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Family Health Insurance

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Advantages of Family Health Insurance

Comprehensive Cover
Mediclaim policy offers comprehensive protection to your family by covering all the medical needs. You can avail benefits like outpatient treatments, international hospitalisation and maternity in this policy.
Lifelong Renewability
Once you buy individual health insurance, you can renew the policy for a lifetime. This means that you can avail the lifelong cover against expensive hospitalisation costs and enjoy the financial protection.
Medical Expense Cover
Family health insurance offers protection against higher hospitalisation costs by taking care of out-patient treatment, in-patient care, lab test and day-care procedures. AYUSH treatment can also be covered.
Free Health Checkup
Many family floater health insurance plan offers free health check-ups periodically after every claim-free year. You can avail such medical check-ups via cashless at empanelled hospitals and diagnostic centres.

Benefits of Family Health Insurance

Cashless Claims

  • All family health insurance companies in India offers cashless hospitalisation facility which means you do not have to pay in cash for the treatment. This facility offers financial relief in case of emergencies.
  • Daily hospitalisation expenses and surgery cost can be covered under the cashless facility and are paid directly by the insurer.
  • Cashless health insurance plan relieves the stress on you and your family to arrange the cash for hospitalisation.

Day Care Surgeries Covered

  • Individual health insurance offers coverage for more than 140 day-care procedures which require hospitalisation for less than 24 hours.
  • The policy covers expensive treatments such as cataract, radiotherapy, chemotherapy, angiography and dialysis under day-care treatment.
  • Disease diagnosis tests such as liver biopsy or lipid profile which does not require hospitalisation are covered.

Less Room-rent Capping

  • Room rent capping is the most important aspect of health insurance coverage. It is basically a limit on the maximum amount you can avail to cover your daily room rent in hospital.
  • There are various types of room-rent limits available such as a private room or shared room limit, fixed amount or percentage of sum insured and no-limit on room rent.
  • Room rent sub-limits impact medical expenses like doctor fees and nursing charges. Hence you should choose rooms wisely during hospitalisation.

FAQs

Any medical condition, illness or ailment for which you have received any medical treatment before a certain period of buying the health policy is considered as a pre-existing disease. These are generally covered under the family health insurance plan, but only after completion of the specified waiting period. Generally, this period ranges from 2 to 4 years.

Domiciliary hospitalisation cover pays the expenses incurred in the medical treatment for any illness, injury or disease at home. This home-based treatment is covered only if the room is not available at the hospital or the condition of the patient is such that he cannot be moved to the hospital.

Generally, family health insurance cover of 5 lakhs may be sufficient in non-metro cities. But if you are an individual living in metro cities like Delhi or Banglore, where the cost of medication is higher, you need to consider a higher sum insured for the policy. Also, it is recommended that family health insurance coverage should be 50% of your annual income.

In basic family floater health insurance, maternity expenses are excluded. But many insurance companies offer maternity cover and new-born baby cover as an add-on which you can include in your policy by paying the extra premium. But this benefit comes with a specific waiting period, which you should check in the policy terms.

No, individual health insurance does not cover any expenses of cosmetic surgery such as liposuction, otoplasty etc. This is one of the common exclusion in health insurance policies. However, if the insured has to undergo plastic surgery in case of an accident, then such costs will be covered under the policy.

Cashless mediclaim policy for family offers the facility to insured to get treated in any of the network hospital empanelled with the insurance company without settling any hospitalisation bill. Once the insured gets discharged, the hospital will send the medical reports and bills to the insurance company, where it is verified and the claim is settled.

Yes, you can file a claim under health insurance if you get admitted and treated in not-network hospital. But such claims would always be on the reimbursement basis. This means, first you have to pay all the medical bills from your pocket and then get them reimbursed from the insurer after submitting all the required documents to the insurer.

While filing the claim, you should make sure that all the required documents are submitted to the insured within the specified time. Some of these common documents include identity proof, policy copy or health card, medical report, and original bills with receipt and prescriptions. An insurer may require any other additional documents as well in order to process your claim.

The cashless amount may differ from actual medical expenses as it depends upon various factors like a number of days of hospitalisation, hospital nursing and consulting charges, and other medical charges. Also, whether the proposed surgery is covered in health insurance or not, decides the amount of cashless claim.

Yes, you can avail cashless claim facility for the planned hospitalisation in order to treat your pre-existing diseases. In order to do so, you should get treatment in the network hospital. Then you should send the claim form to the TPA or health insurance company. Once the claim is approved, all medical expenses will be settled with the hospital by the TPA directly.

Yes, health insurance plans for family covers all the medical expenses incurred during pre and post-hospitalisation. But this coverage is subject to a particular condition and for a specified time limit. This time limit varies between 30-60 days for pre-hospitalisation and 60-90 days for post-hospitalisation.

The premium of most of the mediclaim insurance policies does not increase every year. The premium remains same for the defined age bracket as per health insurance company. Once you become older and your age bracket changes, the premium of health insurance will increase. This is because your health risk level increases with increase in age.

If your health insurance policy is expired, you have the grace period of 15 days within which you can pay the premium and renew your policy. If the premium is not paid within this grace period, your policy will be considered as lapsed and then you have to buy a new policy.

There are various factors that affect health insurance premium such as age, gender, family medical history, and pre-existing medical condition. If the person is younger, the premium cost is lower and vice-versa. Any use of tobacco by insured such as the use of cigarettes, alcohol etc also increase the premium cost of health policy.

Yes, you can enjoy the tax benefit on family health insurance premium under Section 80D. You can avail the benefit of an annual deduction of Rs. 15000 for the payment of health insurance for self, spouse and children. If you are paying the premium for health insurance of your parents, you can avail the deduction of Rs.20000, if they are a senior citizen.

Due to technological advancement and more effective medicines, healthcare has become expensive. Health insurance policy safeguards you and your family by covering such enormous medical treatment costs. This policy offers a great support at the time of unexpected health crises and offers financial relief in any such incident.

Group health insurance scheme does not offer tailor-made coverage according to the individual needs and requirements. Also, in case if you quit the job or changes employment, you would be left uncovered. In order to protect yourself from such unplanned events and to get customised coverage, you should buy standalone individual health insurance.

In order to buy the best family floater health insurance, you should consider factors like claim settlement ratio of the insurance company, waiting period of diseases, copayment and sublimits, exclusions, and premium cost. Also before buying the policy, comparison of health insurance plans should be done in order to ensure comprehensive coverage at the best price.

Restoration benefit, also known as refill benefit, is a facility offered by health insurance plans in which your sum insured is restored if it gets exhausted towards the treatment of any health issues. This benefit can be availed only once and can be used only during policy tenure. The restored sum insured can be used for all the treatment except the one for which claim was made.

Insuropedia

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What is Covered under AYUSH benefit in the Individual Health insurance plan?

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