The old adage ‘health is wealth’ rings true today more than ever. With the cost of medical treatment escalating regularly, you need a health insurance to ensure the best treatment options are available, should a family member fall ill. A health insurance plan can cover consultation fees, medical tests, hospitalization as well as cost of surgeries. Instead of opting for an individual plan for each member, insurance companies today offer ‘family health insurance plans’.

Also referred to as the family floater insurance, the plan covers you, your spouse and up to four children. Some insurance providers also cover dependent parents or extended family members at an additional cost. In case of an illness, the cost is reimbursed by the health insurance provider or you can seek treatment at one of the partner hospitals and get cashless treatment facility. Here, the hospital sends the bill directly to the insurance company and only marginal out-of-the-pocket expenses are incurred.

There are many general insurance providers that offer different types of attractive family health insurance plans.

Types of Family Health Insurance Plan

There are primarily two types of family health insurance plans. While these types can vary in coverage based on the insurance company, the basic tenet of these policies are the same across different providers.

The two categories of family floater insurance are as follows:

Medical Insurance: You will get reimbursed for hospitalization or enjoy cashless treatment in a partner hospital. The sum insured is decided by taking into consideration your family’s healthcare needs. The coverage amount can be used by just one person or spread across all the family members. The point to remember is that – when you file a claim, the amount is deducted from the sum insured. As a result, the coverage amount reduces for the remaining time-period.

• Critical Illness Insurance: This type of health insurance plan covers chronic diseases like respiratory failure, heart attack, stroke, and kidney failure. Usually, the sum insured is disbursed as a lump-sum payment. The main point to note here is that it may not cover all members of a. You will have to take out the plan separately for each family member.

List of Best Family Health Insurance Plan offered by Top Insurers

There are many different general health insurance companies that offer a range of family health insurance plans. Some of the best plans that the most sought-after insurers offer are as follows:

Bajaj Allianz Health Insurance

Name of Insurance: Family Floater Health Guard

Age: Covers adults from the age of 18 to 65 years, and dependent children from the age of 3 months to 25 years

Sum Assured: Minimum amount INR2 Lakh and maximum amount INR10 Lakh if you buy the insurance before the age of 55 years. Otherwise the maximum amount reduces to INR5 Lakh if you are over 55 years.

Pre and Post Hospitalization: The plan covers pre-hospitalization for 60 days and post hospitalization for 90 days.

Pre-existing Diseases: The family health insurance plan covers pre-existing diseases, but after a waiting period of 48 months


Star Health Insurance

Name of Insurance: Family Health Optima Insurance Plan

Age: Covers adults from the age of 18 to 65 years. It offers lifelong renewability after the age of 65. Dependent children are provided coverage after the 15th day.

Sum Assured: Minimum amount is INR1 Lakh and the maximum is INR 15 Lakh

Pre and Post Hospitalization: The plan covers pre-hospitalization for 30 days and post-hospitalization for 90 days, but with a caveat. It covers 7% of the expenses post-hospitalization to a maximum of INR5,000.

Pre-existing Diseases: Pre-existing diseases are covered after a waiting period of 48 months.


National Insurance Company

Name of Insurance: National Insurance Mediclaim Policy

Age: Covers adults aged 18 to 65 years and dependent children from 3 months to 25 years. The plan comes with renewability up to the age of 65 years.

Sum Assured: Minimum amount is INR50,000 thousand and maximum amount is INR5 Lakh

Pre and Post Hospitalization: Pre-hospitalization is covered for 30 days while post-hospitalization is covered for 60 days.

Pre-existing Diseases: People with pre-existing diseases have a waiting period of 48 months.


New India Assurance              

Name of Insurance: Family Floater Mediclaim Policy

Age: The plan provides coverage to adults between the ages of 18 and 65 years; dependent children are covered from 3 months to 18 years. The plan comes with lifelong renewability.

Sum Assured: The minimum coverage amount is INR2 Lakh while the maximum is INR5 Lakh.

Pre and Post Hospitalization: Pre-hospitalization is covered for 30 days and post-hospitalization for 60 days.

Pre-existing Diseases: It has a waiting period of 48 months for pre-existing diseases.


United India Health Insurance

Name of Insurance: Family Medicare Policy

Age: It covers adults from the age of 18 years to 80 years. Dependent children are covered from 3 months of age to 18 years. The policy has lifelong renewability.

Sum Assured: Minimum coverage amount is INR1 Lakh and maximum is INR10 Lakh

Pre and Post Hospitalization: Pre-hospitalization is covered for 30 days and post-hospitalization for 60 days, and to a maximum of 10% of the sum insured.

Pre-existing Diseases: There is a waiting period of 48 months, if you keep renewing the insurance policy with the company.

Advantages of Family Floater Mediclaim Policy

It is important you understand the benefits of family floater mediclaim policy to decide.

Some of the advantages of the family health insurance plan are as follows:

  • Savings: You can cover the entire family with a single health insurance plan. This costs less than buying separate plans for each family member.
  • Tax Benefits: You can avail tax deducts for the premium you pay under Section 80D of the Indian Income Tax Act.
  • Restore Benefits: In case the entire coverage amount is used, approach your health insurance provider to restore the benefits. These benefits can be used just for unrelated claims.
  • Hassle-free: A family floater plan saves you the hassle of managing and tracking renewals or premiums for multiple health insurance policies. The paperwork is also reduced with a single policy.
  • Discounts: Most insurers offer discounts and incentives with their family plans. You can avail these with ease. This helps to bring down the cost of the insurance plan.
  • Easy to Add New Members: If your family expands, you can easily add a new born child or a retired parent to your family health insurance plan. There is no need to worry about taking out a new or fresh policy.
  • Include Parents and In-Laws: Family plans can be extended to include your parents or your spouse’s parents. However, additional charges may be applicable.
  • Long-Term Cover: It is common for insurers to offer continuous coverage for a period of 2 years without any increase in the premium amount.

Features of Family Floater Mediclaim Policy

The plan can be a deciding factor for the treatment you can seek when the need arises. Knowing the features can help in choosing the best one.

Here are some of the features of a family health insurance plan:

  • You can cover your spouse, minor children, elderly parents, and parents-in-law.
  • Wide range of policy terms, right from 1 year to 3 years. Choose a term that you find most suitable.
  • If you have a no claim year, you can add the no claim bonus to your sum insured. This increases the amount of coverage.
  • If you get treated at one of the partner hospitals, you can enjoy cashless claim settlement. Filing the paperwork is done on your behalf by the nominated hospital.
  • Many insurers offer rebates on high sum insured and you can take advantage of it.
  • The basic coverage is the same for most family floater plans. This includes pre- and post-hospitalization, day care treatment, ambulance cost and in-patient hospitalization. However, many insurers offer attractive features like organ donor expenses, maternity expenses, and new born cover under a family insurance plan.

Exclusions of a Family Health Insurance Policy

Before you buy a family health insurance policy, it is important to read the fine print to know expenses covered or not covered by the plan. It is important to understand about the waiting period, pre-existing diseases, and cashless treatment facility.

Some of the common exclusions in a family floater insurance are as follows:

  • Claim made within 30 days of the waiting period. Only if the claim is related to an accident will it be covered
  • Treatment for fertility issues, STDs or expenses incurred for routine medical check up
  • Surgery to undergo gender change
  • Opting for life support in circumstances when the state of health cannot be improved
  • Cosmetic or plastic surgery for aesthetic reasons
  • Outpatient department treatment
  • Treatment carried out overseas
  • Treatment for mental illness, stress or addiction to stimulants and depressants
  • Injury or illness due to alcohol, drugs, self-infliction, and tobacco
  • Voluntary termination of pregnancy unless it is ectopic pregnancy

Eligibility Criteria for Family Health Insurance Plan

Some of the eligibility criteria for family health insurance plan are as follows:

• Entry Age: Most insurers stipulate an entry age, which basically means the age of the policy holder. The entry age for adults is from 18 years to 65 years. The upper limit of the age can be relaxed in some policies. For children, the entry age begins from 3 months of age until 25 years of age. The lower limit for the entry age can vary from insurer to insurer.

• Medical Test: Some insurance providers may stipulate a medical test for all family members covered by the policy. This test is carried out at designated medical centres. There are a few insurers that may not opt for medical test until the insured reach a particular age.

• Renewal of Family Health Insurance: Most insurance providers offer lifelong renewal. It goes without saying that the family health insurance plan must be renewed before it expires. Even after expiration of the policy, most companies give a grace period of about 30 days to complete the renewal process. If the policy is not renewed during this period, it lapses. You will then need to buy a new policy.

How to Buy a Best Family Health Insurance Plan

If you already have a health insurance plan, speak to your health insurance provider about family health insurance. Find out the inclusions, exclusions, sum insured, claim settlement process and partner hospital network.

Now go online and compare different family health plans and the one offered by your insurance provider. Based on your comparison and budget, you will be able to find a plan that best fits into your budget. However, it is important not to use the premium as a selection criterion. Make sure the plan offers adequate coverage for emergency medical treatment or diseases you are pre-disposed to. Insufficient coverage means out-of-pocket expense and dipping into your life savings.

Claim Process of Family Health Insurance Policy

A family health insurance policy offers two types of claim processes. One is cashless settlement and the other reimbursement of expenses.

  • Cashless Settlement: In cashless treatment, you must provide the hospital with your health insurance plan details for verification. If the ailment, illness, or surgery is covered by the insurance, the insurer will pay for the costs associated with the treatment. The hospital will send the bills and relevant documents directly to the insurance provider, who will settle the claim after due diligence.
  • Planned Treatment: In case, a treatment plan is scheduled, inform your insurance provider a minimum of four days prior to the treatment to enjoy cashless treatment. Fill out forms and submit it to the insurance company, which will then give the go-ahead to the hospital that the payment for the treatment will be borne by them. You will need to present a confirmation letter to the hospital at the time of admittance, which will state that the bills and documentation are to be sent to the insurance company for settlement.
  • Emergency Treatment: For an emergency treatment available at one of the impanelled hospitals, you can avail cashless emergency treatment. Visit the hospital and present your insurance card. The hospital will create the necessary documentation and send it to the insurance company. Here too, the bills are sent directly to the insurance provider, who will settle any amount based on the sum insured. If the amount is more than the sum insured, you will have to pay the difference.
  • Reimbursement: Sometimes, you or a loved one cannot get treated at one of the partner hospitals. Under such circumstances, cashless treatment and hospitalization cannot be availed. In such cases, pay the hospital dues and present the original bills to the insurance company. After checking the bills, the insurer will decide whether to accept or deny your claim. If your claim is accepted, you will be reimbursed for the treatment.

Documents Required for Health Insurance Claim Reimbursement

If you are claiming reimbursement from your health insurance company, a few documents are to be submitted along with a duly filled out reimbursement claim form. The documents required are as follows:

  • Original medical certificate by the doctor treating the patient
  • Original discharge certificate issued by the treating hospital
  • Original receipts and bills
  • Prescriptions issued by the hospital
  • Cash memos for medications purchased from the pharmacy
  • Tests and investigation reports
  • If you are availing treatment due to an accident, the FIR registered by the police or Medico Legal Certificate
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