What are Family Health Insurance Plans?
Family Floater Health Insurance relates to a type of insurance that essentially covers your medical expenses. A health insurance policy like other policies is a contract between an insurer and an individual/group in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy.
Frequently Asked Questions
You should check out these factors before buying an insurance-
1. Is the coverage level sufficient?: Hospitalization plans are those health insurance plans that reimburse the hospitalization and medical costs of an individual, subject to the sum insured. Hence, these plans are also known as indemnity plans.
2. The limit on covered expenses: Family health insurance plans cover the entire family in one health insurance plan. It works under the assumption that not all members of a family will suffer from illness at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.
3. Check the waiting period: As the name suggests, senior citizen health insurance plans are for the older people of the family. These plans cover health issues arising during old age. As per IRDAI guidelines, each insurer must provide cover up to age of 65 years.
4. Co-Payment: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses.
5. Network of Hospitals: Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalization.
What is covered in Family Floater Plans
1. Cashless facility: The insurance company issues an identity card to the Insured and on showing this card on the networked hospital, he/ she can avail cashless facility meaning insurance holder need not pay anything to the hospital. The Insurer would have a tie-up on almost all the hospitals already to facilitate cashless facility.
2. Hospitalization cash benefits: Every day hospitalization expenses are covered to reduce the financial burden of the insurance holder. This would be a great help to the insured as this amount would compensate for the loss of earnings and other costs.
3. Pre and post hospitalization costs: Usually pre and post hospitalization expenses are covered up to 60 to 90 days and some insurance company even approve up to 140 days. Most health insurance policies also cover domiciliary hospitalization.
4. Ambulance charges: Even ambulance charges are covered by some insurance company and the insurance holder need not worry about those charges.
5. Health checks up: In case there is no Claim for a certain number of years, some company even provides free health check up to the insured.
What is not covered in Family Floater Plans
1. Pre-existing diseases: Pre existing diseases are which you may have had prior taking the policy such as high blood pressure diabetes etc will not be covered under the health insurance policy; also the complications arising in the future due to pre existing diseases would not be covered. However, some companies do cover pre existing diseases after a continuous renewal of policy without any breaks.
2. Some specific medical condition: Some medical conditions such as hernia, cataract, gall bladder stone removal, calculus diseases, hydrocele, joint replacement, sinusitis, Fibromyoma, Benign prostatic hypertrophy, piles, fistula in anus and age related ailments like Osteoarthritis and Osteoporosis are not covered for a specific period of time, this time duration is different in each insurance company.
3. Cosmetic surgery: Cosmetic surgery are usually not covered in health insurance as it does not affect an individual life and it is not life threatening. Cosmetic surgery like liposuction, Botox and others are not part of the health insurance coverage.
Practical example that you can relate to:
- For instance, in a family floater plan of Rs.5 lakhs covering 4 members, any one member can make a claim up to Rs.5 lakhs. However, if one member has made a claim in a policy year, another member can make another claim only up to the remaining Sum Insured (which is 3 lakhs in this case). However, in an individual policy of Rs 5 lakhs can only be used by one single person. Now, if your wife or mother needs a higher claim than their individual policy coverage, then your coverage amount cannot be utilised.
Premiums payable for a family floater plan is cheap against the premium payable for insuring each family member under separate individual health insurance plans. This is the primary reason why family floater plans are preferred by most families. The probability of falling ill together is negligible. Thus it saves money and time. Since all family members are covered under a family floater plan, it reduces the hassles of managing multiple individual health plans of each family member. You have to remember one renewal date, pay renewal premium once and review your coverage one time too.
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