Health Insurance

Best Health Insurance Plans for Family in India

by SMCIB on Tuesday, 05 December 2023

Best Health Insurance Plans for Family in India

After a long day at work, we come home to heal and recharge, before we tackle the next challenge. No matter where we go, our family is always there for us, so we should also stand by them when they need us the most - through health and sickness. This means it is our duty to ensure that they have the best possible health care and support, whenever the need arises.

Medical inflation is skyrocketing, driving up the cost of healthcare. Without a proper financial buffer, you can end up in a financial bind, especially when there is a medical emergency. A health insurance policy is the financial preparation you need.

If you want to cover your entire family under one plan, you can choose a family floater policy. In today's market, there are many options to choose from. So, how do you find the best one from the lot?

In reality, there is no such thing as the 'best' policy. You need to choose a health plan that offers the features and benefits you need, and purchase it from the right insurance company because that's what makes it the best.

Having said that, let's discuss health insurance plans for families in India. What are their benefits? And, what are the top health insurance policies available for families on the market?

 

What is Family Health Insurance?

Family health insurance, also known as a family floater plan, allows you to protect several family members with a single health insurance policy. Under this plan, the total sum insured is divided among the covered family members. This means that it offers financial protection for the medical expenses of various family members, all under the umbrella of a single insurance policy.
 

Health Insurance For Families

A family floater policy, which covers your entire family under a single policy, is one of the popular types of health insurance plans you can consider for your family. The cover amount is shared by your family members under this policy. If one family member needs expensive medical treatment, they can utilise the entire cover amount.

In any case, the insurer shall pay for the hospitalisation expenses only up to the sum insured and the policy’s terms and conditions. Hence, the claim amount should be as per the policy terms and not exceed the sum insured, regardless of whether one or more members make a claim.

For example, Rakul lives with her spouse, son, and mother. She buys a family floater policy with a sum insured of Rs 30 lakhs covering all of them. Her husband requires immediate kidney surgery which costs around Rs 15 lakhs. The family floater policy will cover his surgery expenses. She also needs to undergo hernia surgery the same month, which costs around Rs 4 lakhs. Two months later, her mother undergoes knee replacement surgery that costs Rs 3.5 lakhs. All of these hospitalisations happen in the same year - and, the treatment costs shall be covered by the family floater policy.
 

Benefits Of Family Floater Policy

  1. Cheaper Than Individual Plans

    Since the entire family is covered under one plan, you are able to get large coverage at a lower price. As a result, your overall premium will be lower. For example, if you purchase 3 individual policies for your 3-person family, each with a sum insured of Rs 10 lakhs, you may have to pay higher premiums than if you purchased a family floater policy of Rs 30 lakhs.

    Note: It is important to note that some family floater policies can cost more than individual health insurance policies for the same number of people.

  2. Family Members Can Share One Large Cover

    As mentioned earlier, each member of the family shares the coverage, so the entire sum insured under a family floater policy can be used even if one of the family members becomes seriously ill and requires hospitalisation. It is highly unlikely that all members of the family will fall sick and require hospitalisation in the same year, so this is a suitable option for families.

  3. Managing One Policy Is Easier

    With a family floater policy, all of your family members are protected under one single policy, so you only have to handle one plan and pay one premium. This makes policy management a breeze.

  4. Easy To Add New Family Members

    Adding a family member to an existing family floater policy is simple and easy. When it comes to individual health insurance, you have to purchase a new policy for each member. A family floater policy, however, allows additional family members to be covered for an additional premium.

    If you are adding new members to an existing family floater policy, make sure you increase the sum insured - to ensure adequate coverage.

  5. Tax Benefits

    This policy also offers tax benefits. Under Section 80D of the Income Tax Act of 1961, you can claim tax benefits on your annual premiums for family floater policies.
     

Benefits of Buying Health Insurance Plans for Family

When you buy family health insurance, also known as a family floater plan, you can enjoy the following benefits -

  • Comprehensive Coverage for the Whole Family
    Family health insurance, also known as a family floater plan, is like a big umbrella that can protect multiple members of your family under a single cover.

     
  • Shared Sum Insured
    The sum insured or cover amount is shared among all covered family members.

     
  • Flexible Family Member Inclusions
    You can include yourself, your spouse, dependent children, parents, and parents-in-law in family health insurance, also known as a family floater plan. Some plans even allow you to add additional family members like aunts, uncles, or siblings. However, there are usually some rules and limits on how many adult members and dependent children you can include. Please note that such specific rules can vary between insurance companies.

     
  • Streamlined Administration and Documentation
    By having just one policy, managing health insurance for your entire family is easier than ever. However, you may still need to provide medical declarations. And, in some cases, all family members may need to undergo tests. But once the policy is approved, you will not have to deal with multiple documents, pay numerous premiums, or worry about missing payments and losing coverage.

     
  • No Strict Usage Restrictions
    In family health insurance, also known as a family floater plan, there are no strict restrictions on how much cover each family member can use. Also, it is unlikely that everyone in your family will need major hospitalisation in the same year. So, if one family member gets seriously ill and requires expensive treatment, the entire cover amount is available for their treatment. For example, if you have Family health insurance, also known as a family floater plan, with a cover amount of Rs. 30 lakhs for three members and one member falls ill, the entire sum insured is available for their treatment.

 

What Does A Family Health Insurance Plan Cover?

Family health insurance, also known as a family floater plan, takes care of several expenses, including –

  1. Inpatient Hospitalisation Expenses
    Costs incurred when you or a family member stay in the hospital for more than 24 hours, such as room and board charges, nursing fees, the expense of prescribed medications, ICU fees, and other related costs are covered.

     
  2. Pre and Post Hospitalisation Expenses
    The plan also covers expenses incurred both before hospitalisation such as consultations, tests, checkups, lab reports, and other pre-hospitalisation costs. And expenses related to medical check-ups, rehabilitation sessions, and physiotherapy that you incur after you are discharged from the hospital are also covered. However, all such expenses must be related to the condition that led to hospitalisation and your claim must be approved under inpatient hospitalisation  to be eligible for coverage.

     
  3. Day Care Procedures
    Family health insurance plans provide coverage for day care procedures, i.e. treatments which no longer necessitate a prolonged 24-hour hospital stay, thanks to advancements in medical technology. These plans encompass a broad range of treatments, such as cataract surgery, dialysis, etc. ensuring that you and your loved ones receive adequate financial support for evolving healthcare needs.

     
  4. Domiciliary Treatment
    Domiciliary treatment are medical treatments or procedures that are carried out at home when a patient's condition is too severe to be taken to a hospital or when local hospitals have no available beds. Many family health insurance plans (also known as family floater plans) include coverage for such domiciliary treatment expenses.

     
  5. Organ Donor Expenses
    In some cases, family health insurance plans (also known as family floater plans) may also provide coverage for organ transplantation, if  the insured individual is the recipient. Expenses related to harvesting the organ from the donor during the transplantation process are typically covered.

     
  6. Modern Treatment Coverage
    Health insurance plans for families include coverage for modern treatments such as balloon sinuplasty, stem cell therapy, etc.

     
  7. AYUSH Treatments
    Many family health insurance plans also provide coverage for AYUSH treatments, which encompass alternative therapies like Yoga, Siddha, Ayurveda, Homoeopathy, Naturopathy, etc.

Note: The terms and conditions associated with the coverage may differ between insurance providers.

What Does a Family Health Insurance Plan Not Cover?
Exclusions are situations your health insurance will not provide coverage for. They include -

  • Standard Permanent Exclusions
    The Insurance Regulatory and Development Authority of India (IRDAI) has instituted a list of ‘standard permanent exclusions' that all insurance companies need to follow. Some of them include –
  1. Obesity/Weight Control: Surgery or treatment for weight control or obesity.
  2. Observation: Hospital admission for observation purposes only.
  3. Rest and Respite Care: Admission to a facility to rest, without active treatment.
  4. Gender Change: Treatment to change your body's characteristics to the opposite sex.
  5. Plastic/Cosmetic Surgery: Surgeries or treatments for change of appearance or body characteristics.
  6. Hazardous Sports: Expenses for injuries while engaging in extreme sports like skydiving, snorkelling, scuba diving, bungee jumping, etc., as a professional.
  7. Criminal Activity: Medical costs incurred for someone who committed or tried to commit a crime, resulting in breach of law.
  8. Excluded Providers: Treatment from a doctor or hospital not covered by your health insurance policy.
  9. Narcotics: Treatment for addictions like alcohol, drugs, etc.
  10. Domestic Establishments: Expenses for treatment taken in health spas, nursing homes, or places for domestic purposes.
  11. Diet Supplements: Buying vitamins, minerals, etc. without a medical practitioner's prescription.
  12. Refractive Errors: Expenses related to correcting vision refractive issues up to 7.5 diopters for better eyesight.
  13. Unproven Treatments: Medical procedures that are not proven to be effective.
  14. Birth Control and Fertility: Contraception, sterilisation, artificial insemination, advanced reproductive tech like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  15. Maternity Expenses: Costs related to pregnancy and childbirth, including pre/post-natal care, etc.
  • Additional Permanent Exclusions
    Apart from the above-mentioned standard permanent exclusions, insurance companies might add other exclusions for specific situations or medical conditions. If you have certain diseases or severe medical problems that insurers regard too risky to cover, they might permanently exclude them from your policy. But it is important to know that insurers can only apply permanent exclusions to illnesses or diseases that are present on the list provided by the Insurance Regulatory and Development Authority of India (IRDAI). This means that they cannot exclude illnesses or diseases that are not mentioned on that list.
  • Temporary Exclusions or Waiting Periods
    After getting a health insurance plan, some illnesses may not be covered for a certain period of time. This timeframe is called the waiting period. Once this period is over, you can claim for these conditions.

    Some of the commonly applicable waiting periods are –
     
  • Initial Waiting Period
    There is an initial waiting period of 30 days for all medical conditions, except for accidents. This means, for the first 30 days, you cannot make a claim for hospitalisation unless it is due to an accident.

     
  • Waiting Period for Pre-Existing Diseases
    A pre-existing disease is any medical condition or illness you have had within 48 months before applying for health insurance. There is a waiting period of 2-4 years for pre-existing diseases and so, during this time, the policy will not cover expenses related to those pre-existing diseases.

     
  • Waiting Period for Specific Diseases:
    Insurers have a list of specific diseases or conditions that come with a waiting period, apart from your pre-existing conditions. This waiting period is decided by the insurer and does not depend on your current state of health. Typically, there is a 2-4 year waiting period for these specific diseases.


Eligibility for Family Health Insurance Plans

When it comes to buying health insurance for your family, the eligibility criteria can vary between different insurance providers. The minimum entry age for adults is around 18 years, while dependent children can be covered from birth or when they are just a few days or months old.

Most insurance companies offer policies that allow you to cover your immediate family members including yourself, your spouse, dependent children, parents, and parents-in-law. However, you might come across plans that also permit you to add other family members, like aunts, uncles, or siblings.

You should keep in mind that most insurers set certain conditions and limits on the total number of adult members and dependent children that can be added under a single family health insurance policy. These specific limits can vary from one insurer to another.

Also, the eligibility of family members for coverage might depend on their individual medical history and any pre-existing medical conditions. Before providing coverage, insurers may evaluate the health status of each family member.

 

Things To Keep In Mind When Getting a Family Health Insurance Plan

Here are a few important points to consider before choosing your health insurance plan –

1️⃣Limitations on Family Members
Before you buy a family health insurance plan (also known as a family floater plan) it is important to check how many family members it allows you to cover. You need to choose a plan that exactly matches your family's needs.

2️⃣Choose a Higher Cover Amount
In a family health insurance plan (also known as a family floater plan), the total cover amount is shared among all the family members and hence, you must choose an amount that can take care of everyone's medical needs. This will help ensure that no one faces inadequate coverage. It is important to understand that one big claim can use up your health cover for the rest of the year, especially if you have a plan with a low cover amount. So, to ensure the total sum insured is adequate for your family, it is recommended to go for a higher cover.

3️⃣Scope of Coverage
When choosing a health insurance policy, it is also crucial to consider the extent of coverage it offers. Ensure that the policy you select provides comprehensive coverage with minimal or no restrictions, such as low or no room rent limit, co-pay, etc.

Room-rent limits can result in deductions if the cost of your chosen room exceeds the predefined limit. This can also impact other hospitalisation expenses related to the room. To avoid significant out-of-pocket expenses, you should opt for a plan that does not have room-rent restrictions.

The co-payment clause requires you to contribute a portion of the approved claim amount before the insurer pays for the rest. If possible, you should choose a policy with no or low co-payment to minimise your financial burden.

4️⃣Policy Limitations
Check your health insurance policy for any  coverage restrictions for certain diseases or treatments. Opt for one without these specific limits to ensure comprehensive coverage for your needs.

5️⃣Add-Ons and Riders
Check if your chosen plan offers add-ons or riders. Add-ons are extra benefits that can be added to your base policy at an additional cost. For instance, if critical illnesses like cancer run in your family, consider adding a critical illness rider to your family health insurance plan (also known as a family floater plan).

6️⃣Regular Premium Payments
To get continued coverage, it is crucial to pay your premiums diligently. Make sure the premium amount fits your budget and ensure that you never miss a payment to keep your coverage active.

7️⃣Restoration Benefit
Look for policies that provide a restoration benefit - a feature that promises flexibility in increasing the sum insured. Some family health insurance plans (also known as family floater plans) come with this feature, which restores or refills the sum insured if one family member exhausts it within a year. It ensures that other family members are not left without coverage. While some insurers provide it as a default feature, others offer this as an optional benefit.

 

Choosing the Right Sum Insured for Your Family Health Insurance Plan

Family health insurance plans (also known as family floater plans) act as a shared umbrella of coverage, where a single sum insured covers all members included in the plan. When deciding on the sum insured for such a plan, several factors should be taken into account, such as age, inflation, healthcare needs, etc. In order to ensure comprehensive protection for every family member, it is advisable to add the specific sum insured you had in mind for each individual.

This approach ensures that every family member has adequate coverage, even on the rare occasion when all family members require hospitalisation in the same year. This is why it is important to consider inflation and other relevant factors when determining your cover amount.


How to Purchase Health Insurance for Your Family Online from SMC?

Here’s how you can buy your family health insurance plan through SMC -

  1. First, go to our website at https://www.smcinsurance.com/.
  2. Upon opening our website, you will find a range of services we offer, including car insurance,  bike insurance, health insurance, etc.
  3. Navigate to the 'Health Insurance' option in the menu and click on it.
     
  4. Select the number of family members you wish to insure and enter their ages.
     
  5. Next, enter your phone number and PIN code.
     
  6. Click the 'View Quotes' button.
     
  7. You will see a list of health insurance plans we provide.
     
  8. The next step is to customise your health insurance plan to match your unique preferences. You can adjust factors like the cover amount, policy duration, add-ons, the type of health insurance, etc.
     
  9. Once you have personalised your plan, compare the various options available, review the policy specifics, examine the associated premium costs, etc.
     
  10. After careful consideration, choose the plan that best meets your family's health insurance requirements.
     
  11. To start the policy application process, click the 'Buy Now' button.

 

Essential Documents for Family Health Insurance

The documents that are required to be submitted for your family health insurance plan (also known as a family floater plan) might vary depending on the insurance company. However, some common documents include –

  • Proof of age
  • Proof of identity
  • Proof of address
  • Any medical test reports, etc.

 

Best Health Insurance Plans for Family in India

As a matter of fact, there is no such thing as a 'best' plan - Choosing the one that meets your and your family’s needs is what makes it the ‘best’. Here is a comparison of the top plans currently available in the market -

  Care Insurance - Care (Supreme) ICICI Lombard - Complete Health Insurance (Health Shield) Manipal Cigna - ProHealth Prime (Protect) Tata AIG - Medicare (Premier)
Room Rent Limit No limit No limit No limit Single Private AC Room
Pre-hospitalization Expenses

Covered up to sum insured

Covered for 60 days

Covered up to sum insured

Covered for 30 days

Covered up to sum insured

Covered for 60 days

Covered up to sum insured

Covered for 60 days

Post-hospitalization Expenses

Covered up to sum insured

Covered for 180 days

Covered up to sum insured

Covered for 60 days

Covered up to sum insured

Covered for 180 days

Covered up to sum insured

Covered for 90 days

Day Care Treatment Expenses All day care treatments covered All day care treatments covered All day care treatments covered 541 day care treatments covered
Modern Treatment Expenses Covered up to sum insured Covered up to sum insured Covered up to sum insured Covered up to sum insured
Organ Donor Expenses Harvesting expenses covered up to sum insured Harvesting expenses covered up to a maximum of Rs. 10 Lakhs Inpatient expenses covered up to sum insured Harvesting expenses covered up to sum insured
Domiciliary Treatment Expenses Covered up to sum insured Covered up to sum insured Covered up to sum insured Covered up to sum insured
PED Waiting Period 48 Months 24 Months 24 Months 24 Months
Specific disease Waiting Period 24 Months

24 Months

(3 Months for Hypertension, Diabetes and Cardiac conditions)

24 Months 24 Months
No Claim Bonus

Available

The bonus will increase by 50% in every claim free year. It will increase up to a maximum of 100% of the sum insured

Available

The bonus will increase by 10% in every claim free year. It will increase up to a maximum of 50% of the sum insured

Available

The bonus will increase by 25% in every claim free year. It will increase up to a maximum of 200% of the sum insured

Available

The bonus will increase by 50% in every claim free year. It will increase up to a maximum of 100% of the sum insured

Super No Claim Bonus

Available

The bonus will increase by 100%, up to a maximum of 500% of the sum insured

Available

The bonus will increase by 50%, up to a maximum of 100% of the sum insured

Available

The bonus will increase by 50%, up to a maximum of 100% of the sum insured

Not available

Refill/ reload of sum insured Available Available Available Available
Annual premium ₹18,213 ₹16,540 ₹21,340 ₹24,029

Please Note: The premiums are taken on 10.01.2023 for a family of 3 - a 30-year-old male, a 30-year-old female, and a 1-year-old son. The sum insured taken is ₹10 Lakhs and the premium amount is inclusive of taxes.

 

How to Raise a Claim Under Family Health Insurance Policy?

When it comes to settling health insurance claims, there are essentially two types -

  • Cashless Claims
    These claims apply when you receive medical treatment at a hospital that is part of your insurance company's network. A network hospital is one that has an agreement with your insurance provider. So, if you opt for a hospital from the list of network hospitals approved by your insurer, they will directly settle your medical expenses with the hospital.
  • Reimbursement Claims
    Under this option, you initially pay for your medical treatment expenses upfront. Following this, you can submit a reimbursement claim directly to your insurance company. After a thorough verification process, they will reimburse you based on the terms and conditions specified in your policy.

Let's now understand about the claim settlement process and the several essential steps it involves –

?Cashless Claims Under Family Health Insurance Policy
Here are the steps you need to follow to file a cashless claim -

Step 1: Eligibility Check
The first step is to determine if you are eligible for a cashless claim. This is especially important for medical conditions typically covered after a waiting period of 2 to 4 years.

Step 2: Cashless Service Availability
Make sure to check if your insurance company offers cashless services at the hospital where you intend to receive treatment.

Step 3: Check the Hospital Provider
It is important to confirm if your chosen hospital is not on the list of excluded providers, as this would make a cashless claim impossible. If it's not excluded, reach out to the hospital administration to ensure they accept cashless payments from your insurer.

Step 4: Understand Your Policy
You will need to understand the limits and conditions of your insurance policy. Check for any financial restrictions, such as room rent limits, ICU charges, or limits on specific diseases and treatments, particularly for planned medical procedures. Also, verify whether your policy covers non-consumable items and whether there is a specific list of items the policy will not cover. This thorough understanding will help you estimate potential out-of-pocket expenses.

Step 5: Prepare Essential Documents
For a smooth cashless claim process, it is crucial to have the necessary documents readily available –

  • A copy of the policy document or cashless card.
  • All previous medical records associated with hospitalisation, including initial consultation notes and follow-up documentation for any medical condition, whether it pertains to the current ailment or not.
  • KYC documents of the proposer, like PAN Card, Aadhar Card, and a passport-sized photo.
  • The patient's ID proof.
  • An FIR (First Information Report) if there was an accident.

Without these essential documents, your cashless claim could be rejected. This will result in you having to pay the bills upfront and then seek reimbursement. Therefore, it is essential to keep all the necessary paperwork easily accessible to ensure a hassle-free claim process.

Step 6: Notify in a Timely Manner
When you are planning for hospitalisation, it is important to initiate a claim request at least 3-4 days before your admission date. In cases of emergencies, this request should be made within 24 hours of your admission. The hospital will require specific details and documents from you to initiate a pre-authorisation request with your insurer for cashless claim approval.

Here are some documents that you’ll need to submit -

    • Health insurance card given by your insurance provider.
    • KYC documents of the proposer, including PAN card, Aadhar card, and a passport-size photo.
    • Patient's identification proof.
    • KYC details of the insured individual.
    • Policy number.
    • Full name of the policyholder.
    • Name and address of the insured person for whom the claim is being filed.
    • Details regarding the nature of the illness or injury and the necessary treatment or surgery.
    • Name and address of the attending medical practitioner.
    • Planned date of hospital admission.
    • Complete medical history, including past conditions, whether related or unrelated to the present health issue. Note that any discrepancies with the health declarations made during the policy purchase may result in a claim denial.

 

Step 7: Be Ready for a Possible Advance Deposit
The pre-authorisation process can take anywhere between 6 to 24 hours, depending on the insurance company. They may also have queries that require your timely response. During this period, the hospital might ask for an advance deposit, which your insurer will later reimburse. To avoid any financial strain, it is advisable to maintain an emergency fund for such advance payments.

Additionally, it is important to note that any medical expenses incurred before your hospitalisation will need to be claimed separately from your insurer. Therefore, it is essential to keep all original prescriptions, bills, receipts, and reports, which include any films, that are associated with the hospitalisation, safe and secure.

Step 8: Keep Track of Your Claim's Progress
Once your discharge date is confirmed, the hospital's insurance desk will inform your insurer and submit all the necessary paperwork, including your final bill and discharge summary. Your insurer may provide updates on your claim's status on your registered mobile number or email. However, there could be instances where the hospital fails to notify the insurer about your discharge or send the required documents, leading to delays in the approval process.

It is thus crucial to stay informed about your claim's status. You need to regularly check for communication from your insurer. Generally, the approval process is completed within 2-6 hours after your insurer is informed of your discharge, and they may also have questions that require prompt responses. To ensure a swift claim settlement, it is vital to follow up on the process with your insurer.

Step 9: Review the Final Bill and Approval Letter
Upon receiving the final bill and approval letter, examine them carefully to know the approved and unapproved expenses. If you have any questions or doubts, do not hesitate to contact your insurer for clarification. You should pay close attention to the approval letter, as it might specify expenses that should not be billed to the patient. Avoid making payments for such expenses.

Apart from these, there may be other costs that are not approved, and you will need to  cover these expenses out of your pocket before leaving the hospital.

?Reimbursement Claim Under Family Health Insurance Policy
Here are steps you need to follow to file a reimbursement claim -

Step 1: Check if the Hospital is in the Excluded List
Before getting treatment at a non-network hospital, make sure to confirm whether it is on the list of excluded providers. If it is, your claim will not be accepted, and you will need to choose a different hospital. You can verify this by contacting your insurance company through their toll-free number, email, or SMS.

Step 2: Inform Your Insurer
It is important to notify your insurer about your hospitalisation within 24 hours of admission. You can find their contact details on your policy document or the insurer's website.

Step 3: Collect Hospital Documents
Once your treatment is complete, it is essential to gather all the original documents from the hospital before your discharge. These include –

  • Original receipts and invoices for your medical expenses.
  • Discharge summary.
  • The claim form, partly to be filled by the hospital.
  • Essential medical reports containing MRI or X-ray films.
  • Prescriptions issued by the doctor.

Also, make sure to double-check the patient's name, gender, and age on all these documents, get any errors rectified, and keep everything well-organised in a file. If possible, request a detailed bill that breaks down all the costs from the hospital. Additionally, ask for a copy of the case sheet/indoor case papers and the hospital's registration certificate -  if the non-network hospital agrees to provide them,

Step 4: Gather All Documents
Before proceeding with a reimbursement claim, you should ask your insurer for the list of required documents. You’ll generally need these documents -

  • Your health card or a copy of your health insurance policy.
  • Proposer’s KYC details including your PAN card, Aadhar card, passport-sized photograph, etc.
  • A bank statement showing policyholder’s bank name, account number, and IFSC code, or a copy of your bank passbook with the most recent transaction page, or an original cancelled check with policyholder’s name on it.
  • Patient's identification proof.
  • A fully filled and signed claim form.
  • All documents, test reports, films, receipts, and medical prescriptions pertaining to the treatment you received.
  • The original discharge summary from the hospital.
  • IOL sticker and hospital invoice if your claim relates to procedures like knee replacement or cataract surgery, which involve implantation.

Step 5: Complete the Claim Form
Once you have gathered all the necessary documents, you can initiate your reimbursement claim. Fill out the claim form and submit it along with the required documents to your insurer.

Step 6: Submit Supporting Documents
In addition to your hospitalisation bills, you can also include any pre- or post-hospitalisation bills, along with the prescriptions and reports to ensure that eligible expenses are not overlooked.

Step 7: Keep Copies and Get an Acknowledgment
Retain copies of every original document you provide to the insurer. Also, obtain an acknowledgment from the insurance company or third-party administrator (TPA) when submitting the original documents.

Step 8: Stay Informed on Your Claim's Progress
After submitting your claim, it is essential to keep track of its progress with your insurer. They will assess and approve the claim and may occasionally request additional information or documents that should be promptly provided for a swift settlement.

Step 9: Review the Claim Settlement Details
Once the process is complete, the approved amount will be deposited into the bank account you’ve specified. You will receive a settlement summary that outlines all deductions made. Thoroughly examine these deductions, and if you have any questions, do not hesitate to contact your insurer.

 

Tax Savings with Family Health Insurance

Every year, the premiums you pay for health insurance are eligible for the tax deduction under Section 80D of the Indian Income Tax Act of 1961. It can be claimed for the health insurance premiums you pay for yourself, your spouse, dependent children, and dependent parents. The maximum deduction amount that can be claimed varies depending on your and your family members’ age –

  • Individuals and Parents Below 60 Years
    • You, your spouse, and your children – Up to Rs. 25,000.
    • Parents below 60 years – Up to Rs. 25,000.
       
  • Individuals Below 60 Years of Age and Parents Above 60 Years
    • You, your spouse, and your children below 60 years – Up to Rs. 25,000.
    • Parents above 60 years – Up to Rs. 50,000.
       
  • Individuals and Parents Above 60 Years
    • You, your spouse, and your children above 60 years: Up to Rs. 50,000.
    • Parents above 60 years – Up to Rs. 50,000.
       
  • Members of Hindu Undivided Family (HUF)
    • Members below 60 years – Up to Rs. 25,000.
    • Members above 60 years – Up to Rs. 50,000.

HUF includes male descendants, their wives, and unmarried daughters.
 

  • Non-Resident Individuals (NRIs)
    • Self, spouse, and children (dependent) – Up to Rs. 25,000.
    • Parents up to 60 years – Up to Rs. 25,000.
    • Parents above 60 years – Up to Rs. 50,000.

The health insurance premiums you pay to the insurer including taxes are eligible for deductions as discussed. However, this tax exemption applies only if such premiums are paid for your immediate family members, such as your spouse, children, and parents. To claim these tax benefits, it is also necessary to pay the premiums via bank transfers, credit/debit cards, cheques, or demand drafts. This is because cash payments generally are not qualified for tax exemptions under Section 80D, except when it comes to preventive health check-ups.

Under Section 80D of the Income Tax Act of 1961, you can also claim tax deductions for payments you have made on preventive health check-ups to detect illnesses early. You will be eligible to claim a tax deduction of up to Rs. 5,000, and this deduction applies even if you pay for the health check-ups in cash.

Please note that these tax benefits are available only when you purchase insurance from a company authorised by the Insurance Regulatory & Development Authority of India (IRDAI) or the Central Government.
 

Wrapping up!

When it comes to ensuring the safety of your family, there can be no compromises. We hope this article has provided you with enough information about family floater policy, its benefits, as well as the top policies currently available on the market. If you want your policy to be the 'best', ensure you choose the one that precisely meets your and your family’s needs.
 

FAQs

  1. What is the best health insurance for my family?
    There's no one-size-fits-all answer to the best health insurance because your and your family's needs are unique. The ideal health insurance policy is one that matches your specific requirements and circumstances.

     
  2. What are the policy term options for family health insurance?
    Typically, family health insurance plans (also known as family floater plans) offer policy terms of 1, 2, or 3 years with a renewal option. However, the available terms can vary depending on the specific insurance plan.

     
  3. How many individuals can be covered under family health insurance?
    The number of individuals that can be covered under a family health insurance policy (also known as a family floater plan) varies between insurance companies, as each product is unique.

     
  4. Who can be covered under a family health plan?
    Typically, family health insurance plans (also known as family floater plans) allow you to include the following individuals –
  • Yourself
  • Your Spouse
  • Up to 4 dependent children (who are under 25 years of age)
  • Up to 2 Parents or Parents-in-law

Please note that the specific inclusions may vary based on the terms and conditions of the plan you select. Some insurers may even provide the option to add aunts, uncles, siblings, and other relatives to the plan. Additionally, certain insurers may allow the coverage of a combination of members, like one parent and one parent-in-law.

  1. Can I include my parents in a family health insurance plan if they are over 60?
    If there is no significant age difference between your parents and they do not have chronic medical conditions, you can consider covering them under a separate floater plan.
  2.  
  3. Does family health insurance cover AYUSH treatments?
    AYUSH treatments such as  Yoga, Siddha, Ayurveda, Homeopathy, and Naturopathy, may or may not be covered depending on the specific health insurance plan you choose.

     
  4. How do I choose the right mediclaim policy for my family?
    When it comes to health insurance, there is no universal “best” policy that suits everyone’s needs. The key is to customise your policy to match your family's unique needs and situation. This means tailoring your coverage by choosing the features and benefits that are relevant to you and your family. Additionally, it is vital to opt for a reputable insurance company known for outstanding customer service and efficient claims processing to ensure that your plan genuinely serves your best interests.

     
  5. How long can I cover my dependent children in the best family medical insurance?
    The duration of coverage for dependent children can vary from one insurer to another. Generally, you can include your dependent children in your family medical insurance plan from birth or shortly after, up to a specific age, such as 24, 25, or 30. This age limit varies among insurance companies. Once your children reach the age specified by the insurer, they can be ported to individual health policies, with credit for any waiting periods already completed.

     
  6. What are the waiting periods in a family health policy?
    In family health policies, there are 3 primary types of waiting periods –

Waiting Period

What Does It Mean?

Duration

Initial Waiting Period

Claims cannot be filed during the initial days of policy purchase, except for accidents.

30 Days

Pre-existing Waiting Period

Claims for any medical condition or illness that occurred within 4 years prior to purchasing the policy.

2-4 years

Specific treatment or illness Waiting Period

Claims for specific listed illnesses or treatments, whether or not you have experienced it before, are not covered by the insurer for a certain period.

2-4 years

11. Which is better, a family health insurance plan or an individual health insurance plan?

The choice between these two types of plans depends on your unique situation and preferences. There isn't a single, universal answer because each plan has its pros and cons. If the family members you are looking to cover have a similar age range and do not have significant pre-existing or chronic health issues, a family floater policy could be a suitable option for you.
 

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