Family Health Insurance

Family Health Insurance is a comprehensive health insurance plan for you and your family that offers protection against any medical emergencies. A Family Health Insurance Plan can be easily customized depending on your family’s needs and medical history. A Family Health Insurance policy covers the entire family for a fixed sum assured where only a single premium is required to be paid annually. Family Health Insurance policies are more convenient as you need not buy individual plans for your family members, rather you can cover them under a single insurance umbrella. Also, buying Health Insurance Plans for the family is cheaper in comparison to buying individual Health Insurance Plans.

Usually, a Family Health Insurance policy covers a family i.e. individual, spouse, and children (Up to 4 children). Some health insurance companies also have a provision that lets you include your parents in your existing Family Health Insurance policy. While some others allow you to include your extended family members, such as your in-laws, in your existing Family Health Insurance plan on payment of additional premium.

Buying health insurance for family is an important step towards securing your loved ones against emergencies. To ensure that you choose what is best for your family, you must make detailed research and compare different Family Health Insurance policies before buying, so that you may make the best decisions for them.

Types of Family Health Insurance Plans

There is a wide range of different health insurance companies in the market. Each of these companies has several health insurance policies of their own. These policies are all designed to cater to the dynamic and unique needs of their potential investors and customers. Depending on the kind of health coverage offered, Family Health Insurance plans can be chiefly divided into two categories:

• Medical Insurance

  It is a type of insurance plan that covers hospitalization expenses related to the treatment undergone by you and your family members. Under the medical insurance policy, the expenses are borne by the insurer and the policyholder receives the coverage in the form of cashless benefits or reimbursements.

• Critical Illness Insurance

  In this type of insurance policy, the policyholder is provided with a cover against chronic ailments like heart attack, kidney failure, etc. Under the critical illness insurance policy, the policyholder receives the entire sum assured as lump-sum from the insurance company. However, such receipt is subject to policy coverage.

  Critical illness insurance alone cannot be purchased as a Family Health Insurance Plan, it is required to be purchased as an additional cover.

Reasons to Buy Family Health Insurance Plan

If you are wondering why you should consider buying a family health insurance plan, here are some of the benefits of having a secure plan for health and medical emergencies:

• Secure your Family’s Future

  Buying a Family Health Insurance Policy is an effective way to secure your family’s medical future. Family floater plans act as a single solution in safeguarding your family against any financial strain that may be caused due to health issue

• Cost-effective

  Family medical insurance policies are more cost-effective than individual health insurance policies. You can save a great amount on insurance premiums by opting for family health plans and cover the entire family for an adequate amount of sum assured

• Increasing Medical Costs

  With a changing lifestyle, medical costs are also increasing. The higher the medical costs, the more is the burden on the family. To save yourself and your family from such unprecedented burdens, it is wise to buy a family floater plan that covers your entire family

• Shields Savings

  Medical emergencies come without any prior warnings and can drain you out of your savings. A family health insurance plan shields your savings against any such unwelcomed health emergencies

• Coverage Provided

  Family health insurance plans not only provide coverage in case of hospitalisation but also covers the medical costs that may be incurred before or after the course of treatment. E.g. doctor’s fee, diagnosis fees, daycare procedures, ambulance charges, etc.

• Access to Quality Treatment

  Family Health Insurance service providers have a wide network of hospitals and health care experts. You can avail quality health care treatments for you and your entire family by buying these health insurance policies for family

• Tax Benefit

  The premiums paid on Family health insurance policies are liable to be Tax Deductible under Section 80 D of the Income Tax Act

• Claimless Bonus

  If the policyholder or insured does not issue a claim for treatment during the previous year of the policy, then a bonus element is payable to the policyholder. This bonus is generally added to the Sum Assured

• Room Expenses

  Incurring the expenses of getting a room in a hospital can become a burden to financially maintain. Family health insurance policies allow the policyholder to get coverage for room expenses during hospitalisation depending on the premium that is being paid by the insured

Best Family Health Insurance Policies in India

Though there are various family floater plans offered by different insurers in the market. The following is a list of best health insurance plans for which you can choose from and subsequently purchase:

Documents Required to Buy Family Health Insurance Plan

The following documents are required to be attached with the filled out policy document in order to buy a family health insurance plan:

• Identity Proof

  • A family floater plan is issued in the name of family members. An identity proof is required to check the authenticity of the details furnished by the applicants
  • For e.g. Driving license, passport, PAN, etc.

• Age Proof

  • A valid age proof is required to purchase a family health insurance policy. The services rendered under a health insurance policy are directly linked to the applicant’s age
  • For e.g. Birth certificate, Voter ID, driving license, passport, etc.

• Address Proof

  • The applicant is required to submit an address proof to which any future communications shall be sent
  • For e.g. Telephone Bill, electricity bill, bank a/c statement, etc.

• Income Proof

  • This is a requisite only for applicants who have a source of income
  • For e.g. Salary slip, ITR form 16 (Not more than 3 years old)

• Medical Reports

  • In some cases, applicants may be required to undergo pre-medical screening and submit the reports to the insurer. The kind of medical tests required are specific to the type of insurance opted for

• Passport-size Photo

  • Along with all other documents, the applicants are required to submit a passport size photograph to the insurer

  For online purchasing of a health insurance policy, the required documents need to be scanned and uploaded to the online forum as images. These image documents must be attached to the online insurance application form and duly submitted.

Eligibility Criteria For Family Health Insurance Policy

In case of a Family Health Insurance plan, the eldest member of the family is considered to be the policyholder. The entry age for different category of family members is as follows:

Adults: The minimum entry age for adults in case of Family Health Insurance policy is 18 years. The maximum age of entry is 65 years in most cases. However, some insurers consider the maximum entry age as 70 years.

Dependent Children: Usually family floater plans cover children starting from 91 days to 25 years, some insurers also provide cover for a new born. The minimum entry age for children differs from one insurance provider to another.

Pre-medical Check-up: Some insurance service providers require applicants to undergo medical testing in order to be eligible for the health insurance policy. Such testing is usually applicable to applicants who are aged 45 years or above.

Features and Benefits of Family Health Insurance

Following are the salient features of Family Health Insurance:

• Cover for the Entire Family

  As the name says, a Family Health Insurance Plan covers the entire family under a single comprehensive plan. There is no trouble of dealing with individual policies for every family member

• Allows Inclusion of new members

  When a new member joins the family, you can easily include them in your existing Family Floater Plan. In case of individual policies, every time a new member is added to the family, a new plan is required to be purchased. However, this is not the case in case of Family Health Insurance Plans, the new member can be covered under your pre-existing policy

• Death of one family member does not affect others

  The policy shall not be terminated in the event of death of one of the family members. Even if a senior member of the policy expires, other family members can continue the policy without lapse of any benefit

• Hassle-free Coverage

  Under a family floater plan, you do not need to keep track of separate policies for each of the family members. You can easily cover the entire family in a single plan

• Continuous Coverage

  Some of the Family Health Insurance service providers offer an option of policy cover for continuous 2 years. This facilitates continuous coverage at the same premium amount for the selected tenure

• Flexible Options

  Family Health Insurance Plans allows customers to choose their plans according to their needs. Every family is different and so are their requirements. Family Floater Plans allows flexibility for the policyholders in their choice.

• Increase in Sum Insured

  With the increase in cost of living, the cost of medical and hospital bills has also increased. In order to cope up with this, many insurance providers offer the option of increasing the amount of sum insured for Family Health Insurance Policies.

• Cashless Hospitalisation

  The members of the Family Health Insurance Plans are provided with the facility of cashless hospitalisation in network hospitals. To avail this facility, the policyholder is required to fill a pre-authorisation form and get prior approval from the insurance service provider.

  In case of planned hospitalisation, the policyholder is required to inform the insurance company prior to getting admitted in the hospital.

  In case of emergencies, the policyholder is required to follow the payment norms of the hospitals, and can get reimbursement from the insurer later.

• Renewal of Policy 

  The regulating body of the insurance sector IRDA has made it mandatory for health insurance service providers to provide policy cover till the age of 65. Most of the health insurance service providers give the option of life-long renewal of the policy

• Discounts Offered

  Many health insurance companies offer discounts on purchase of medical insurance for family. The terms of such discount vary from one company to another.

• Include Your Parents and Parents-In-Law

  • Most of the family health insurance companies allow you to cover your parents and parents-in-law under the same health insurance policy
  • Some of the insurance providers also allow you to include your siblings on paying an extra amount.

Core Benefits of Family Health Insurance Plans

Following are some of the key benefits of Family Health Insurance Plans:

• Cover for Hospitalisation Expenses

  Health insurance policies for families provide cover for pre and post hospitalisation expenses. Usually the medical costs incurred 30 days prior the actual hospitalisation are covered by the insurer. For e.g. Medical tests, Doctor’s fee, etc.

  Some of the insurers cover the expenses incurred up to 60/90 days or even more (varies from insurer to insurer) post discharge from the hospital. For e.g. the expenses incurred on follow-up visit to the doctor, diagnosis, medicines, etc.

• Cover for Day Care Procedures

  Expenses incurred for medical treatments that do not require minimum 24 hours of hospitalisation are also covered under Family Health Insurance Policy. The reimbursement of expenses incurred in relation to day care procedures is according to the scope of the health insurance plan

• Hospital Cash Allowance

  The hospital cash benefit is payable to the policyholder on a daily basis. To avail this benefit, the policyholder is required to fulfil the ‘Minimum Stay’ criteria as per the policy terms and conditions

• No-Claim Bonus

  For every claim-free year, policyholders are entitled to receive no claim bonus. The bonus is offered as a discount on future premium amounts towards the health insurance plans.

• Domiciliary Expenses

  If the patient is not in a condition to be transferred to the hospital or there is an unavailability of hospital beds, the medical treatment may be required to be done at home under the guidance of a medical practitioner. The expenses incurred for such medical treatments at home are also reimbursed under Family Health Insurance policies

• Organ Donor Expenses

  In respect to the terms and conditions stated in the policy document, the expenses incurred in the process of organ donation are covered to the extent mentioned in the policy.

• Free Health Check-ups

  Most of the health insurance companies offer in-built add on cover of free health check-up. Policyholders are also required to undergo free health check-up at the time of renewal of the policy

• Benefit for Senior Citizens

  Health insurance service providers usually deny renewing policies for senior citizens. But such is not the case under family health insurance policies. Most of the health insurers allow life-long renewal of the policies.

• Tax Benefit

  Apart from other benefits offered, Family Health Insurance Policies also extend tax benefits. The premium paid towards medical insurance for families is eligible for deduction u/s 80D of the Income Tax Act, 1961.

• Grace Period

  Family Health Insurance service providers provide a grace period of 30 days from the date of expiry of the policy.

• Free Look Period

  If the policyholder is not satisfied with the terms and conditions mentioned in the policy, he has the option to cancel the policy during the free look period. A free look period of 15 days is allowed under Family Health Insurance Policies

• Cumulative Bonus

  Most health insurance policies for families have cumulative bonuses that can add on to the Sum Assured. By not having to issue a claim during the policy tenure, the policyholder can get an additional cumulative bonus to the Sum Assured at the end of the policy tenure of 5%.

Inclusions of Family Health Insurance Plan

In comparison to individual health policies, Family Health Insurance policies are a better choice. It is mandatory to safeguard your family against medical emergencies. Following is a list of common inclusions of a Family Health Insurance policy:

• Hassle-free Claim Settlement
• Cashless Treatment
• Hospital Cash Benefit
• Restoration of Sum Assured
• Cover for Pre and Post Hospitalisation Expenses
• Cover for Pre-existing Diseases
• Domiciliary Treatment
• In-patient hospitalisation
• Free Medical Check-ups
• Life-long Renewal of Policy
• Day Care Procedures
• Ambulance Charges

Exclusions of Family Health Insurance Policy

In addition to knowing what is covered in a family health insurance policy, it is also very important to have a clear understanding of what is not covered by it. Before buying health insurance policy for family, make sure to read the policy terms and conditions carefully.

Following is a list of common exclusion of a Family Health Insurance policy-

• Claim during Waiting Period

  Any claim raised within 30 days of the waiting period.

• Pre-existing Medical Ailments

  Some health insurers do not cover pre-existing diseases such as joint treatment, cataract, kidney stones, etc. Generally, pre-existing diseases have a waiting period associated with them, depending on the severity of the disease

• Pregnancy

  Expenses towards child-birth, pregnancy related tests, fertility treatment, vaccination, abortion, and miscarriage are some amongst many.

• Alternative Treatment Costs

  Magic therapy, aroma therapy, homeopathy, and other non-allopathic treatments are excluded from being covered under Family Health Insurance policy.

• Abuse of Toxic Substances

  Any health issue arising due to excessive intake of toxic substances such as drugs and alcohols are not covered under health insurance policies. For e.g. liver cirrhosis due to excessive drinking

• Dental Treatment

  Any cost incurred towards oral and dental treatment is not provided for

• Cosmetic Treatment

  Cosmetic treatments and procedures done with the intention to enhance looks is not covered under Family Health Insurance policies. However, cosmetic surgery done in cases of accident or injury is usually covered

• Expenses Due to Suicide Attempts

  Family Health Insurance plans do not cover expenses incurred in relation to injuries caused intentionally. This includes any medical expenses arising due to self-harm or suicide attempts

• Diagnostic Fees

  No claim shall be reimbursed towards expenses incurred for diagnostic tests that show no positive result. If tests show positive and the person is required to be hospitalised, in such case the insurer shall cover the costs related to it

• Sexually Transmitted Disease

  Health insurance policies for family do not cover sexually transmitted diseases (STDs) such as AIDS or HIV. The insurer is under no liability to provide cover for STDs under no circumstance.

• Mental Disorder

  Any loss or damage caused due to mental disorder of the policyholder shall not be covered under the family health insurance policy.

• Cap on Hospital Expenses

  It is crucial to read the terms and conditions because insurance service providers often put a cap on expenses. For e.g. If your total room rent is Rs.3,000 per day and your health insurance policy allows only Rs.2,500 per day. This means that you will have to pay the balance Rs.500.

  In order to be fully aware about the upper limit of expenses, you should thoroughly go through the policy documents before buying.

• Genetic Conditions

  Depending on the plan and insurance agency, the insured may not revise coverage if he or she suffers from a medical condition that is hereditary or genetic in nature.

• Self-Harm

  The insurer is not liable to provide coverage if the policyholder has faced a medical situation as a result of self-harm. Deliberate actions that cause self-harm like attempted suicide or self-harm brought by conscious actions shall not be covered by the insurance agency and their health insurance plans.

  When comparing different family health insurance policies, it is always beneficial to carefully compare and weigh different inclusions and exclusions of different policies. This will help in making a better choice and finding the optimal policy for you.

How to Claim Family Health Insurance Policy?

When you are buying a medical insurance for family, you should make sure that the health insurance service provider has a high claim settlement ratio. This ensures that you don’t have to run pillar to post in case of emergent situations. Don’t forget to check the terms and conditions related to claim before investing in the insurance policy.

The claim process for Health Insurance Plans for Families is the same as any individual health insurance policy.

The following steps are to be followed while filing a cashless family health insurance claim:

Emergency Situations

In case the hospitalisation is sudden and unplanned, for e.g. in case of an accident, the following steps are to be followed:

• Step 1: Approach a Network Hospital

  • The first steps towards a cashless claim settlement are approaching a hospital that is included in the network of hospitals of your insurance service provider.
  • The list of network hospitals can be easily availed from your insurer’s official website.

• Step 2: Contact the Insurer

  • The health insurance company or the third-party administrator (TPA) is required to be informed within 24 hours of hospitalisation.
  • Such intimation is required to generate the claim intimation or the reference number

• Step 3: Arrange the Documents

  • In order to avail the cashless claim facility, the below mentioned documents are required to be procured:
    • Insurance card of the member hospitalised
    • Copy of the policy of the member admitted in the hospital
    • Identity proof of the member with Photo
    • Address proof of the person hospitalised
    • A duly Filled CKYC Form

• Step 4: Filling the Cashless Hospitalisation request form

  • A duly filled form for cashless hospitalisation is required to be filled and submitted to the insurer.
  • The number of hours within which the form is required to be submitted, in case of emergency situations, is mentioned in the policy document.

• Step 5: Procuring the Authorisation Letter

  • Once the insurer receives the Cashless Hospitalisation request form, it shall go through the documents and issue an authorisation letter.
  • In case of approval of your cashless claim request, the health insurance company shall directly pay your medical bills to the hospital.
  • In case of rejection, the insurance company shall intimate you the same via email and SMS. This intimation will also include the reason/s for rejection of your claim.

Planned Hospitalisation

In case you have planned a treatment or surgery on a particular date and are aware of the hospitalisation, the following steps are to be followed:

• Step 1: Intimate the Insurance Service Provider

  • In cases of planned hospitalisation, the policyholder is required to intimate the insurer about the same minimum 5 days prior to the treatment.
  • Such intimation can be made via an email or submitting a letter for availing the cashless claim facility.

• Step 2: Wait for the Approval

  • After the health insurance provider receives your request for cashless claim, they shall notify the hospital about the same and send you a confirmation.
  • Such letter is valid only for a particular period of time from the date of issue.

• Step 3: Submit the Letter of Approval

  • Once you have received the letter of approval from your health insurance service provider, all you need to do is submit it at the hospital desk on the date of admission.
  • After this the insurer shall directly pay your medical bills to the hospital.
  • In case of rejection, the insurance company shall intimate you the same via email and SMS. This intimation will also include the reason/s for rejection of your claim.

The following steps are required to be followed to raise a Reimbursement Claim with your family health insurance provider:

Reimbursement Claim

• Step 1: Verify the Accuracy of the Details

  • It is important to cross-verify the details of the medical bills before paying them.

• Step 2: Procure the Required Documents

  • A number of documents are required to be submitted to raise a reimbursement claim. Some of them are:
    • Duly filled and signed Claim form
    • Insurance Card or Policy Copy
    • Medical Certificate signed by the doctor
    • Pathological reports like X-ray reports
    • Hospital discharge card
    • Original Bills and receipts
    • Original Pharmacy bills
    • Investigation report, if any
    • In case of an accidental claim, a copy of FIR / MLC is required
    • NEFT Details for crediting the amount of Claim Settlement
    • Duly Filled CKYC Form
  • It may happen that all of the above documents may not be available immediately at the moment. The claimant should do a follow-up to procure all the necessary documents

• Step 3: Submit the Documents

  • Once you have the documents in hand, submit it to your insurance service provider or the TPA, as specified by your insurer.

• Step 4: Wait for Approval of Claim

  • After the insurer or TPA has received your documents they will review it and start processing your claim.
  • In case of rejection of your reimbursement claim, the insurance company shall intimate you the same via email and SMS. This intimation will also include the reason/s for rejection of your claim.

Renewal Process for a Family Health Insurance

Step 1: Log in to your insurer’s official website and click on the ‘Renewal’ link.

Step 2: Fill in the required details such as policy number, member ID, and all other information as asked by the insurer.

Step 3: After you have duly filled the required information, pay the premium amount of your family health insurance policy.

Step 4: Once the payment is made and your policy is successfully renewed, you will receive an intimation regarding the same via email and/or SMS.

If you are opting for offline renewal of your policy, then you can also visit the nearest insurance branch of the company from which you have purchased your policy. Submit a copy of the original health insurance policy. Attach the required documents and pay the renewal premium upfront or through net banking.

Offline renewal has the added advantage of consulting with an insurance agent on the spot in case of any queries or doubts.

Steps to Buy a Family Health Insurance

Buying a health insurance plan for family is an easy process. But before investing in one, you should compare and evaluate the different policies offered by various insurers.

Steps to buy the insurance Online:

Step 1: Visit the official website of the insurance company from which you wish to buy the family health insurance policies.

Step 2: Compare and contrast the different Family Health Insurance policy and plans that the company has to offer.

Step 3: Select the type of plan you wish to buy.

Step 4: Fill the required details about your family members you wish to include in the policy.

Step 5: After you have selected the policy type and filled the information, the final step is making the payment. Pay your premium amount through the online payment portals available on the website.

Once the payment is made, your Family Health Insurance policy will be emailed to you.

Steps to buy the insurance Offline:

Step 1: For buying Family Health Insurance policy offline, you need to visit the nearest branch of the opted family health insurance company.

Step 2: Get in touch with the insurer’s executive and comply with all the procedures.

A vital aspect that should be kept in mind while purchasing a health insurance policy is to compare plans with each other before finalising. This not only applies to the different plans of a single company. Comparing plans and policies across different insurance firms will help generate a better idea of what you are looking for in your health insurance. This will make the decision making process easier and will help you find the perfect plan that caters to your needs and specifications.

When purchasing a health insurance policy, it is always advised to consult your general physician to have a better understanding of where you stand medically.

Also, consulting an insurance agent for choosing the right policy will also facilitate the process even more.

Family Health Insurance – Frequently Asked Questions