When Mahesh started earning recently, he knew his responsibilities had increased. One of his priorities was to get health insurance plans for his family. He had seen the struggle his father had gone through to provide for them when he had suffered a stroke. Mahesh did not want to jeopardise his savings and be under debt because of medical expenses thus, of late he has been trying to select the best health insurance policy for himself.
The scenario with Mahesh is very similar to many young people in the country. There are many people who wish to invest in health insurance plans for family, but often they are prohibitive and because of ignorance about health insurance, they end up buying an unsuitable policy. In order to select the best family floater health insurance, it is imperative that you understand the concept of health insurance and the different family floater health insurance plan covers that are available.
Types of Family Health Insurance:
Finding the best medical insurance for the family can be a daunting business and unless you know the different types of family health insurance, you would not be able to make the right choice.
There are two types of health insurance plans that can be taken for your family:
- Individual Health Insurance Plan
- Family Floater Health Insurance Plan
👉 Individual Health Insurance Plans: An individual health insurance plan covers an individual only. You can, however, choose to buy separate health insurance plans for every member in your family. This way each member would have his own sum insured and exclusive coverage. On the other hand, in a family floater health insurance plan, the sum insured would be used to cover the medical expenses regardless of any member falling unwell.
For example, there are four family members in your family, and you cover each member with a sum insured of INR 2 lakhs for each member the total sum insured would be INR 8 lakhs. If one member falls sick and has incurred a medical bill of INR 2.5 lakhs, his individual health insurance policy would cover only up to INR 2 lakhs, the remaining INR 50,000 would have to be borne by you. However, in the case of floater health insurance with the same sum insured of INR 8 lakhs, the expenses up to INR 8 lakhs, irrespective of the member, would be covered.
👉 Family Health Insurance Plan: As discussed earlier, floater health insurance would cover the family of an insured member. Different insurance companies include different relationships in their definition of ‘family'. All the members of the family are covered under the single umbrella coverage. The entire sum insured is shared by all the members of the family. Let us take a look at the various aspects covered in family floater health insurance:
- In-Patient Expenses: The treatment cost of hospitalisation that is due to a sickness or an injury is covered by your health insurance policy.
- Day Care Procedures: Certain treatments do not require hospitalisation and are completed within 24 hours. Such treatments are also covered in your family floater health insurance plan.
- Pre and Post-Hospitalisation: Your treatment expenses are not limited to hospitalisation, your family floater policy would cover the pre and post-hospitalisation expenses up to a specific number of days.
- Pre-Policy Medical Tests: In most health insurance plans for family, there is an age limit up to which, if you enjoy good overall health, you need not undergo any medical screening.
- Cashless Treatment: Under your family floater plan, you can avail of cashless treatment at a network hospital. Without having to compromise on the expenses, the insured family member can get excellent healthcare services.
- Sum Insured Rebound: Many insurance companies offer a recharge of the sum insured. In case the health cover is exhausted, the company reinstates the policy to treat the next hospitalisation.
Family Floater Health Insurance Claim Process:
If you are to be hospitalised for a treatment that is covered under your family floater policy, you need to follow the claim procedure carefully. In case of hospitalisation, you need to notify the company about the same. Inform the insurance company 72 hours before in case of planned hospitalisation, and in case of an emergency, inform within 24 hours of hospitalisation. Depending on the hospital you get admitted to you can make your claim.
- Cashless Claim: At a network hospital for your treatment, you can avail the convenience of cashless treatment. At the time of admission, you need to produce your company-issued Health Card along with the other required documents at the help desk. After verification of the documents, your treatment can be started. The insurance company would settle bills directly.
- Reimbursement Claim: When you get admitted to a non-network hospital, make sure you inform the company at the earliest. Post-treatment, you would have to pay the bills yourself, however, you can claim reimbursement from the company. You would have to submit all the treatment-related documents along with the claim form. Once the paperwork is verified by the company, the reimbursement will be done in a few days.
- Required Documents: At the time of making a claim, you generally need to submit below mentioned to Insurer:
- Valid Photo ID
- Duly filled and signed Claim Form
- Cancelled Cheque
- Original discharge summary
- All diagnostic and pathological Reports
- All bills, receipts issued by the hospital
- Original ambulance receipt
- Police FIR or Medico-Legal Certificate in case of accidental injuries
Family Health Insurance Renewal Process:
When you buy a family floater health insurance plan, you need to keep in mind that the policy benefits will cease when the policy tenure is over. Before the policy expires, you should request for Policy Renewal. Once the expiry date is reached, a 30-day grace period starts, during which the policy must be renewed. Remember that no claim can be made in the grace period.
At the time of renewal of the policy, keep the following points in mind:–
- Your floater health insurance will lapse if the renewal is not done on or before the expiry date
- Claims made in the Grace Period will not be allowed
- Any changes in sum insured or addition of Insured Members can be made at the time of renewal
- Depending on the plan opted for, you can get the renewal online or offline
Family Health Insurance Exclusions:
Listed below are some of the most common exclusions in floater health insurance, for details please read your policy document:
- There are certain waiting periods during which treatment is not covered
- Self-inflicted injuries/ suicide attempts are not covered
- Expenses on dental treatments except when due to an accident is required
- Treatments for infertility, birth control, surrogate pregnancy are not covered
Other Important Aspects of Family Health Insurance:
- It is quite easy to add new members to your existing policy
- In case the eldest family member passes away or is no longer eligible for the policy, the other members can still avail of the policy benefits
- In most family floater health insurance policies, there is an entry age limit for children
- Depending on the plan opted, you can pay the health insurance premium on a monthly basis
The Bottom Line:
With the corona pandemic hovering all over the globe and an unabated increase in lifestyle diseases, everyone has realised the importance of having a health insurance policy. Knowing about the details of a health insurance policy would help you in making an informed decision.
Life is unpredictable, and a medical urgency can strike anyone anywhere. If you haven’t done it already, invest in a health insurance policy for yourself and your family today. The right policy is indeed a sure-fire way to ensure that in case of an untoward incident, you would be able to manage the finances.
Q. What documents are required at the time of buying a family floater plan online?
A. No such documents are required to get health insurance online. Few insurance companies ask for identification or age proof if required, else everything goes on self-declaration. During claims time, all details are checked where all KYC are thoroughly checked, and any mislead will result in claim rejection.
Q. Can I purchase more than one family floater health insurance policy?
A. Yes, you can purchase this plan online.
Q. Can I avail of tax benefits if I have invested in a floater health insurance plan?
A.Yes, the premium that you pay towards your family floater plan is deductible under Section 80D of the Income Tax Act. Please note tax benefits are subject to changes in the tax laws. You may consult your tax advisor for details.
Q. What is a health card?
A. The health card acts as an identification of your policy. At a network hospital, you need to produce your health card to avail cashless treatment.
Q. Can I increase my sum insured after I make the purchase?
A. One can increase the sum insured and is purely an underwriting decision of the insurer. The waiting period shall be applicable for increased premium as per the policy schedule.