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Health Insurance Plans for Family: Benefits and Eligibility

Team AckoMay 3, 2021

For many, the family holds the utmost importance in life. Their well-being gains top priority be it in terms of physical or financial safety. While physical safety can be achieved by taking care of things like driving safely, keeping away from potentially dangerous things, harnessing safety equipment, etc. the financial safety regarding their health can come with adequate coverage of Family Health Insurance Plans. The following article will give you an insight into such health insurance plans for family and why you need to review coverage regularly.

Health Insurance Plans for Family

What is a Family Health Insurance Plan or Family Floater Plan?

Family Health Insurance Plan or Family Floater Plans provide insurance coverage for the policyholder and his/her family members. The person who purchases the policy becomes the policyholder and the family members are called insured members of the health insurance plan. 

The coverage of a Family-Floater plan is shared among the insured members of the family and the policyholder. This means the sum insured of the policy can be used by more than one person in the family in case of a medical issue. 

Types of Health Insurance Plans:

A health insurance policy can provide monetary help in case of medical emergencies or planned procedures. While such plans can be of various types, the person buying health insurance should choose the type of health insurance that is most suitable to their needs. Here are various types of Health insurance plans available in India:

  1. Family-Floater plans

  2. Individual Health insurance

  3. Employee Group Health Benefit

  4. Critical Illness plans

  5. Senior Citizen Health Insurance

Steps to Buying Family Health Insurance Online:

Nowadays, it has become fairly easy to buy any insurance online. Likewise, buying a health insurance policy online is also easy as compared to the traditional offline method that involved a lot of form filling and postal communications. Buying health insurance online is quick and easy. Here are the steps you can follow to buy the best health insurance for family online:

Step 1: Know your requirements

Buying a health insurance policy that fulfills your requirements will provide the best financial aid when you or your family face a medical emergency. The number of family members, your budget, medical history of the people being incurred, etc. are the few things that will help you determine what you are looking for in health insurance.

Step 2: Compare plans

Once you understand your requirements, you will know that there are several similar health insurance policies available in the market. So the next logical step would be to compare such plans and find the one that offers more coverage at a lower price.

Step 3: Know more about the insurance company

If you are buying the policy from a particular insurance company for the first time, you will have to look into the company's reputation to be sure about making the purchase from them. Thanks to social media, you can check the reviews and ratings of the insurer that existing customers have shared. You can choose to proceed if you are happy with the feedback for the insurance company.

Step 4: Review the policy

Visit the chosen insurance company's website and look for your selected health insurance plan. Now thoroughly check the policy details and go through the terms and conditions as well.

Step 5: Payment 

The final step after making sure that you are purchasing the right plan from a reliable insurance company is to make an online payment. You can use any methods like net banking, mobile wallets, etc. After the transaction, your health insurance company will send the insurance policy to your registered email address.

3 Benefits of Buying Family-Floater Health Insurance Plan:

An insurance policy helps you secure your finances against a situation that is covered under the plan. Family Health insurance will give you the following benefits:

Insurance Coverage for Medical Issues

A medical emergency is both financially and physically a stressful event for the patient and the family. Regular tests conducted on the patient and visits by the family members make hospitalization a difficult time. Buying health insurance ensures that the patient is covered for various parts that come with a medical issue. Hospitalization, tests, ambulance charges, doctor visits, medicines, and much more are covered under health insurance.

Financial Back-Up in The Time of Need

One can be sure that quality treatment is available for the patient in a timely manner. If the insured gets treated in a network hospital, then the policyholder need not worry about the financial aspect of treatment at all. As the major part of the hospital, the bill is borne by the insurance company, the policyholder needs to pay a minimal amount under deductibles. 

Peace of Mind Regarding Family's Health

Buying health insurance will help you attain peace of mind regarding the finances related to a medical problem. You can rest assured that the insurance company will have your back in the time of need. All you have to do is keep the insurance plan active even if no claims are raised.

Importance of Family Floater Mediclaim Policy:

A Family-Floater Mediclaim Policy will help you cope with the financial burden of suffering from a medical issue. Especially in times when medical treatment has become very expensive. Hospitals offer comprehensive packages for most types of diseases like COVID-19 package, Cancer treatment package, Annual Health package, etc. The cost of these is not regulated and the medical facility is free to price it as per the quality of treatment offered. This is where health insurance gains importance. A good health policy will help you cover the cost of treatment as per the sum insured you choose to buy. Additionally, a Family-Floater plan insures your dependents, and they can get immediate treatment without you worrying about the finances.

Who is Eligible to Buy a Family Health Insurance Plan?

A Family Health Insurance Plan can be bought by anyone who wishes to get a financial backup for medical emergencies for themselves as well as the family. Most insurance companies have set the entry age at 18 years for buying the plan. The dependents however can be between the ages of 91 days to 65 - 75 years as per the conditions of the insurance company.

Required Documents:

The following documents are usually asked by the insurance company while buying a health insurance plan:

  1. ID proof

  2. Address Proof

  3. Medical records

  4. Photographs

Family Health Insurance Premium Calculator:

The Insurance premium calculator helps you understand approximately how much money you need to spend for buying an insurance policy. Many insurance companies have added a premium calculator on their website. This will help the policyholder get control of the type of coverage he/she is purchasing. Family Health Insurance Premium Calculator works similarly. It helps you understand the premium or "quote" for your policy.

To calculate the premium, you need to feed details like the type of insurance required, the number of family members, add-on covers, amount of sum insured, and personal details like name, age, and medical history of the insured people. Based on these inputs, the calculator will provide a quote. You can then proceed to review the coverage, terms and conditions, and then make payment.

Inclusions of Family Health Insurance:

Here are the basic things that are covered by most insurance companies in their Family Health insurance policy:

  1. Room Rent: These commonly come under room or bed charges. 

  2. ICU charges: ICU or Intensive Care is required when the person is suffering from a serious condition. ICU charges are more than the charges for basic hospitalization.

  3. Doctor visits: Multiple types of doctors may visit the patient during hospitalization, for example, the general physician, a specialist, anaesthetist, nutritionist, paediatrician, lactation consultant, etc.  

  4. Operation Theater charges: These charges are applicable in case the patient needs to undergo surgery.

  5. AYUSH Treatment: Treatments like Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy come under AYUSH treatment. Such treatments are becoming mainstream nowadays. Your insurance company may offer to cover such charges as well.

  6. Daycare procedures: Minor operations that do not require prolonged hospitalization are covered under Day Care procedures. For example, Cataract surgery, removal of tonsillitis, etc.

  7. Ambulance charges: The insurance company will bear the cost of hiring an ambulance once or twice per claim.

You can check what is covered under your Family-Floater health insurance policy, by reading the policy wordings. This document will be available online. Consider speaking to the customer care executive when in doubt.

Exclusions of Family Health Insurance:

Every insurance company has a set of conditions under which they cannot honour the claim. These conditions are called exclusions of the policy. These are basically the things that are not covered under your health insurance policy. Here is a general list: 

  1. Pre-existing diseases up to a certain period of time.

  2. Claim raised during the look-up period.

  3. Expenses related to infertility or related treatment.

  4. Expenses related to treating any kind of addiction.

  5. Treatment for injuries suffered while breaking the law or while engaging in criminal activity.

  6. Injuries related to adventurous sports.

Add-on Covers for Family Floater Health Insurance:

Add-ons are additional coverages that are usually not a part of your standard health insurance policy. You need to pay more premium for buying add-ons. They provide more coverage, and you can claim for situations that are usually not covered. Here are a few add-ons that may be available with your Family-Floater health insurance policy:

  1. Second Opinion Add-on: Through this add-on your health insurance policy will cover the charges of a second opinion either from a local doctor or from an international medical expert (as per the terms and conditions of the insurance policy).

  2. Daily Hospital Cash: This add-on provides monetary help for a fixed number of days during hospitalization.

  3. Maternity Benefit: The costs related to pregnancy and childbirth are covered under this add-on.

  4. Room Rent waiver: Usually there are limits imposed on room rent charges borne by the insurance company. If the policyholder chooses to avail treatment in a hospital room that costs more than the sub-limit, he/she will have to bear the difference from their pocket. With the Room Rent waiver add-on, the sub-limit can be either increased or completely removed from the insurance plan.

  5. Critical Illness cover: This add-on can cover the costs of treating a critical illness like cancer.

Difference Between Family-Floater and Individual Health Insurance:

Family-Floater Health Insurance plan covers some members of the same family. Here the insured persons are related by blood. Whereas an Individual Health insurance policy offers insurance benefits only to the policyholder. Here are the major differences between these two types of health insurance policies:

Parameter Family-Floater Health insurance Individual Health Insurance
General meaning Family-Floater Health is a type of health insurance policy that covers family members. An Individual Health insurance policy covers the policyholder under medical insurance.
Who is insured? The policyholder and his/her family members are insured under this plan. The policyholder him/herself is insured under this plan.
Available Sum Insured The sum insured of this policy can be higher than the sum insured of an Individual Health insurance plan as more number of people are insured under one policy. Sum insured can be lower than that of a Family-Floater plan because only one person is insured under the plan.
Exit criteria Children up to the age of 25 years are insured under a Family-Floater plan. Most Individual Health insurance plans end when the policyholder reaches the age of 65 years. After this, the policyholder can purchase a senior citizen's plan.
Premium The cost of this policy is higher than an Individual plan. The cost of this policy can be lower than compared to Family-Floater Health insurance policy.

Factors to Consider while Buying Family Health Insurance Policy Online:

One should not make haste while buying a health insurance plan because this can lead to buying a cover that may insufficient in the time of need. Thus, one should consider the following factors while buying a Family-Floater health insurance policy:

  1. The number of family members: The number of family members matters when it comes to buying health insurance for all of them. Usually, health insurance companies allow five dependents other than the policyholder. This will have a direct impact on the sum insured and the cost of the policy.

  2. Budget: Your budget matters when it comes to buying a proper health insurance plan. One of the most important things is to compare similar types of plans offered by different insurance companies. It is easy to compare plans online. This way you can buy more coverage for a lower price.

  3. Insurance coverage: The type of policy and coverage is important when it comes to claim. You need to make sure that the policy covers you for possible medical emergencies. The coverage or inclusions of the policy are considered when you make a claim.

  4. Required Add-ons: Health insurance add-ons will reduce your out-of-pocket expenses during claims. For example, buying the Room Rent Waiver add-on will help you choose a hospital bed as per your need. Else, you have to bear the difference between the cost of the room and the sub-limit of the insurance policy. 

  5. Sum Insured: The total sum insured of the policy will be shared among family members listed in the insurance policy. This amount should be adequate for all members during a medical issue.

  6. Medical History: the medical history of family members should be considered to determine which type of coverage you require. For example, you should buy add-ons that will provide additional help during hospitalization.

Claim Process for Family Health Insurance:

A claim should be raised against your Family-Floater health insurance policy when you or an insured family member suffer from a medical condition. The claim can be raised in the following two ways:

  1. Cashless Claims: A cashless claim can be availed when the insured person is admitted to a network hospital. The insurance company will have a tie-up with the hospital, and they will settle the major part of your hospital bill among themselves. You just need to bear the cost of deductibles. Get in touch with The Third-Party Administration at the time of admission and the claim process will begin. 

  2. Reimbursement Claims In this type of claim, you need to pay the entire hospital bill first, collect documents, and submit them to the insurance company for processing the claim. You can avail a reimbursement claim in a non-network hospital. Just intimate the insurance company at the time of admission and then raise a claim within the stipulated number of days.

Waiting Period in Family Health Insurance:

The waiting period is the time when a policyholder cannot raise a claim for a certain ailment. These are the conditions which the policyholder is suffering from before buying the health insurance policy. The waiting period on a Family-Floater plan can range from a few months to a few years or renewal cycles. For example, a person suffering from type 2 diabetes cannot raise a claim in the first 48 months of buying health insurance for the treatment of this ailment. However, after 48 months the insurance company will bear the expenses related to the treatment of type 2 diabetes for the policyholder.

Main Tips to choose the right Health Insurance Policy for Your Family:

Family health insurance policy will be your financial safety net if you or your family member needs treatment. Such an important insurance policy should be bought after making sure that adequate coverage is available when required. Additionally, the cost of the policy should also be light on the pocket. Here are the main tips to choose the right health insurance policy:

  1. Find a plan that has the lowest waiting period: Waiting period increases the out-of-pocket expenses for availing treatment for a particular disease. Choosing a plan with the less waiting period will allow you to make a claim earlier.

  2. Compare Family health insurance plans: Comparing insurance plans will help you find a policy with adequate coverage and low price.

  3. Go through the inclusions: Going through the inclusions of the policy will be helpful for figuring the right insurance coverage. Go through the entire list of inclusions and also exclusions to understand the coverage of the plan. 

Frequently Asked Questions:

1) How to compare the cost of health insurance policies?

You can compare health insurance policies online and find the one with the best coverage and a lower premium.

2) Is there a tax benefit for buying Family Health insurance?

Yes, one will be eligible for a tax benefit under section 80D of the Income Tax Act, for buying a Family Health insurance policy.

3) Which factors affect the cost of health insurance policy?

The extent of coverage, type of health insurance policy, number of insured persons, the sum insured, etc. affects the cost of a health insurance policy.

4) How to choose the best health insurance for a family in India?

You can get the best health insurance policy by considering your needs and by comparing similar plans online. This way you will find a policy that is both feature-rich and less costly.

5) Why do you need a Health Insurance Family Floater Cover for your Family?

Health Insurance Family Floater Cover will provide a financial back-up when you or a family member needs medical attention. You don't have to arrange funds while taking care of the health of your family member. Moreover, if you avail a cashless claim, the major chunk of the hospital bill will be borne by the insurance company.

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