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Family Health Insurance
Family Health Insurance
The family health insurance policy is a kind of health insurance plan that provides coverage for the entire family under a single insurance plan against a fixed sum insured. This type of health insurance policy can be tailored and customized according to the convenience of the family. Apart from covering the insured person, the policy can cover his/her spouse, dependent children, parents, among others. In a nutshell, it gives you overall comprehensive health coverage against different diseases and thus offers financial protection to you and your family.
Which one is best for you- Family health insurance or Individual health insurance?
Under a family health insurance policy, the policyholder can insure his/her entire family under single health insurance and for that, the single sum insured is required whereas the standard or individual health insurance plan provides coverage for only one person. This denotes that if you are a family of 5 members, then you have to buy separate 5 insurances for each and bear the expenses. That is hazardous and might put a burden on your pocket. But under family health insurance, you don’t need to carry this burden as all the 5 members can be covered under a single family health insurance plan.
You might be thinking that the premiums paid for family insurance are higher than the individual health insurance. But unfortunately, you are wrong. The premium paid for family health insurance is lesser than the premium paid for individual health insurance. Let us understand this with the help of an example.
Mr. Sharma has bought HDFC ERGO Optima Restore Family Floater Health Plan that offers coverage for the two persons (Mr. Sharma and his spouse) under a single plan. On the other hand, Mr. Bose has purchased HDFC ERGO Optima Restore Individual Health Plan for himself and for his wife. In this case, he has to pay two separate premiums for each policy.
Under Optima Restore Individual health plan of Rs. 50 lakhs (Sum Insured), Mr. Bose needs to pay Rs. 44950 for I year.
|Mr. Bose||Rs. 22475|
|Mrs. Bose||Rs. 22475|
On the other side, under Optima Restore Family Floater Health of Rs. 50 lakhs (Sum Insured), Mr. Sharma only needs to pay Rs. 31,466 to cover himself, his wife, and his child as well for one year.
Here we can see that Mr. Sharma has saved Rs. 13,484 per year as he opted for family health insurance rather than an individual health plan. For this reason, almost 95% of people in India go for a family floater health insurance plan.
But one thing you need to remember is that though a family floater is cheaper and more convenient under this policy the insured people have to share the sum insured. That means if the husband and wife are covered under Rs. 10 lakhs sum insured, it is true that anybody can use the amount but if a situation arises where both of them need medical aid of Rs. 10 lakhs at the same time, only one of them is eligible to use the amount. But this type of situation comes up rarely, so still, the family health insurance plan is more suitable than the individual health policy.
Key Benefits of Family Health Insurance Policy
A family health insurance policy not only covers the insured person but also provides coverage for the entire family, even for the grandparents, parents, and dependent children. It comes with several other benefits. Let us have a look at the key advantages of this plan below.
Comprehensive Protection to The Entire Family – Under one family health insurance plan, you can cover your entire family and you need not buy separate insurance policies for the family members. It is not only hassle-free but also convenient and pocket-friendly.
Affordability – The premiums that you have to pay for the family floater health insurance that is way cheaper than the premiums paid for the individual health plans. For better understanding, suppose, you are a family of 4 members, by buying one single-family health insurance plan, you can cover all the four members while buying an individual health plan for each member, and paying 4 premiums separately would be costlier and hazardous.
Additional Benefits – Different insurance companies come up with varied add-ons to extend the benefits of the policy to make protection for you and your family stronger. Such extensions are critical illness cover, maternity cover, newborn and child’s marriage cover, and so on.
Tax Benefits – Under this policy one can avail of the tax benefits under Section 80D of the Income Tax Act, 1961.
Protection Against Covid-19 – Almost all the insurance companies are now offering coverage for the coronavirus under the family health insurance plans.
Availability of Discounts – Under this type of health insurance policy you can also grab some discounts and a perk in the form of incentives as offered by the insurer. This is the easiest and simplest way to secure your family’s health.
Best Family Health Insurance Policy available in India 2021
As there are lots of insurance companies that offer family health insurance policies with varied benefits, it becomes difficult for the policy-seekers to find the best and convenient ones for themselves. To lessen your burden here is a list of top insurance companies of 2021 that provide family health insurance plans in India.
|Insurance Company||Name of the Family Health Plan||Entry Age||Sum Insured||Pre and post-hospitalization||Pre-existing Diseases Covered||Benefits of the Plan|
|Star Health Insurance||Star Family Health Optima Insurance Plan||Minimum – 18 years|
Maximum – 65 years
Children – 16 days
|Rs.3,00,000, Rs.4,00,000, Rs.5,00,000, Rs.10,00,000, Rs.15,00,000, Rs.20,00,000, Rs.25,00,000/-||After 48 months of continuous Insurance without break with the Insurer.|
|HDFC ERGO||Optima Restore Family Health Insurance Plan||Minimum – 18 years|
Maximum – 65 years
Children – 91 days to 5 years
|3 lakhs, 5 lakhs, 10 lakhs, 15 lakhs, 20 lakhs, 25 lakhs, and 50 lakhs.||Covered after a waiting period of 3 years|
|ICICI Lombard||ICICI Lombard Complete Health Insurance||Adults – 21 years and above|
Children – 3 months to 20 years
|From 3 Lakhs to 50 Lakhs||Covered after a waiting period of 24 months|
|Care Health Insurance||Family Health Insurance||Minimum – 18 years|
Maximum – No upper limit
Children – 91 days to 5 years
|Up to 75 lakhs||Covered after a waiting period of 4 years|
|Bajaj Allianz Health Insurance||Health-Guard||Adults – 18 years to 65 years|
Dependent children – 3 months to 30 years
Silver Plan: Rs.1.5/2 lakhs
Gold Plan: 3/4/5/7.5/10/15/20/ 25/30/35/40/45/50 lakhs
|Covered after a waiting period of 36 months|
|Tata AIG Health Insurance||Wellsurance Family Policy||Adults -18 years to 65 years|
Children – 6 months to 18 years
|Classic – 2 lakhs|
Supreme – 3 lakhs
Elite – 4 lakhs
|Covered after a waiting period of 48 months|
|Aditya Birla Health Insurance||Activ Health Plantimum Essential|
Adults – 18 years – no upper limit
Dependent child – 91 days
|From 2 lakhs to up to 200 lakhs||Covered after a waiting period of 36 months|
|Max Bupa Health Insurance||Heartbeat Family First Health Insurance Plan||X||From 1 lakh to 50 lakhs|
48 months in the Silver plan
24 months in Gold and Platinum Plan.
Disclaimer- The values are taken from respective plan brochures and are subject to change.
How Can You Choose The Best Family Health Plan For Your Family?
There are lots of family health policies in the market offered by different insurers with some varied benefits. For this reason, it becomes difficult and confusing for the policy-seekers to select the proper and convenient. But this is not such a heavy task if you consider a few factors before going for any plan and the mentions are as follows.
Coverage and Benefits – At first always look for the benefits offered by different insurers. Look for what type of coverage it provides, the amount of the sum insured, the premium rate, etc, and then compare it with the other plans. Only then go for the most convenient one for you.
Understand Your Requirements – Most of the family health insurance plans provide coverage for you, your spouse, dependent children, and your parents. But if you have an extended family and you wish to cover your brother, brother-in-law, or a few members of your family, then you have to go for those plans that allow you to cover maximum family members. But it would be advisable to purchase a separate policy for the extended family members and insure only your immediate family.
Claim Process – We purchase insurance policies so that at the time of any emergency we can avail of a hassle-free claim process. So it is vital to understand your company’s claim procedure. Go through it thoroughly so that you don’t face any hazards at the time of a medical emergency.
Network Hospitals – To avail of the cashless treatments, one needs to get admitted at one of the network hospitals of the company. So look for the company’s network hospitals and make sure that you have at least one network hospital within your vicinity so that at the time of the medical emergency you can get admitted smoothly and quickly. It has to be remembered that if you get admitted to any non-network hospital, then you have to pay the medical bills out of your pocket only, and then you can apply for the reimbursement claim.
Flexibility – You might not be sure about the amount of the sum insured at the time of buying the policy and want to increase the sum insured later. For this, you have to go for those insurers that allow you to do so. Always get in touch with the insurer for more updated information.
Maximum Renewal Age – Most health insurance companies offer policy renewal till the age of 60-65. But presently a handful of them are offering lifelong renewal facilities. Make sure your family health insurance should be there beside you when you need it the most.
Whom should you include under family health insurance?
Most of the insurers allow 2 adults and 4 dependent children to be covered under a single-family health insurance policy. However, the age of the child might vary from one insurer to another.
A handful of insurance companies are there in the market, which provides coverage for the extended family under a single health plan. Such plans allow more than 2 adults to be covered and can provide coverage to the relations like, self, father, mother, spouse, brothers, sisters, uncles, aunts, children and etc. but this type of plan is very rare in the market and hence, for extended members of the family one has to go for separate policies.
It is not a good idea to include your extended family members under a single family floater health plan. There are lots of reasons for it. The most important one is that every individual has separate medical requirements according to age. For example, if you include your grandparents under the same policy, you will land up having the same sum assured for the entire family while in general, the older people need a higher sum assured as they are more prone to the risks of health hazards.
The second reason is that many companies calculate the premium cost based on the age of the eldest members of the family. Hence, you need to pay much more if you include your grandparents.
Thirdly, this type of plan for extended family is hardly available in the market. So you will not be left with many choices.
The fourth reason is that there is a very high chance of exhausting your sum assured if the number of members increases. Suppose, you share the health insurance policy with your spouse and children. The chance of requiring medical treatments for more than one member at the same time is very rare in this case. But if the number of members of the plan increases, the chance of falling ill at the same time increases as well which also increases the chances of exhausting the sum assured.
Therefore, it would be wiser to buy separate health insurance plans for the extended members of the family according to convenience such as, a senior citizen health insurance plan for grandparents and include only the immediate family members like your spouse, dependent children under the family floater health plan. It is to be noted that most of the family health insurance plans offer coverage to the dependent children up to the age of 21 years, after that you have to buy separate health insurance plans for them.
Common Exclusions of Family Health Insurance
The exclusions under a family health insurance policy may vary from one insurer to another. The general inclusions are as follows.
Expenses arising out of any kind of plastic surgery.
Treatments that are taken outside on foreign lands (unless specified in the Policy Wordings).
Any treatments or injuries occurred due to wars, war-like situations, strikes, riots, or any public unrest.
Intention or self-inflicted injuries.
Injuries occurred due to some unethical activities or adventurous sports.
Expenses due to complications during childbirth unless it is mentioned in the policy.
Expenses arising out of consumption of alcohol or any other drugs or intoxicating substances outside registered doctor’s prescription.
Expenses incurred on life-support machines.
Any pre-existing health condition is not covered until the completion of the waiting period.
Buying Process of Family Health Insurance Policy
If you already have a family health insurance policy and you want to add a new family member to it, it would be better to talk to your insurer about it. But if you are a policy-seeker and want to buy a new family health insurance plan, you have various options to do it.
You can buy it online by visiting their official websites as it is a simple and the most convenient one as you can compare different policies and then can select the right one for you. It would be advisable not to look for the cheapest one as you should not compromise with the coverage.
Otherwise, you can purchase it offline by paying a visit to the selected insurer’s nearest office and their experts will help you throughout the process to buy this policy seamlessly.
Claim Settlement Process of Family Health Insurance Policy
Every health insurance company is open to two types of claim settlement processes namely – Cashless claims and Reimbursement Claims. However, the processes can differ from one insurer to another but the general and standard procedures are as follows.
Cashless Claim Procedure
For availing of the seamless cashless claim settlement follows the below-mentioned steps.
Submit the duly filled pre-authorization form, which you can find at the TPA or at the insurance desk of the hospital. You can also download the form online.
For cashless treatment, you need to get admitted to one of the network hospitals of the insurer.
Notify the insurer as soon as the emergency situation arises.
Submit all the documents, discharge certificate, medical reports, diagnostic reports, bills, etc.
The insurer will review the claim request and provide the confirmation to the network hospital and will share the same with you via mail or text.
If the claim is approved, after the treatment, the company will settle the claim with the hospital directly.
If the claim is not approved, you can file a reimbursement claim.
Reimbursement Claim Procedure
If you get admitted to a non-network hospital, you need to file the reimbursement claim according to the following steps.
Inform the insurer as early as possible if a medical emergency occurs.
Submit the signed and duly filled claim form with other required documents as it was mentioned at the time of purchasing the policy.
You need to address the queries raised by the claim management team of your insurer.
Either your claim will be rejected or approved and you will be notified accordingly by the company.
Frequently Asked Questions
Most frequent questions and answers about health insurance for family
Yes, you can change the hospital during the course of treatment on the grounds of better treatment and services. However, in this case, at first, you need to inform your TPA who will evaluate your case on the basis of the policy’s terms and conditions.
Yes, you can buy multiple health insurance plans. If in case the cost of your treatment exceeds the sum insured of one policy one can claim the balance from the other policy.
Yes, most of the insurance companies provide coverage for the AYUSH (Ayurvedic, homoeopathy, Siddha, and Unani) treatments. But it would be wise to talk to your insurer at first regarding this.
If you exhaust the entire amount, other insured members under the policy will not have any coverage left. But there are some insurers that offer a sum insured refill/reinstatement benefit.
You can call the helpline number of your TPA or else you can also check the status on the official website of your insurance company.
The required documents are as follows.
- Age proof
- Identity proof
- Address proof of all the insured members
- Income proof of the policy proposer.
- Signed and duly filled proposal form
- Medical test reports if required.
- Any other documents demanded by the insurer.