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Family Health Insurance Plan Research Team | Posted On Saturday, August 04,2018, 06:58 PM

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Family Health Insurance Plan



A family floater health insurance plan is a health insurance plan which offers insurance coverage to an entire family. It covers an entire family from unexpected medical expenses. It is also called a family floater mediclaim policy.

A family floater health insurance plan saves a lot of money, time and hassles as against multiple individual health insurance plans for the family. The best family floater health insurance plans in India cover the policyholder, spouse and dependent children. However, few insurers cover policyholder’s dependent siblings, parents and parents-in-law.

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Family Health Insurance Plan

As the sum assured in a family floater health insurance plan India is shared among all the insured family members, it should be sufficient for all the members of the family.

Key features of family floater health insurance plans:

  • There is a sub-limit on the room rent.
  • A family floater may also be subject to a co-pay clause. You pay a part of the hospitalization expenses and the insurer pays the rest. These include deductibles and co-pay. These plans usually have lower premiums.
  • Most insurers seek medical examination for members aged 45 and above.
  • Family floater health plans have a free look period of 15 days. They can even be ported.
  • Family floater plans allow addition and deletion of members to the policy.
  • A family floater should be renewed each year. If you fail to renew the policy before the due date, the policy gets terminated.

Eligibility criteria for Family Health Insurance Plans:

  1. Entry age for the policyholder or proposer: In a family floater health insurance plan, the eldest person becomes the main holder of the plan. Such a person should be aged between 18 to 65 years. Some insurers allow the maximum age to be 70 years and above.
  2. Entry age for other family members: The minimum entry age for adults is 18 years and the maximum is 65 or 70 years (depending on the insurer). The minimum age for dependent children to enter a family health insurance plan in India is 90 days (or 30 days, depending on insurer) and the maximum is 25 years.
  3. Medical tests: Some insurers may ask the insured to undergo a medical test at nominated centers. Usually, members aged 45 and above are required to take medical tests.

Advantages of a family floater health insurance plan:

  1. By covering your entire family with a single family floater insurance plan, you save a lot of money.
  2. The policyholder of a family floater health insurance plan can avail tax benefits on the premiums paid under Section 80D.
  3. Most family health insurance plans offer an option called as restore benefit. With this option, you can reinstate or refill the sum assured after it is exhausted during the policy period.
  4. You can easily add new members like your children or any other family member to the same family floater plan.
  5. A family floater plan continues to exist with all benefits even if a member is deleted from the insurance plan.

SEE ALSO: Why Should Retirement Planning Be On Your Priority List?

Inclusions in a Family Health Insurance Plan:

  1. In-patient hospitalization: Medical expenses are covered if the insured is hospitalized for more than 24 hours.
  2. Pre-hospitalization expenses: Medical expenses incurred before hospitalization like X-ray, MRI, blood test, urine tests, and so on are covered.
  3. Post-hospitalization: Medical expenses incurred after the discharge from the hospital like medicines, medical test, follow-ups are covered.
  4. Hospital daily cash: If you opt for hospital daily cash benefit, the insurer provides a daily cash allowance to meet the hospital expenses like transportation costs, attendant’s cost and so on.
  5. Daycare: Daycare treatments are those treatments which don’t require 24 hours of hospitalization. Example: Cataract, dental surgeries, and so on.

Note: Inclusions vary from insurer to insurer. Read the policy documents to know what is included in your policy.

SEE ALSO: Tips To Port Health Insurance Plan

Exclusions of a Family Health Insurance plan:

  1. Hospitalization expenses arising within 30 days of availing a best health insurance policies in India is are not covered unless it arises due to an accident.
  2. Sexually transmitted diseases like HIV/AIDS are not covered.
  3. Fertility issues are not covered.
  4. Plastic surgeries and treatment or gender change is not covered.
  5. Treatment of mental illness or psychological disorders are not covered.
  6. OPD treatments are not covered unless expressly mentioned in the policy document.
  7. Treatment of illness due to consumption or abuse of tobacco, drugs and alcohol are not covered.
  8. Self-inflicted injury, suicide or attempted suicides are not covered.

SEE ALSO: Exclusions of Health Insurance Policy

Types of health plan

Health insurance is a type of insurance cover that pays for medical and surgical expenses incurred by the insured. An individual having a health insurance policy would be reimbursed the hospitalization expenses, or the insurer would settle medical bills directly with the hospital through cashless plans. There are three types of health insurance plans that you can choose from. They are as follows:

  • Individual health insurance plan: this health insurance policy covers the medical expenses for the policy holder in case of hospitalization. This policy covers a single individual and the premium amount depends on the sum assured.
  • Family floater policy: a family floater health insurance policy is similar to an individual health insurance policy. The difference is that the insured amount can be used by any of the insured family members. These plans usually cover the individual, spouse and children.
  • Unit linked health plans:  Many health insurance companies have introduced Unit Linked Health Plans. In such plans, you get health insurance along with an investment component. 
    Returns in such ULIPs depend on market performance. In India, such plans are quite new and are still in the development phase.

SEE ALSO: Low Cost Health Insurance in India

How to choose a family floater health insurance plan?

An ideal family floater mediclaim policy should have the following features:

  • Maximum renewability: Most insurers offer the policy renewability option till the fage of 60 to 65. Some health insurers also offer lifelong renewability.
  • Sum insured: In India, medical inflation is rising at 20% each year. Most health insurance companies allow the insured to increase the sum assured to cover rising medical costs. Also, some insurers offer a No-Claim Bonus (NCB) to the insured if they don’t make any claims in the previous year. NCB is in the form of an increase in the sum insured.
  • Cashless facility: The insurer settles your hospitalization bills directly with the hospital. In this case, you must be hospitalized only at a network hospital. The claim settlement is fast. Make sure the network hospitals are good.
  • Addition of members: What if you plan on having a baby? An ideal family floater plan should offer an option to opt for maternity and newborn baby cover.
  • Pre-existing conditions: Covers maximum pre-existing conditions.
  • Critical illness rider: Have an option of availing a critical illness rider.

Is a Family Health Plan better than an Individual Health Plan?

Health insurance plans in India must always be availed based on the individual needs of the policy buyer. Both the plans i.e. family health insurance plan and individual health insurance plans, work differently and sometimes choosing between the two is quite difficult. The family floater health insurance plan provides insurance for more than one member of the family. Under the family floater plan, the sum insured can be availed by one or all the family members. While an individual health plan covers only one person and can be bought separately for each member of the family, a family floater covers the entire family.

The family health insurance plans provide better cover at low cost vis-a-vis multiple individual health insurance plans. But, in case a family member suffers from a critical illness or has a chronic health condition, then buying an individual health insurance cover can take care of long term medical expenses.

How to buy a New Family Health Plan?

A family floater health insurance plan allows several members of a family to be covered under a single plan. A family of 4 members can easily fit in a family health insurance plan as the annual premium of this policy is lower than that of the combined premiums payable on individual health plans. To buy a family floater health insurance plan, you can go online and carefully evaluate the different family health insurance plans  in India and choose the one that best fits your budget. To buy family health insurance plans online, follow the steps given below:

  • Visit the web portal of any online insurance provider.
  • Compare the different types of health insurance plans available in the market.
  • Compare the network hospitals provided by the insurer.
  • Compare the benefits provided by various health insurance plans.
  • Carefully evaluate the inclusions and exclusions of the health insurance policy.
  • Choose the plan that is best suited to your family needs

Is it beneficial to buy an online health insurance plan?

You can select the best insurance product for your family without being pressurised to buy any particular product. You can also compare and evaluate the different policies online. These aggregators offer an online platform, where the buyer can find complete details on the product along with customer reviews and ratings on the insurance policy. Therefore, the policy buyer can make a better choice through recommendations and informed dealings. 

10 Hidden Benefits in Health Insurance Policies

If you are under the impression that a Health Insurance Policy only covers hospitalization expenses, then you are not entirely right. The best health insurance policies pay for more than just hospitalization.

Health Insurance Policies have various hidden benefits which remain unutilized by policyholders. Some of these benefits come free of cost as value-added benefits, while some might have additional costs.

Let check out the 10 hidden benefits in health insurance policies:

1. Recovery benefits:

Apart from hospitalization benefits, health insurance policies also offer recovery benefits. The insurer takes care of your recovery expenses. Recovery benefit is also called convalescence benefit or recuperating benefits. Recovery benefit covers additional costs like loss of income arising from hospitalization and so on. In case of prolonged hospitalization ranging from 7 to 10 days, the insurer pays a lump sum. Some policies also cover associated costs like compassionate visits by family members.

2. Alternative treatment:

Insurers did not cover alternative treatment in the past. But with rising popularity of alternative treatment like Ayurveda, Homeopathy, Unani and so on, many insurance companies now cover alternative treatments. However, coverage of alternative treatment methods are capped at a pre-decided percentage of the sum assured. Also, only alternative treatment in government hospitals or at institutes recognized by Quality Council of India and National Accreditation Board on Health are covered.

3. Expenses related to organ donors:

An organ transplantation can cost Lakhs of rupees. A kidney transplant can cost around Rs 3 Lakhs to Rs 5 Lakhs. Most health insurance policies cover surgery costs of the organ transplantation, as part of regular health insurance plans. The insurer may either reimburse the entire cost or they may cap expenses. Some insurers may offer to cover organ transplants as an add-on benefit. It is important to note that insurers only cover the surgery costs for organ harvesting or organ procurement. Donor’s hospitalization costs, post-surgical complications costs and screening costs are not covered.

4. Domiciliary treatment:

Insurers have been adding a number of additional features to basic health insurance policies. One such additional feature is coverage of domiciliary treatment. Many insurers now offer to cover treatment taken at home under medical supervision. Nevertheless, insurers have put a cap on such expenses and the number of days for which the benefit is offered.

5. Attendant allowance:

Insurers nowadays cover attendant allowances. The conditions are:

  • The insured must be a child
  • The attendant must be an adult

This add-on benefit comes with a cap on the number of days for which the attendant allowance is fixed.

SEE ALSO: 4 Insurance Plans You Must Have

6. Daily hospital cash allowance:

Hospitalization comes with additional financial needs like expenses on food and travel. These expenses are not covered by the basic health insurance policy. However, some of the best health insurance policies offer daily cash benefit up to a pre-decided amount per day. The amount increases in the case of ICU and hospitalization for accidents.

7. Free health checkup:

Health checkups can cost thousands of rupees. So, insurers offer free periodic health checkups to you after every 4 or 5 claim-free years. This is mainly to reward you for not making any claims on the policy. It also encourages you to take extra care of your health. If you avail health checkups at network or empanelled hospitals or centers, some insurers offer cashless health checkups.

8. Dental treatment:

Some insurers offer to cover dental treatment. However, dental treatment cover comes with sub-limits. Also, such cover is subject to a waiting period, which differs from insurer to insurer.

9. Weight loss surgeries:

Obesity and related health problems are increasing at an alarming rate. Obese people battle with medical conditions related to being overweight. Weight loss surgeries or bariatric surgeries are a solution to their woes. Weight loss surgeries were previously cosidered as a cosmetic weight loss procedure. However, now these surgeries are considered a life-saving technique for obese patients. Many insurers cover bariatric surgeries if done for medical purposes.

10. Wellness programs:

Health insurers today offer wellness benefits as a reward for maintaining a healthy lifestyle. This is a value-added benefit to your basic health plan and comes at no additional cost. Wellness benefits under health insurance policies are offered through wellness programs.

Now that you are aware of these hidden benefits of a health insurance plan, do ask your insurer if they offer any of these benefits. Do not hesitate to opt for these benefits, even if they come with additional costs. Make the best use of the value added benefits which come free of cost. Make sure you speak to the insurer and clear all your doubts before signing on the dotted lines.

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