Family Floater Health Insurance

 The increasing cost of healthcare has made it crucial for everyone to have health insurance. A health insurance policy provides financial support in the event of a medical emergency or even a planned medical procedure. 

What is family floater health insurance? 

A family floater health insurance, also called family health insurance plan, is one in which one or more members of the family are covered under one plan. It will have a single annual premium and a fixed sum insured. The premium to be paid is dependent on the age of the family members. It usually covers the policyholder, spouse, and up to 4 children. There are plans in which parents, siblings, and extended family members (such as in-laws) are also covered for an additional premium. 

How do family floater health insurance plans work? 

A family floater health insurance provides a sum insured that can be used by all the members of the family who are covered under the plan. Different amounts can be used by different members according to the individual requirement. Depending on the plan, even if two or more family members need to be hospitalised or undergo a treatment at the same time, coverage will be provided. In the event that the entire amount of the sum insured is required for one family member alone, further claims for any other family member cannot be raised. 

To illustrate this in detail, let’s look at the following example: 

Mr. Venkatesh has a family floater health insurance plan for his family of 6 with a total sum insured of Rs.12 lakh. His mother-in-law was hospitalised at a network hospital with the cost of the treatment going up to Rs.5 lakh. This means that there is a total of Rs.7 lakh remaining from the sum insured to cover any future medical expenses for the rest of the family members. Within the Rs.7 lakh limit, the other family members can avail coverage for varying amounts. 

Family Floater Health Insurance Plans available in India 

Benefits and features of a family floater health insurance plan 

• Cost savings: Buying an individual health insurance policy for each person in the family can be a drain on your finances. A family floater health insurance plan is more cost effective. Some providers also provide rebates when you choose a higher sum insured which results in even more savings. 
• New member additions: New members of the family can be added into the existing plan without the need to take out a separate one for them. 
• Sum insured is larger: Sum insured for each person will be lower under an individual health insurance policy whereas in a family floater plan it will be much higher. 
• Streamlined policy/premium: You can save time with a family floater plan because it makes it easier to pay, track, and manage payment of premiums. 
• Tax savings: Premiums paid are eligible for tax benefits under Section 80D of the Income Tax Act 1961. 
• Restoration of coverage: Some providers offer a feature called Restore Benefit, where you can restore the full coverage if it has been exhausted during the policy period as long as it is for claims that are unrelated. 
• Cashless hospitalisation: Getting your medical expenses reimbursed afterwards can be a hassle and financially challenging as you need to pay the bills upfront. However, with a family floater health insurance plan, you can get cashless treatment in network hospitals.  
• No claim bonus: If there have been no claims during the policy period, you will get an increase in sum insured the next year when the policy is renewed. 
• Flexibility in policy terms: There are different options available in policy terms, ranging from 1 to 3 years. This is convenient if you don’t want the hassle of remembering to renew your policy every year. 
• Newborn and maternity cover: This is very beneficial for those who are planning a family although there is a waiting period for this that varies from insurer to insurer. 

Inclusions of family floater health insurance plans 

These are some of the common inclusions in family floater health insurance plans: 

1. Pre-hospitalisation cost: Any expenses related to diagnostics or tests before hospitalisation. This can include sonography, blood tests, MRI, x-rays, urine tests, etc. 
2. In-patient hospitalisation cost: If the duration of the hospitalisation exceeds 24 hours, all the associated expenses will be taken care of under the plan. 
3. Post-hospitalisation cost: Any follow-up medical tests or medicines to be taken after discharge is covered under the plan. 
4. Hospital cash: A daily cash allowance for transportation and other expenses is provided for the person who is attending to the patient. 
5. Ambulance expenses: Emergency ambulance charges are provided for and vary from insurer to insurer. 
6. Daycare treatment: These are treatments that can be completed in under 24 hours, such as cataract surgeries, etc. 
7. Restore benefit: If the entire coverage gets over within the policy period, the Restore Benefit restores the basic cover but is only applicable for unrelated claims. 

Exclusions of family floater health insurance plans 

1. Treatment for fertility issues. 
2. Treatment for sexually transmitted diseases. 
3. Claims raised during the waiting period (usually 30 days) of the policy unless it is an accident-related claim. 
4. Gender change or gender reassignment surgeries or treatments. 
5. Routine medical checkups. 
6. Treatments related to plastic surgery or other aesthetic procedures and consequences of such treatments. 
7. Artificial life maintenance, which includes the use of a life support machine, in cases where recovery may not be possible. 
8. Treatments undertaken in foreign countries. 
9. Out Patient Department (OPD) treatments. 
10. Treatment due to abuse of depressants or stimulants. 
11. Injuries or illnesses caused due to the abuse of intoxicating drugs, alcohol, hallucinogens, or tobacco. 
12. Treatment of mental illness, stress, or psychological disorders. 
13. Treatments related to pregnancy, abortion, childbirth (including Caesarean section), miscarriages (with the exception of miscarriage due to accidents), or associated complications. 
14. Attempted suicide, suicide, or self-injuries when insane or sane. 
15. Illnesses or injuries that, directly or indirectly, arise from or caused by breach of law by the insured with any criminal intent, nuclear/biological/chemical attack, civil war, war, hostilities, acts of foreign enemies, military or usurped power, mutiny, insurrections, revolutions, detainment, restraints, capture, seizure, arrest, of any kind. 

For a comprehensive list of exclusions, always read the policy document carefully.  

Eligibility criteria for family floater health insurance plans 

For a family exceeding 4 members, there may not be strict eligibility criteria, depending on the insurer. 

• Age of entry: For adults, it is 18 and for children, it is from 30 days to 25 years. The maximum age for adults is 65 to 70 years. The policyholder is almost always the eldest person in the family and the entry age ranges from 18 to 70 years. 
• Medical tests: Some insurers do not require medical tests for up to 45 years of age while some have mandatory medical tests which are carried out at nominated centres. 

Waiting period for family health insurance plans 

You cannot raise a claim during the waiting period with some insurers making an exception for accidents which are covered from the first day. The waiting period for general medical treatments is usually 30 to 90 days. Depending on the insurer, pre-existing illnesses can have a waiting period of up to 48 months.  

Documentation required 

• Age proof: Certificate of birth 
• KYC: Proof of identity and address of all the family members 
• Medical reports: For family members above 45 years of age 
• Photographs: Two passport-size photographs for each family member 

Process for renewal of family floater health insurance policy 

You can easily renew your policy on the website of your insurer or by visiting the nearest branch office. To renew online, you will have to log in to your account with your registered user ID and password. Then you would have to enter your policy number and select the renewal option. Payment can be made online through net banking, credit card, debit card, etc. 

There is a grace period of 30 days given to renew your policy after the due date. If the policy is not renewed within this period, it will be terminated. 

Types of family floater health insurance policies 

There are two broad categories of a family floater health insurance policy. These are: 

Critical illness insurance: This provides coverage against diseases such as kidney failure, stroke, heart attack, etc. However, it cannot be purchased for the entire family as a single policy. 

Medical insurance: The cost of hospitalisation subject to the treatment is borne by the insurer in the form of reimbursement or cashless hospitalisation. 

Claims process 

The general claims process is given below: 

Reimbursements: 

• Bills are paid by the policyholder/family. All bills and original documents should be kept carefully. 
• Submit the reimbursement form to the insurer’s or TPA’s claims team along with all the hospital bills, reports, and original documents. 
• Claims are validated by the claims team. 
• Once cleared, the money is reimbursed to the policyholder. 

Cashless treatment: 

• Submit the insurance ID card at the insurance desk of the hospital before the hospitalisation. 
• Identity is verified by the hospital. 
• A pre-authorisation form will be provided which has to be duly filled up and submitted. 
• The documents are checked by the insurer or TPA and approval is given subject to the terms and conditions. 
• A field executive will be assigned by the insurer who helps to simplify the process for the policyholder. 

Documents required for claims procedure 

• Discharge card 
• Medicine bills 
• Test results 
• X-rays and other imaging tests 
• Doctor’s written consultation report and receipts 
• Hospital bills signed and stamped by the hospital authorities 
• Any documents relevant to the treatment 
• Claim form of the insurance firm that is duly filled up and signed by the policyholder 

FAQs about family floater health insurance plans 

1. Is there any advantage to buying the policy online? 

Buying the policy online has several advantages. The first one is that you will be able to compare different plans from different insurers and get all the information you need in one place. The second benefit is that buying a policy online is usually cheaper since there is no payment of commission to an agent. It is also easier to renew and pay for your policy online. 

2. What is AYUSH Benefit? 

AYUSH Benefit gives coverage for Ayurveda, Unani, Siddha, and Homeopathy treatments. There is a percentage of the sum insured that you can use for these treatments, which differs from insurer to insurer, but is usually in the range of 7% to 25% of the plan. 

3. Will my family and I be covered if we move cities? 

Yes, you will be covered even if you move to a different city within India. However, this would be dependent on the network of hospitals with which your insurer has partnered for cashless treatment. Sometimes, cities are divided into different zones by the insurer which means you may have to pay an amount out of your pocket if you change cities. 

4. Is a family floater health insurance policy required if I am already covered under my corporate health insurance policy? 

Your corporate health insurance cover is only valid as long as you are employed. Also, the sum insured may be low and not all diseases may be covered.  

5. What is the co-pay option? 

Co-pay feature is one in which you pay a certain percentage of the expenses out of your pocket, which can help bring down your premiums. However, this is offered by only a few insurance companies. 

6. How is the premium calculated? 

Premium is calculated based on factors such as age of the proposer, sum-insured, percentage of co-pay (if any), city of residence, pre-existing diseases, etc. 

7. If I want to get treated at a non-network hospital, will I still get coverage? 

If you choose to get treated at a non-network hospital, you will get reimbursement, but not cashless hospitalisation. 

8. Are medical examinations required at the time of renewal also? 

If your policy is renewed every year, then it is not required. 

9. How do I find out if a hospital is on the list of network hospitals? 

The list of network hospitals will be provided to you or will be available on the website of the insurer. 

10. Is it possible to change the hospital in the middle of a treatment and will it be covered? 

Yes, you can change hospitals if required for better medical treatment. It will be evaluated by the TPA and approved based on terms and conditions.