Health insurance policies are a smart way to reduce or eliminate expenses arising due to hospitalisation or other medical reasons. Health insurance plans can be purchased for a single individual or for the entire family. In case it is purchased to provide health cover for the entire family, the plan will be called a Family Floater Health Insurance Plan.
These plans offer a larger sum insured and they can be used in varying amounts by different members of the family. Family floater health insurance plans are usually much cheaper than buying individual insurance plans for each member of the family. They are also much easier to manage since there is only one master policy and only a single premium needs to be paid towards it.
A family floater health insurance policy can be utilised to cover all members of the family under a single insurance policy. It will reduce the hassle of managing multiple insurance documents and paying premiums for each of them. The benefits offered by the policy is similar to an individual health insurance policy wherein protection for in-patient care, day care, and pre and post-hospitalisation is provided. The benefits will differ from insurer to insurer.
A family floater will prove to be beneficial when parents cannot be covered under any other individual policy. The family floater will allow members to use the sum insured amount collectively. So, if a member uses a part of the money for his/her expenses, another member can use the rest of the sum insured at any time during the same policy year.
To demonstrate how a family floater health insurance plan will work, let’s make use of an example. Mr. Raheja has just purchased a family floater health insurance plan for his family of four, for a sum insured of Rs.15 lakh. A few months after he purchases this plan, his wife has to undergo a planned hospitalisation in a network hospital. The total cost of the hospitalisation comes up to Rs.3 lakh. All medical expenses related to her hospitalisation are covered by the family floater health insurance plan. Mr. Raheja and his family still have a total sum insured of Rs.12 lakh left for the rest of the policy term.
In case, this entire sum insured is exhausted by any one member of the family, Mr. Raheja cannot claim for any more hospitalisation expenses that may arise during the policy term. However, each member of the family can use varying amounts of the sum insured.
Family floater health insurance plans offer several benefits to the proposer and his/her family, such as:
Family floater plans are a cost-effective way to avail a comprehensive health insurance cover for all members of the family. The key features of these plans are listed below:
|Insurer Name||Plan Name||Age Range||Basis||Coverage/Sum Insured||Co-Payment||Waiting Period|
|Oriental Insurance||Happy Family Floater Policy 2015||18 – 65 years||Family Floater Plan||Silver Plan: up to Rs.5 lakh Gold Plan: up to Rs.10 lakh Diamond Plan: up to Rs.20 lakh||Silver Plan: 10% co-pay||Pre-existing diseases: 48 months|
|Max Bupa Insurance||Heartbeat Family Floater Health Insurance Plan||18 – 65 years||Family Floater Plan||Platinum Plan: up to Rs.1 crore Gold Plan: Up to Rs.50 lakh||Co-pay options: 10% or 20%||General medical treatment: 30 days Specific diseases: 24 months|
|Apollo Munich Insurance||Easy Health Family Floater Plan||18 – 65 years||Family Floater Plan||Standard Plan: up to Rs.15 lakh Exclusive Plan: up to Rs.50 lakh Premium Plan: up to Rs.50 lakh||Pre-existing conditions: 3 years Specific diseases: 2 years Maternity: 3 or 4 years, based on plan option chosen|
|Apollo Munich Insurance||Optima Restore Family Plan||5 – 65 years Children over the age of 91 days can be covered||Family Floater Plan||Up to Rs.50 lakh||General medical treatment: 30 days Pre-existing conditions: 3 years Specific diseases: 2 years|
|Apollo Munich Insurance||Optima Super Family Floater Plan||Adult members: 18 – 65 years Children over the age of 91 days can be covered||Family Floater Plan||Up to Rs.10 lakh||General medical treatment: 30 days Specific diseases: 24 months Pre-existing conditions: 48 months|
|Max Bupa Insurance||Health Companion Family Floater Plan||18 – 65 years||Family Floater Plan||Up to Rs.1 crore||Medical treatment: 30 days Specific waiting period: 24 months|
|Bajaj Allianz Insurance||Family Floater Health Guard Policy||Adult members: 18 – 65 years Dependent children: 3 months – 30 years||Family Floater Plan||Silver Plan: up to Rs.2 lakh Gold Plan: up to Rs.50 lakh||Co-pay of 20% if members residing in Zone B avail treatment in Zone A||Specific diseases: 2 years Bariatric Surgery: 36 months Pre-existing diseases: 3 years PIVD/ Joint replacement: 3 years Maternity expenses: 6 years|
|New India Assurance Co. Ltd.||Family Floater Mediclaim Policy||18 – 60 years||Family Floater Plan||Up to Rs.5 lakh||Co-pay percentage will be based on which zone the member avails treatment in||General Illnesses: 30 days Specific illnesses/diseases: 2 years or 4 years|
The Happy Family Floater Policy 2015 from Oriental Insurance offers health insurance cover for the proposer, the spouse, children, dependent parents and parents-in-law. Anybody between the ages of 18 to 65 years can purchase this plan. Policy buyers can also purchase additional riders, such as the Personal Accident cover and the Life Hardship Survival Benefit to customize their plan. There are three plan options to choose from – the Silver Plan, Gold Plan, and Diamond Plan. The benefits and sum insured for each plan will vary accordingly.
The Max Bupa Heartbeat Family Floater Health Insurance Plan comes with two plan options – the Gold Plan option and the Platinum Plan option. The minimum sum insured for the Gold Plan is Rs.5 lakh and the maximum sum insured is Rs.50 lakh. The minimum and maximum sum insured for the Platinum Plan are Rs.15 lakh and Rs.1 crore, respectively. This plan offers policy buyers a one-year or two-year policy tenure option. Anybody between 18 years and 65 years of age can purchase this plan.
The Easy Health Family Floater Plan from Apollo Munich comes with three plan options – Standard, Exclusive, and Premium plans. This policy can be purchased by anyone who is over the age of 18 years and under the age of 65 years. Policy buyers can also purchase an additional rider to protect themselves and their families from critical illnesses. You can choose a policy term of 1 year or 2 years, as per your needs. A maximum of 2 adults and 5 children can be included, under this policy.
The key benefit of the Optima Restore Family Plan from Apollo Munich is that the sum insured gets automatically reinstated, even if the whole sum insured amount is exhausted during the policy year. Policyholders are also offered a Critical Advantage Rider, if they opt for a Sum Insured of Rs.10 lakh or higher. Policy buyers can choose a policy term of 1 or 2 years. Anybody between 91 days and 65 years can be covered under this policy.
The Optima Super Family Floater Plan from Apollo Munich can be purchased by any adult who is over 18 years of age and under 65 years of age. Also, children over 91 days can be included under this policy. The premiums for this plan are linked to the age of the eldest family member. The primary benefit of this policy is that even if your total hospitalisation expenses were to cross the threshold limit, you can still claim for expenses over and above the said limit. You can choose a policy term of 1 year or 2 years.
The Health Companion Family Floater Plan from Max Bupa Insurance comes with 3 plan options. All three plan variants have top-up options. The minimum entry age for this plan is 18 and the maximum entry age is 65 years. You can choose a policy tenure of 1 year or 2 years, under this plan. The key benefits of purchasing this plan include guaranteed plan renewal for the proposer’s lifetime, direct settlement of claims, cashless facility, etc.
The Family Floater Health Guard Plan from Bajaj Allianz offers members many benefits, including cover for pre-hospitalisation and post-hospitalisation expenses, reinstatement of the sum insured, a 1-year, 2-year, or 3-year policy term option, cover for day-care procedures, etc. Prospective policy buyers under the age of 45 years don’t have to undergo any medical tests. This plan also provides cover for maternity expenses and new born baby care expenses, after the due waiting period has been completed. The proposer needs to be a minimum of 18 years and a maximum of 65 years in order to purchase this policy. Dependent children between the ages of 3 months to 30 years can be enrolled under the policy. The floater policy can be used to provide health cover for the proposer himself/herself, the spouse, and any dependent children.
The Family Floater Mediclaim Policy from New India Assurance will cover health-related expenses of the proposer, the spouse, and a maximum of 2 children. The premiums for this plan will be based on the entry age of the proposer. This policy offers many benefits such as cover for pre- and post-hospitalisation expenses for a 30-day and 60-day period, respectively, cover for day-care procedures, a good-health discount, and a loyalty discount, among others. The policy can be purchased by anyone over the age of 18 years and under the age of 60 years. Those over the age of 60 years can be enrolled if they were insured under this policy in the past, continuously, without any breaks. The floater cover can be used by the proposer, the spouse, and a maximum of 2 children.
Listed below are a few general exclusions under which the insurer will not be liable to pay your claim for hospitalisation expenses:
Each insurer’s exclusion criteria may vary, and hence you must ensure you read your policy document for plan-specific exclusions.
The proposer might be required to undergo a medical examination, based on his/her age, at the time of purchasing the policy. Some insurers will pay for the medical examination, provided it is deemed satisfactory, while in some cases, you might have to bear the costs of the medical examination in part or full. Medical examinations are usually not required if you renew your policy every year.
Policyholders can claim for tax benefits under Section 80D of the Income Tax Act, 1961, for all premiums that they pay. Individuals below the age of 60 years can avail tax benefits for up to Rs.25,000 of their taxable income, and senior citizens can avail tax benefits for up to Rs.30,000 of their taxable income.
Each insurer will have a list of network hospitals, in which you can avail cashless hospitalisation facility. However, even if you choose to have your treatment at a non-network hospital, you can file for reimbursement, and the insurer will compensate you for your expenses. Most insurers will have the network hospital list on their official website.
In most cases, the insurer will pay the entire hospitalisation expense, excluding the non-medical expenses. If you have opted for co-pay, you will have to pay a percentage of the medical bills on your own. Further, if your treatment falls under the insurer’s exclusion criteria or if the claim happens while you are still on your waiting list, you will have to pay the hospitalisation charges out of your pocket. Also, if your treatment exceeds the sum insured, you will have to pay the difference amount.
Medical expenses are actual, valid expenses that the insured has incurred due to hospitalisation. Examples of medical expenses include procedure charges, post-hospitalisation expenses, pre-hospitalisation expenses, etc. Non-medical expenses are usually not paid for by the insurance company. Expenses such as registration desk charges, charges for toiletries, etc. fall under this category.
Most family floater health insurance policies will cover the proposer, the spouse and 2 children. However, some plans will also allow the proposer to include more children, parents, parents-in-law, grandparents, etc., under the policy, for an additional fee.
Your insurer will calculate your premium based on a few factors, such as:
Almost all individual health insurance policies come with a waiting period, during which the insured cannot make a claim. The waiting period may differ from insurer to insurer, but the waiting period for general medical treatment is usually 30 days. Waiting period for specific illnesses and pre-existing diseases will usually be anywhere between 2-4 years, or more.
Co-pay is a certain percentage of your hospitalisation bill that you will have to bear, out of your pocket. Co-pay percentages vary and not all insurers offer this option to members. However, opting for co-pay is one way to reduce your premiums.
Nowadays, many insurers have made a provision for you to renew your policy online, through the insurer’s website, by providing a few details like your name, policy number, etc. However, in case your insurer doesn’t offer online renewal of policies, you can also renew them at the nearest company branch.
In most cases, you can avail medical treatment even in different cities within India. However, some insurers categorize different cities into different zones, and if you avail medical treatment at a zone that’s different from the one that you live in, you might be liable to pay a certain percentage of the bill, out of your pocket. Also, you will have to check your insurer’s list of network hospitals in the new city, if you want to avail cashless treatment.
Not all insurers provide a Critical Illness Rider. However, if your insurer does, you can choose to purchase this additional cover/rider since it will offer additional protection for you and your family members.
A pre-existing condition is any condition or disease for which the symptoms were observed, diagnosed or treated, in the past, before your family floater health insurance policy was issued by the company. In order to raise a claim for hospitalisation expenses related to a pre-existing condition or disease, you will need to have completed the waiting period specified by your insurer.
Your corporate health cover will only be valid as long as you work for your employer. Further corporate health covers may or may not cover certain ailments or diseases, and the Sum Insured may also be quite low. In order to get comprehensive coverage that perfectly matches your needs, for your entire family, it is recommended that you purchase a Family Floater Health Insurance Policy.
If you have raised a claim for hospitalisation due to a certain ailment, any medical expense that you may have incurred a few weeks before and after the actual hospitalisation will be covered by your insurer. You will have to read your policy document in order to ascertain how many days pre and post your hospitalisation you can claim medical expenses for.