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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.
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.
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.
|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|
These are some of the common inclusions in family floater health insurance plans:
For a comprehensive list of exclusions, always read the policy document carefully.
For a family exceeding 4 members, there may not be strict eligibility criteria, depending on the insurer.
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.
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.
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.
The general claims process is given below:
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.
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.
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.
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.
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.
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.
If you choose to get treated at a non-network hospital, you will get reimbursement, but not cashless hospitalisation.
If your policy is renewed every year, then it is not required.
The list of network hospitals will be provided to you or will be available on the website of the insurer.
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.
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