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Family Health Insurance

A family health insurance plan or family floater offers coverage for complete family against any medical emergency. Most family mediclaim policies cover two adults and up to four dependent children. An insured can avail such insurance plans for a fixed sum assured against one annual premium.

Family comes first – ALWAYS, and to protect loved ones against any medical emergencies and thus provide smooth treatment are topmost responsibilities of an individual. Since medical costs are increasing day by day and in such situation spending from pocket in case of health issues may result in financial crisis. In order to avoid such situations, it is recommended to have family health plan that covers more than one family member.

Most of these plans also give option to include parents in the existing policy of the insured. In addition to that, some plans as well allow including the in-laws of the insured in the same plan by paying additional premium.

Key Features of Family Health Insurance Plan

The hectic lifestyle and day to day stress are causing health issues in majority of the population of India at an early age. Apart from this, with advancement of medical facilities, the cost of medical treatments is also rising day by day. To avoid a medical emergency from becoming financial crisis, it is advised to have medical insurance plan. Moreover, to protect entire family against any medical or health emergency, it is wise to take health insurance for entire family as well.

Enlisted are the key features of a family floater health insurance plan:

  • Cashless Treatment: All the insured members of the family can avail the benefit of cashless treatment in any of the network hospitals of the insurance provider. This saves the family and friends of the person who is admitted in the hospital from the stress of arranging money for treatment.
  • Pre and Post-Hospitalization: Under this feature your family are eligible to take the benefits of pre and post hospitalization for a month or 60 days depending upon the policy. However, the insured is reimbursed after submitting the bills of all the expenditure.
  • Co-Payments: Some policies offer the feature of co-payments wherein the policyholder pays a part of the expenses incurred and the insurer pays the rest. The premium, in this case, is usually low as the insured pays a percentage of the cost of hospitalization.
  • Flexibility in Sum Assured: If the insured wants he/she can extend the sum assured for covering more family members if the requirement arises. Additionally, the insured can zero in or lower the sum assured according to the need.
  • Room Rent: Some of plans as well include rent of the hospital room up to a certain limit during hospitalization.

Best Family Health Insurance Plans in India

There are various insurance providers that offer family health plans to their clients. An individual can choose a plan after comparing different policies of this category online with the help of an insurance web aggregator. For reference, we are providing a list of best health insurance plans for family in India. From this list one can compare different policies and select the most suitable:

Health Insurers Family Health Plan Incurred Claim Ratio (%)
2016-17
Entry Age Sum Assured Maximum No of Covered Members Waiting Period
Religare Health Insurance Care Plan 51 Min: Children 3 months, Adults 18 years

Max: No limit (Lifelong renewability)

Min: Rs. 3 Lakh

Max: Rs. 60 Lakh

6
  • Pre-existing medical conditions: 4 years
  • Policy-specified diseases: 2 years
Apollo Munich Health Insurance Optima Restore Family Plan 55 Min: Children- 5 years, Adults-18 years

Max: 65 years (Lifelong renewability)

Min: Rs. 3 Lakh

Max: Rs. 50 Lakh

6
  • Pre-existing medical conditions: 3 years
Star Health Insurance Family Health Optima Plan 61 Min: Children-16 days, Adults-18 years

Max: 65 years (Lifelong renewability)

Min: Rs. 2 Lakh

Max: Rs. 15 Lakh

5
  • Pre-existing medical conditions: 4 years
  • Policy-specified disease- 2 years
Max BUPA Health Insurance Health Companion Plan 52 Min: Children-3 years, Adults-18 years

Max: No limit (Lifelong Renewability)

Min: Rs. 3 Lakh

Max: Rs. 1 crore

6 (4 adults + 2 children)
  • Pre-existing medical conditions: 4 years
  • Policy-specified disease: 2-3 years
HDFC Health Insurance Health Suraksha Plan 41 Min: Children- 3 years, Adults – 18 years

Max: No limit (Lifelong renewability)

Min: Rs. 2 Lakh

Max: Rs. 7.5 Lakh

4
  • Pre-existing medical conditions: 4 years
Bajaj Allianz Health Insurance Family Floater Health Guard Plan 73.59 Min: Children – 3 months, Adults – 18 years

Max: Children – 25, Adult – 65 years

(Life renewable option)

Min: Rs. 2 Lakh

Max: Rs. Rs. 10 Lakh

6
  • Pre-existing medical conditions: 28 months
Oriental Health Insurance Happy Family Floater Plan 114 Min: Children – 3 months, Adults – 18 years

Max: Children – 25 years, Adults – 55 years

Min: Rs. 1 Lakh

Max: Rs. 10 Lakh

8 (6 adults + 2 children)
  • Pre-existing medical conditions: 28 months
SBI Health Insurance SBI Life

Smart Plan

54.41 Min: Children – 3 months, Adults – 18 years

Max: Children – 22 years, Adults – 65 years

Min: Rs. 1 Lakh

Max: Rs. 5 Lakh

6
  • Pre-existing medical conditions: 28 months

Types of Health Insurance Plans for Family in India

As its name suggests, a family health care policy provides coverage against any medical emergency to the insured family as per the terms of the policy. As per the type of health care services offered, a health insurance policy can be divided into two major categories, mentioned below:

  • Critical Illness Insurance: To cover chronic disease such as kidney failure, heart stroke, etc. in a health insurance policy, this type is included. As per the terms of the insurance policy, an insured either gets entire sum assured from the insurance company or as lump-sum. However, a critical illness policy cannot be bought as a single insurance plan for the complete family.
  • Medical Insurance: Provides coverage against expenses incurred in mentioned medical care or specified healthcare treatment. Most of the mediclaim policy for family cover hospitalization expenses and an insured can take this benefit either in the form of cashless facility or as reimbursement.

How a Family Health Insurance Works in India?

Instead of taking individual health insurance policies for each member of the family, it is wise to take a plan that covers the entire family. For instance, if an insured has to pay only one premium to cover him/herself, spouse, and dependent children (up to four children in some policies) for a health insurance policy, then it is definitely better option than paying multiple premiums.

The entire sum assured of the family floater plan can be availed either by one or all the members of the family. Therefore, it is not restricted to one person like individual health insurance policy. Generally, family floater health insurance policy takes the benefit of the fact that there is very low possibility of all the family members falling ill in same year or at the same time.

Any individual who wants to cover his/her family including self, wife/husband, children (under 25 years or unmarried, divorced, or widowed daughter), and parents who are dependent. It is always better to take a health insurance plan that provides coverage of Rs.8 Lakhs to each person of the family who are covered instead buying individual plans for each family member that offers covers of Rs.2 Lakh for every individual.

What is the Requirement of Family Health Insurance?

Ill health and accidents can happen to anyone anytime, therefore to protect self and family is one’s responsibility. A health insurance plan for family comes as one of the necessities to safeguard against such situations.

Therefore, it is rightly said that without a health insurance plan it is practically impossible to deal with emergency medical treatment costs. Below mentioned are some of the points to explain the necessity of a family health plan:

  • To Afford the Expenses of Lifestyle Diseases: The modern lifestyle is full of stress and lack of exercise, but with a large quantity of junk/unhealthy food. These factors are leading to lifestyle diseases like diabetes, high blood pressure, etc. The lifestyle illnesses are more expensive to treat and can be life-threatening than ordinary infectious illness. Even though regular exercise, healthy eating habits, and other lifestyle changes can help to overcome the issues related to lifestyle illnesses, but sudden medical emergency can come anytime. Therefore, to protect self and family members from such issues, buy mediclaim policy for family.
  • Medical Cover from Employer is Not Sufficient: While most of the employers provide health insurance to its employees, but these medical policies do not provide enough coverage. Apart from this, one is eligible to get the benefits of an employer health plan until he/she is employed with that company. Therefore, it is always better to have a health insurance plan independent of employer. This protects an individual as well as his/her family in various health issues.
  • Benefits of No Claim Bonus: Most of the health insurance companies provide benefits to the policyholders who have not made any claim in a policy year. This benefit can be in the form of discount over the premium, successive addition on the sum assured, or both. This bonus gets cumulative with every claim-free year.

Benefits of Family Health Plans in India:

There are several benefits of family floater health insurance. The advantages are mentioned below:

  • Stress-free coverage:A health plan for family trims down the task of choosing a separate individual health policy for each family member. Also, an insured don’t have to pay separate premium of a health plan for each member.
  • Grab discounts: Under such health insurance policy, an insured can avail discounts and other perks in form of incentives offered by the policy. This is one of the easiest and simplest ways to protect family’s health.
  • Addition of new family member at ease: In these plans, a policyholder can add a new family member easily. If the senior-most family member passes away or is no more eligible for the coverage, then the other family members can continue with the same plan without losing the benefits of the plan.
  • Get additional cover for your elderly parents or in-laws: One of the major benefits is that an insured can secure the health of his/her parents and that of his/her spouse’s parents under one plan. All one needs to do is pay some additional premium.
  • Tax saving: Under Section 80D of the Indian Income Tax Act, health insurance premium is given a tax exemption. For senior citizens, the maximum exemption limit is Rs. 15,000, which can be extended up to Rs. 20,000. It provides a total tax benefit of Rs. 35,000. If the age of the policyholder and the insured parents is above 65 years, then the deductible amount is extendible up to Rs. 40,000 (Rs. 20,000 for both).
  • Additional Benefits: For young couples, there is an option to get maternity insurance cover and newborn baby cover. However, this feature is subject to a waiting period clause. It is suggested to check the policy documents for the same before buying a mediclaim policy for your family.

Inclusions – What is Covered In a Family Health Plan?

Usually, health insurance plans for family cover the following expenses –

  • Pre-hospitalization Expenses– The insurer pays-off the medical expenses that are incurred before the patient is admitted to the hospital. It includes expenses incurred on blood and urine tests, CT scan, sonography, etc.
  • In-patient Hospitalization– The expenses that are incurred during hospitalization are also covered. It is only applicable for hospitalization of more than 24 hours.
  • Post-hospitalization Expenses– The insurer also recompenses the medical expenses incurred on medical tests, medicines etc., after the discharge of patient from the hospital.
  • Ambulance Charges– Emergency ambulance charges are covered by mostly all the family health insurance plans. The limit, however, may vary from one insurer to another.
  • Daily Cash Allowance–There are certain plans that provide compensation for the expenses incurred on transportation, food, etc.
  • Day Care Treatment– Some policies also cover expenses incurred on daycare treatments like varicose veins, cataracts operations, etc.

Exclusions-What is Not Covered In a Family Health Plan?

Following medical expenses are generally not covered by a family health insurance –

  • OPD treatments and routine medical check-ups
  • Medical treatment required for fertility problems
  • Gender change surgery or treatment
  • Expenses incurred on any aesthetic treatment or plastic surgeries
  • Expenses incurred on life-support machines
  • Hospitalization resulting from anxiety, depression or any psychological disorders
  • Treatment required for sexually transmitted diseases
  • Treatment took abroad unless included in the plan
  • Any illness or injury resulting due to war conditions, unethical activities, nuclear reaction, rebellion, acts of foreign enemies and similar conditions
  • Hospitalization required due to an overdose of alcohol, drugs, tobacco etc.
  • Self-inflicted injuries and suicidal attempts
  • Pregnancy or childbirth-related complications (unless mentioned in the plan), like voluntary termination of pregnancy, miscarriage or abortion unless it is an ectopic pregnancy.

The policy limitations may vary from insurer to insurer. It is advisable that you go through the policy documents carefully before making the purchase.

How to Port a Family Health Insurance Policy?

No one wants to lose the benefits that he/she has accumulated while porting a family health insurance plan. Previously it was not possible to port health insurance plan, but now IRDA has allowed an insured to port an existing health plan from one insurer to another without losing the benefits one has gained such as waiting period in terms of pre-existing conditions. This is not only applicable when an insured is moving from one insurer to another, but from one plan to other of the same insured.

Rights of an Insured for porting:

  • An insured can port a health insurance policy for family from one general insurance provider to and from any general insurance provider or specialized health insurance organization.
  • Any health insurance policy for family can be ported.
  • The new insurance provider has to give the credit ratings to the waiting period of pre-existing diseases that an insured has gained from his/her old insurance company.
  • The new insurance provider has to give insurance to the insured at least up to the sum insured of the old policy.
  • The two insurance providers must complete the process of porting according to the timeline provided by the IRDA.

Conditions for porting:

  • One can port the insurance policy only at the time of renewal.
  • Except for the waiting period credit, all the terms and conditions of the new insurance policy including the premium will be according to the new insurance provider.
  • An insured as to perform the following steps at least 45 days before the renewal of the insurance policy:
    • Inform to the current insurance company regarding the shift in writing.
    • Mention the name of the new insurance company in this application for shift
    • Renew the insurance policy without any break (30 days grace period is provided if the porting is under process).

Steps involved in porting a family health insurance policy:

  1. Select the health insurance provider.
  2. The new insurance provider requires an insured to fill the portability form and attach the existing insurance policy’s copy.
  3. An insured may need to undergo medical examination, if the new insurance provider needs.
  4. According to the rule, the current insurance provider must acknowledge this request within 3 working days.
  5. The current health insurance provider of the policyholder is requested to share all the details related to policy of the insured such as cover, claims, pre-existing disease, etc within 7 working days as per the rules of IRDA.
  6. If everything is perfect, the new insurance provider approves the request of portability.

Eligibility Criteria to Buy a Health Insurance Plan for Family?

With family floater health insurance policy the entire family can avail the insurance benefits under one plan. It depends on whether an insured has opted for an individual plan for each family member or has purchased a family floater health plan where all the members are covered under a single annual premium on a single sum assured.

There is a certain eligibility criterion that an individual needs to meet if he/she is buying a family health insurance plan. Here’s a quick rundown-

  • The policyholder has to be 18 years of age or above
  • By paying a nominal amount of extra premium, an insured can get new members included in a family health plan
  • The amount of coverage for each family member can be increased at the time of including the new member. This way, everyone can get adequate amount of coverage.
  • The eldest member of the family is eligible for a claim until he/she crosses the upper age limit mentioned in the plan.
  • Children are usually given insurance cover up to a certain age. As soon as the age limit is crossed, they will not be covered in the plan.
  • It is not a good idea to include the elderly parents in a family health plan as this will increase the cost of the premium. Rather, buy an individual health insurance plan for parents to provide maximum cover and reduce the amount of premium.
  • Depending on the age of the proposer, pre-medical tests are also required.
  • The premium for a family health plan is lesser than the combined premium of separate individual health insurance plans.

Family Health Plan Claim Process

Claim is a request that an insured submits to the insurance provider for obtaining the services that are provided in his/her insurance plan. A policyholder can either get the reimbursement or can go for the direct settlement of the claim option against all the availed healthcare treatment services. In other words, an insured can either ask for cashless health insurance services from the provider or can submit the reimbursement form.

Methods to Claim a Family Health Insurance Policy

Getting required medical services for self and family members is the actual utility of a family health insurance plan. In order to get quick and simple settlement of all the availed medical services, one is required to initiate the family health insurance process for claim. Basically, there are two ways of claiming a health insurance plan:

  • Cashless Claims: In this type of claim settlement process, the insurance provider directly deals with the hospitals for claim settlement. However, the policyholder is required to be hospitalized in the network hospital only.
  • Reimbursement Claims: Under this claim settlement process, the policyholder pays for all the hospitalization expenses upfront and then requests for the reimbursement from the insurance provider. Here, the insured can take medical services from both network and non-network hospitals.

Claim Settlement Process in case of Cashless Claims:

Even though different health insurance providers have different claim process, but the generic steps of claim settlement in case of cashless claims are:

  • Contact the helpdesk of the insurance provider in the hospital.
  • For identification purpose, show the ID card of the health insurance provider in the hospital.
  • The hospital verifies the identity of the policyholder and submits the pre-authorization form to the insurer.
  • The insurer reviews all the submitted documents of the policyholder and processes the claim as per the terms and conditions of the policy.
  • Once the formalities are completed, the claim is settled according to the inclusions of the policy of the insured.

In Case of Planned Hospitalization:

Planned hospitalization is one wherein the insured is aware of the hospitalization before getting admitted. Below mentioned are the steps to avail cashless treatment in this case:

  • Contact the health insurance provider on its toll-free number beforehand.
  • Fax the filled pre-authorization form on the fax number of the insurer. This form must be filled by the hospital only.

In case of Emergency Hospitalization:

In case of sudden illness or accident, an insured requires emergency hospitalization. The steps to claim cashless treatment in this case are:

  • After admitting the policyholder in the hospital, the family or anyone who is assisting him/her should inform the insurance provider on their toll-free number.
  • The pre-authorization form must be provided to the health insurance provider within 24-hours of hospitalization.

Claim Settlement Process in Case of Reimbursement Claims:

The general steps that an insured must follow in order to claim reimbursement for availed medical treatment are:

  • Intimate the health insurance provider within 24-hours of the hospitalization.
  • The insured is then requested to continue his/her treatment and pay the bills.
  • Collect all the original bills from the hospital.
  • Duly fill the claim form and submit it with all the required documents to the health insurance provider.
  • The insured gets the reimbursement of the medical expenses according to the terms and conditions of the policy taken by him/her.

Documents Required for Family Health Insurance Claim Submission

The policyholder needs to submit the following documents while filing the claim:

  • Copy of health card (ID card of health insurance) issued by the health insurance provider.
  • Consultation papers given by the doctor(s).
  • All the diagnosis and investigation reports like blood reports, CT-Scan, X-Ray, etc.
  • Medical store bills with respective prescription.
  • Submit the Medico-Legal Certificate (MLC) and/or FIR in case of an accident.
  • Discharge summary issued by the hospital.
  • Duly filled claim form.
  • Other relevant documents asked by the health insurance provider/TPA.

Procedure to Renew Family Health Insurance in India

A family health insurance plan must be renewed before the expiry date. However, some insurance providers give the grace period of 30 days after expiry for renewal. Beyond this time, the continuity benefits such as earned cumulative bonus, pre-existing disease exclusion, waiting period of 30 days, etc. are mostly not covered. In this way, any health insurance plan for family renewed after this time is treated as a fresh plan and the insurance provider will not be liable to release any claim incurring within first 30 days after renewal of such health insurance policies for family.

Procedure to Renew Family Health Insurance Policy Online:

Follow the below mentioned four steps to renew a health insurance policy for health online:

  • Provide the number of the policy and the expiry date of the previous policy. Fill the other necessary details.
  • Make the payment for renewal via credit card/debit card/net banking.
  • As soon as the payment for renewal is authorized, the insured gets policy’s digitally signed copy.
  • Generally, in online renewal, the insured gets a username and password to check the policy-relevant details online on the website of the insurer.

Family Health Insurance Cancellation Procedure

An insured can request for the cancellation of his/her family health insurance policy; however, there are certain conditions to get refunds. A policyholder can cancel the health insurance anytime but can get the refund only if he/she has made no claims during that policy year. There are two types of cancellations that any health insurance policyholder can opt for:

  • Free-Look Cancellation: If a health insurance policyholder asks for cancellation of the policy within 15 days of getting the documentation of the policy, then it is termed as ‘Free-look Cancellation’. To avail free-look cancellation, the insured needs to write to the health insurance provider for the same. The insurance provider refunds the premiums after the deduction of stamp duty charges and the risk charges in proportion for the days an insured and his/her family is being covered.
  • Asking for Cancellation Any time After the Free-Look Period: The insurance companies refund some amount in this case as well after adjusting the time in which the insured is covered. However, to get the refund the insured should not have made claim. Different health insurance companies have different grid of refund, but below is the generic example that most of the health insurance companies follow:
Risk Period Premium Refunded
Up to 1 month 75% of the Annual Premium
Up to 3 months 50% of the Annual Premium
Up to 6 months 25% of Annual Premium
Exceeding 6 months up to 365 days Nil

Note: An insurance provider may cancel the policy on the basis of misrepresentation, fraud, or non-disclosure of any relevant fact by the insured or due to non-cooperation of the policyholder by sending a notice of 30 days at the last known address of the insured.

How to Calculate Premium for Family Health Insurance Policy?

Even though every health insurance company has some specific guidelines to finalize the premium of the insurance policy, but there are some general guidelines that most of the companies follow:

  • Savings and Investments: Most of the health insurance companies do investment in public sector instrument. Every investment against the same follows the IRDA’s guidelines. The premiums paid by the insured depend on the returns gained through such capitalization.
  • Administration and Marketing Expenditure: The health insurance companies invest a lot in marketing and advertisement. These expenses also impact the premium paid by the insured.
  • Rate of Mortality: This is the cost that a health insurance company bears in case of some eventuality like death of the insured. The expenses on mortality are different for the policyholders of different age groups and are most of the times higher for older people. In this way:
    • The premium of the health insurance policy becomes as an insured grows old.
    • Premiums are higher for the policyholders who have lifestyle illness like blood pressure or diabetes.
  • Medical Underwriting: To differentiate health insurance policies for individual and group/ family, product of insurance are underwritten. This is one of the important steps as it prevents the health insurance companies from making any loss.
  • Policyholder’s Personal History: It is solely the choice of health insurance provider to ask a customer for health checkup before giving a family health insurance policy. However, the premium of the policy does depend upon the medical history of family members, their age, personal habits, etc.
  • Rate for the Band: According to this, the insurance provider makes a baseline rate that are charged for a specific set of families who possess almost same characteristics such as gender, age, geographical location, profession, size of the family, etc.
  • Modified Rating for Community: This is one of the significant factors for calculating the premium of an insurance policy for family. Under modified community rating section, geographical location, industrial development, political stability of that location, lifestyle of the people of that area, and their trade play a major role to decide the premium.

Is there any waiting period in a Family Health Insurance Plan?

Yes, there is a waiting period involved in every health insurance plan for family. Unlike life insurance plan, a health insurance policy does not cover a policyholder from day one, except for any unplanned hospitalization such as in case of an accident. There are different types of waiting period included in health insurance plans for family:

  • Initial waiting period for standard health insurance policy: Generally, the members of the insured family health plan have to wait for at least 30 to 60 days before availing the benefits of the policy.
  • Waiting period for pre-existing illness: The waiting period for pre-existing illnesses differs than normal waiting period for a health policy for family. Some of the health insurance companies do not cater to pre-existing disease, but, those who cover such diseases come with a waiting period of at least 4 years.
  • Waiting period for maternity benefits: There are some health insurance plans for family that provide maternity benefits. However, there is a waiting period of 9 months to 48 months in these policies.

Is Family Health Insurance Better than Individual Health Plan?

It is a common question that arises in the minds of many people. However, if one has a family and wants to get medical coverage for every family member, then it is wise to buy family health insurance than individual medical plan for every member. Below mentioned are some of the factors to support the same:

  • Premium Cost: If the family members are younger in age, then floater plan is better than individual policy. For example, in a family of four wherein the age of the spouse if 33 to 35 and two children are of age 2 and 5, then paying the premium of the family plan will be cheaper than paying premiums for the health policies of every individual.
  • Better Healthcare Cover: The health plan for family provides better coverage than individual plans. The family that is mentioned in the above example only has to pay Rs.21, 826 yearly to get the cover of Rs.10 Lakhs.

However, if the age gap between the family members is huge, such as the eldest member of the family is of age 70 years and the youngest is 2 years, then taking individual plan for the senior citizens is recommended.

 

How to Choose Best Family Health Plan?

With improvement in the medical services in India, the cost of hospitalization is also increasing. This means one must be financially prepared in order to bear the unexpected medical emergency especially if one has family. Below mentioned are top tips to choose the best health plan for family in India:

  • Who all are covered in the health insurance? The first question that one must keep in mind before purchasing a health insurance plan for family is – whom all one wants to cover? Most of the health insurance plans for family cover two adults and two dependent children. However, if one wants to cover his/her parents who are senior citizens, then it is suggested to not to club them in the family plan. In this case, it is always better to take a separate senior citizen health plan for parents than clubbing them in the family floater.
  • What is the amount of coverage that one wants? Since it is difficult to decide the amount of coverage that one wants in his/her family floater health plan, one must keep the following points in mind:
    • If one wants to cover all possible healthcare expenses for family? If yes, then one must choose a plan that covers all the possible healthcare expenses that one may come across at least in next five years.
    • Extra cover: Many health insurance policies for family do not provide cover for specific disease or critical illness. Moreover, critical illnesses as well are not covered in most of the family health plans. Apart from these, few policies have limitations in room rent also. So, if one has such expectations from his/her health plans, then he/she must inquire about the same from the insurance provider before buying a family plan.
  • Claim Settlement Ratio: The claim settlement ratio is one of the things through which the integrity of the insurance provider can be judged. Therefore, it is suggested to choose an insurance provider that has good claim settlement ratio.
  • Network Hospitals: Consider a health insurance policy that has an extensive list of network hospitals.

Why to Compare Family Health Plans?

There are several health insurance companies in India and selecting one is the most difficult task. However, there are various insurance web aggregators like healthinsuranceplans.in available online. One can compare family health insurance policies here. Healthinsuranceplans.in provides most suitable quotes from different leading insurance providers at one platform. Moreover, one can purchase a plan by making an informed choice here.

How to Buy Family Health Insurance Online?

Before buying a family health plan, it is always recommended that you compare the available plans first. There are various options available in the market; it is difficult to choose the best plan as per your preferences and requirements.

  • What to Look For? Before purchasing a family health plan, make sure that you take into consideration the following features of a policy
  • Policy coverage:It is important that you go through the policy benefits and limitations. Look for certain things like pre and post-hospitalization cover, ambulance charges, critical illness cover, maternity benefits, cashless claim settlement, policy term, hospital cash, in-patient hospitalization etc.
  • The number of family members covered: There are certain health insurance plans that provide coverage to the insured, their spouse and children only. If you want the coverage to be extended to other family members, look for a plan that offers coverage to parents, in-laws, siblings and other family members.
  • Room Rent Limit: Whether you will get a private hospital room, semi-private room or a shared room, it depends on the type of plan you choose. It’s always better to go for a plan that provides higher room-rent limit if you want to avoid paying extra from your own pocket.
  • Waiting Period for Pre-existing Diseases: Any illness or disease that has been diagnosed before the policy purchase date is considered as a pre-existing illness. Almost every health insurance plan covers them after a specified waiting period, which varies from one plan to another. For instance, maternity expenses are usually covered after a period of 2 to 4 years from the date of policy purchase. Make sure that you check the time duration after which the pre-existing diseases will be covered in your family health plan.
  • Co-payment Clause: It is the percentage of amount that you will have to pay from your own pocket. The remaining hospitalization expense is paid by the insurance company. For instance, if you have a policy with 10% Co-pay clause, this implies that for a claim of Rs. 1 lakh, you will need to pay Rs. 10,000 from your own funds while the insurance company pays Rs. 90,000 as part of the claim. You can also go for a “no co-pay” clause.

Family Health Insurance FAQs

Q: What is a family floater insurance plan?

Ans: A health insurance plan that covers all the members of a family under one plan is known as the Family Floater Insurance Plan. In this plan, there is a fixed sum insured that gets exhausted when a member of the family makes a claim or avails some medical service. The members of this plan can be self, spouse, dependent children, and/or parents.

Q: How does a family floater plan work?

Ans: For one policy term, there is a fixed sum insured in a family floater plan, which gets exhausted as and when a family member avails the healthcare services and/or files a claim. If the full sum insured gets exhausted on one family member only, the rest of the members then will not be able to avail any medical service until the policy gets renewed at the end of the term.

Q: What is the need for a family floater?

Ans: It is always better to take one comprehensive health insurance policy than buying individual medical plans for every family member. Additionally, a policyholder can add and remove an immediate family member as and when required.

Q: Please provide the list of documents required to get a family floater plan?

Ans: The following documents are needed:

  • Provide the proof of age, address, and identity of every family member that is to be insured in the plan.
  • Policyholder’s income proof.
  • Duly filled proposal form.
  • Some family floater plans may require the members of the family to undergo medical tests.

Q: Can I add my family members to my existing family floater plan?

Ans: Yes, you can add your family members in your existing family health insurance policy at the time of its renewal. This means you cannot add the dependents in the middle of the term except for the newborn baby.

Q: What is the difference between individual health insurance policy and family floater plan?

Ans: An individual health insurance policy is one wherein you get an independent cover for yourself. On the other hand, a family floater plan extends to cover the entire family of yours under single sum assured.

Q: Can I cover my parents and parent’s in-laws in my family floater plan?

Ans: Not all, but some health insurance providers give the option to add parents and parent’s in-laws in family floater plan.

Q: Should I take separate health insurance policy, if my family and I are already covered in my corporate health plan?

Ans: Yes, it is highly suggested to purchase a standalone family floater plan, even if you all are covered in a corporate plan provided by your employer. It is because your organization will provide you medical cover till the time you are working in the organization. The corporate insurance will no longer be useful once you leave the job, get retired, or start your own business or venture. Moreover, if your organization makes certain changes in the policy or suddenly stops the benefit of medical cover, then you and your family will have nothing in hand in case of a medical emergency. With covering yourself and family against any medical emergency, the health insurance plans for the family as well is considered as a good tax saving instrument because you become eligible to get tax benefit under section 80D of Income Tax Act.

Q: What happens when the primary policyholder of the family health insurance plan dies? Can the insurance be renewed by one of the surviving members of the policy?

Ans: Yes, if the primary policyholder dies or reaches the allowed age of renewability, the policy can be continued with other adults of the family. However, any deletion or addition in the policy is possible only at the time of policy renewal.

Q: Am I allowed to change my hospital during the course of medical treatment?

Ans: Yes you can change your hospital during treatment to get better healthcare services. However, you need to inform your TPA in such case as soon as possible. The TPA then evaluates your case on the basis of the conditions and terms of the policy.

Q: What is the process to check the claim online?

Ans: You can check the claim on the official website of the insurance provider or can call on the helpline number of the TPA.

Q: What are the conditions in which the cashless hospitalization is refused?

Ans: Following are some conditions under which the cashless hospitalization is denied:

  1. If the information provided to TPA is not correct or completed.
  2. If the request of pre-authorization is not received on time by the TPA.
  3. When some medical condition or alignment is not covered under the plan.

The insured needs to pay for the entire medical treatment in such cases and you can claim for the reimbursement later.