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Family Health Insurance Plans

A family floater plan is a plan that gives coverage to an entire family. Such a plan is more economical than a regular individual plan. It offers tax benefits to the policyholder under Section 80D of the Income Tax Act.

It is mandatory to think about the financial security of your company so that you can easily afford medical care in future. Family health insurance plans cover the complete medical expenses of your family. A family health insurance plan is basically a medical insurance which cover the medical expenses of all your family members under a single policy.

The plan shares a fixed sum insured to all your family members by assuming that not everyone will get sick at a time. Majority of the family health insurance plans provide cashless hospitalization facilities, pre and post-hospitalization, and maternity benefits.

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What is Covered?

Health insurance policy for family provides flexible, comprehensive, affordable and customized coverage to the policyholders on the basis of mediclaim policy you select for your family. The following are the key coverages provided by the health insurance plans for families to you and your family members: 

  1. 30 days Pre Hospitalization: It incurs all the medical expenses of up to 30 days before you are hospitalized. 
  2. In patient Hospitalization:  It is a type of inpatient facility where you are admitted to the hospital for 24 hours or more based on your medical condition.
  1. Day care Treatment: Family health insurance plans cover over 500 day care treatments to the policyholders. 
  2. 90 days Post Hospitalization: The plans cover medical expenses of up to 90 days after you are discharged from the hospital.
  3. AYUSH Treatment: It covers expenses for the treatments such as Siddha and Homeopathy, Yoga and Naturopathy, Unani, and Ayurveda. 
  4. Maternity Coverage: Family health insurance plans cover all the expenses related to c-section and normal delivery procedures after one year of the waiting period. 
  5. Ambulance Charges: The plans offer Rs.2,000 per hospitalization to transfer the patient from home to hospital and shift them for various tests outside the hospitals. 
  1. Vaccination: The plan incurs the cost of vaccinations for animal bites.
  2. Organ Expenses: It incurs the expenses associated with the procedure of removing the damaged organ from the body. 
  3. Mental Illness: If the policyholder or their family member is suffering from any sort of mental illness, then the insurance company will incur the expenses of the treatment done in India. 
  4. Daily Hospital Cash: The insured will also get a cash amount of up to Rs.8,000 per day at the time of hospitalization for a pre specified period.
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What is Not Covered?

Once you have purchased the health insurance for family, you should go through the policy documents in detail to know what all are not covered in the plan. Apart from this, you should also have a look at the waiting periods under the plan. Given below are the medical expenses which are not covered under the family health insurance plans in India: 

  1. Routine medical check ups and OPD treatments 
  2. Expenses related to life support machines 
  3. Expenses related to any aesthetic treatments and plastic surgeries 
  4. Any sort of illness or injury caused due to nuclear reaction, war, acts of foreign enemies, or rebellion. 
  5. Treatment underwent abroad unless it is added in the plan 
  6. Childbirth or pregnancy complication such as miscarriage, abortion, termination of pregnancy, etc. 
  7. Preexisting medical condition is not covered before the completion of the waiting period. 
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Best Family Health Insurance Plans Available in India

We have prepared a list of the best health insurance plans for family in India which will help you to compare and decide which Mediclaim policy you should opt for your family:

Family Health Insurance Schemes 

Sum Insured 

Benefits 

Bajaj Allianz Health Guard Plan 

Rs.1.5 lakh to Rs.1 crore 

  1. Covers pre and post hospitalization expenses 
  2. Covers preventive healthcare check ups 
  3. Road ambulance charges 
  4. Covers maternity expenses 
  5. Incurs the cost of bariatric surgery 

Aditya Birla Activ Health Platinum Plan 

Rs.2 lakh to Rs.2 crore 

  1. In patient hospitalization coverage 
  2. Covers OPD expenses 
  3. Day care procedures 
  4. Covers obesity treatment expenses 
  5. Covers home treatment expenses 

Care Health Insurance Plan 

Rs.5 lakh to Rs.75 lakh 

  1. Covers in patient hospitalization expenses 
  2. Provides maternity coverage 
  3. Organ donor coverage 
  4. Provides daily allowance 
  5. Incurs expenses of annual health check up 

Bharti AXA Smart Super Health Insurance Policy 

Rs.50,000 to Rs.5 lakh 

  1. Critical illness benefit 
  2. Hospitalization benefit 
  3. Covers expenses related to preexisting diseases 
  4. Organ donor expenses 
  5. Pre and post hospitalization expenses 

Digit Health Care Plus Policy 

Rs.2 lakh to Rs.3 crore 

  1. Maternity expenses 
  2. Pre and post hospitalization coverage 
  3. Covers infertility treatment expenses 
  4. Hospitalization benefits 
  5. OPD coverage 

Cholamandalam Healthline Insurance Policy 

Rs.2 lakh to Rs.25 lakh 

  1. Covers hospitalization expenses 
  2. Emergency ambulance facility 
  3. Maternity coverage 
  4. Outpatient expenses like hearing aid, dental, spectacles and contact lenses 
  5. Extended hospitalization coverage 

Zuno (Previously Edelweiss Health Insurance Policy) 

Rs.1 lakh to Rs.1 crore 

  1. Maternity coverage 
  2. Day care treatment cover 
  3. Provides recovery benefits 
  4. Health check up expenses 
  5. Hospitalization coverage 

IFFCO Tokio Family Health Protector Policy 

Rs.1.5 lakh to Rs.30 lakh 

  1. Covers hospitalization expenses 
  2. Covers the expenses of organ donor 
  3. Vaccination coverage 
  4. Daily allowance  
  5. Domicillary hospitalization expenses 

Future Generali Future Health Suraksha Plan 

Rs.2 lakh to Rs.10 lakh 

  1. Day care treatment expenses 
  2. Incurs ambulance charges 
  3. Pre and post hospitalization charges 
  4. Day care treatment charges 
  5. Patient care 

Liberty Secure Health Connect Policy 

Rs.2 lakh to Rs.15 lakh 

  1. Pre and post hospitalization expenses 
  2. Covers expenses of emergency local road ambulance 
  3. Daily cash allowance 
  4. Cumulative bonus 
  5. Day care procedure coverage 

Kotak Mahindra Health Care Policy 

Rs.3 lakh to Rs.25 lakh 

  1. Covers in patient hospitalization charges 
  2. Ambulance charges 
  3. Free health check up facility 
  4. Pre and post hospitalization expenses 
  5. Day care procedures 

Niva Bupa (Previously known as Max Bupa) Heartbeat Health Insurance Plan 

Rs.3 lakh to Rs.50 lakh 

  1. Maternity coverage 
  2. Alternative treatment 
  3. In patient care coverage 
  4. Covers HIV AIDS treatment expenses 
  5. Covers mental disorder treatment expenses 

ManipalCigna ProHealth Insurance Plan 

Rs.2.5 lakh to Rs.1 lakh 

  1. Covers in patient hospitalization expenses 
  2. AYUSH coverage 
  3. Global emergency coverage 
  4. Domiciliary hospitalization expenses 

New India Assurance Floater Mediclaim Policy 

Rs.2 lakh to Rs.15 lakh 

  1. Hospital cash 
  2. Covers hospitalization expenses 
  3. Covers modern treatment expenses 
  4. Covers congenital disease treatment expenses 
  5. Critical care benefit 

National Parivar Mediclaim Policy (Floater Policy) 

Rs.1 lakh to Rs.10 lakh 

  1. Pre and post hospitalization expenses coverage 
  2. Covers organ donor expenses 
  3. Covers morbid obesity treatment expenses 
  4. Infertility treatment expenses 
  5. Mental illness coverage 

Raheja QuBE Insurance Policy 

Rs.2 lakh to Rs.50 lakh 

  1. Covers in patient hospitalization expenses 
  2. Medical checkup facility 
  3. Provides organ donor coverage 
  4. Incurs ambulance charges 
  5. Daily allowance 

Oriental Happy Family Floater Policy 

Rs.2 lakh to Rs.20 lakh 

  1. Pre and post hospitalization coverage 
  2. Maternity expenses coverage 
  3. Provides domiciliary hospitalization benefits 
  4. Provides mental illness coverage 
  5. Attendant allowance 

Royal Sundaram Lifeline Insurance Policy 

Rs.2 lakh to Rs.1.5 crore 

  1. Day care procedures 
  2. OPD treatment coverage 
  3. In patient care 
  4. Maternity coverage 
  5. Global emergency hospitalization 

Reliance HealthWise Policy 

Rs.1 lakh to Rs.5 lakh 

  1. Covers modern treatment expenses 
  2. Critical illness coverage 
  3. Covers organ donor expenses 
  4. Pre and post hospitalization coverage 
  5. Covers domiciliary hospitalization expenses 

Star Family Health Optima Insurance Plan 

Rs.3 lakh to Rs.25 lakh 

  1. Pre and post hospitalization expenses 
  2. Day care procedures 
  3. New born baby coverage 
  4. Assisted reproduction treatment coverage 
  5. Covers AYUSG treatment expenses 

SBI Arogya Premier Health Insurance Policy 

Rs.10 lakh to Rs.30 lakh 

  1. Covers hospitalization expenses 
  2. Ambulance charges 
  3. Maternity coverage 
  4. Advanced treatments 
  5. Covers expenses related to genetic disorders 

United India Family Medicare Policy 

Rs.3 lakh to Rs.25 lakh 

  1. Pre and post hospitalization expenses cover 
  2. Healthcare checkup coverage 
  3. Day care treatment cover 
  4. Modern treatment cover 
  5. Organ donor coverage 

Tata AIG MediCare Policy 

Rs.3 lakh to Rs.20 lakh 

  1. Ambulance charges 
  2. In patient treatment 
  3. Provides consumables facility 
  4. Provides AYUSH expenses 
  5. Vaccination expenses 
  6. Consumables benefits 

Universal Sompo Complete Healthcare Insurance Policy 

Rs.1 lakh to Rs.10 lakh 

  1. OPD treatment expenses 
  2. Vaccination charges 
  3. In patient hospitalization charges 
  4. Domiciliary hospitalization coverage 
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Eligibility Criteria

Every family health insurance plan has certain eligibility criteria. However, the eligibility criteria differ from plan to plan. The following table highlights the common eligibility criteria of family health insurance plans: 

Categories 

Specifications 

Minimum Entry Age  

Children: 90 days 

Adult: 18 years 

Maximum Entry Age 

Children: 25 years 

Adult: 65 years 

Family Members Covered 

Self, spouse, dependent parents, dependent children, and parents-in-law 

Renewability 

Lifetime 

Documents Needed

The following are the list of the documents that you need to provide while applying for a health insurance plan for family in India: 

Age Proof 

  1. Permanent Account Number (PAN) card 
  2. Aadhar card 
  3. Birth certificate 
  4. Voter ID card 
  5. Driving license 

Address Proof 

  1. Aadhar card 
  2. Driving license 
  3. Utility bills 
  4. Government ID proof 
  5. Voter ID card 

Identity Proof 

  1. PAN card 
  2. Voter ID card 
  3. Aadhar card 
  4. Birth certificate 
  5. Passport 
  6. Ration card 
  7. 10th or 12th marksheet 

Medical Reports 

You also have to provide you and your family members’ medical reports to the insurance company. The insurance company will go through the medical history to get an idea of the possible as well as pre existing health issues. 

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How to Claim?

The policyholder can file a health insurance claim in two different ways such as reimbursement claim and cashless claim. We will discuss about the procedure of both types of claims in detail. 

1. Cashless Claim Process 

  1. Get in touch with the insurance company and inform about your health emergency. 
  2. Fill out the pre authorization form that is available in TPA or insurance desk. 
  3. Submit the duly filled pre authorization form along with other required documents to the hospital. The hospital authorities will forward the documents to the insurer. 
  4. The claim management team of your insurance company will go through the documents. If the claim request is approved, the insurer will send an approval letter to your address. 
  5. In case your claim request is rejected, you can request for reimbursement claim. 
  6. After getting the approval letter, you can start the treatment procedure. After the completion of the treatment, you need to sign all the required documents during discharge procedure. 
  7. The insurer company will incur all the expenses of your treatment. 

2. Reimbursement Claim Process 

  1. Inform your insurance company about your medical emergency. 
  2. Next, you can start receiving the treatment at any of the non network hospital. 
  3. You need to pay the medical bills on your own and collect all the documents before discharge. 
  4. To settle the claim, you have to submit the duly filed claim form by enclosing all the documents to the insurer. 
  5. The claim management team will verify all the documents and will send a letter of approval. 
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Things to Consider Before Buying a Family Health Insurance Plan

The following are the key points that you need to know before you plan to purchase a family health insurance policy in India: 

  1. A family health insurance plan helps on deciding whether or not to add a new member in the policy by paying an additional premium amount. 
  2. The health insurance policy will expire once the eldest family member reaches the maximum age limit.
  3. The policy will no longer cover the dependent child once they have crossed the age limit mentioned in the policy document.
  4. You will get an option to choose to increase the sum assured if you decide to add a new family member in your policy so that you can get a complete coverage for each family member. 
  5. Avoid adding your senior citizen parents in your existing family health insurance plan because it will increase your premium amount. Apart from this, the plan is not ideal due to the age related health problems.
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Benefits of Family Health Insurance Plan

The following are the benefits of family health insurance plan: 

Family Health Insurance Plan Benefits

1. Convenient 

Purchasing a family health insurance plan online is an easy process because you can compare different plans online or even opt for expert advise. Also, you don’t have to fill out list of application forms while purchasing a health insurance plan.  

2. Safe Payment Modes 

Due to digitization, people these days opt for online payment instead if cash or cheque payments. Some of the common digital payment options like net banking, debit cards, credit cards, Unified Payment Interface (UPI), etc. are accepted by the insurance companies while purchasing a health insurance plans for family. 

3. Instant Quotes 

It is very easy to purchase a health insurance plan for family because you can receive quotes from various insurance providers which you can compare and choose the desired one that suits within your budget. 

4. Instant Policy Issuance 

Nowadays, you don’t have to wait for months to get your policy documents delivered at your doorstep. The insurance company will provide the policy documents instantly at your registered email address. 

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FAQs on Family Health Insurance Plans

  • What is family health insurance?

    A family health insurance plan provides coverage for every member of your family under a single health insurance policy. It offers unrestricted access to high-quality healthcare services to you and your family. 

  • How does family health insurance work?

    Each insured family member receives a fixed sum insured amount under family floater health insurance. Whenever medical services are used by a family member, the sum insured amount is reduced. If the amount is used up on one or more members' claims during the duration of the policy, family members will not be able to make a claim until the policy is renewed. 

  • How do I include my family in my current family health plan?

    When your family health insurance policy is up for renewal, you can add family members to it. With the exception of a newborn baby, dependents cannot be added in the middle of the policy. If you want to include family members in your policy, you may need to pay an extra premium.

  • What would happen if the primary insured person passed away?

    The other adult member of the policy may continue with the policy and benefit from the continuity benefit in the event of the primary insured’s demise. To change the policy's proposer, they must notify the insurer.

  • How long may my child continue to use the family health insurance plan?

    The majority of family health insurance plans cover dependent children up to age 25 years. Depending on the plan, the exit age may be different.   

  • What is the difference between group health insurance and family health insurance?

    Family health insurance plans include coverage for the individual and their family members. The family member who buys the insurance in this case will pay the premium. On the other hand, group health insurance plans can only be purchased by businesses, start-ups, and groups. The employer covers the cost of the premiums.

  • Can I purchase multiple family health insurance plans?

    Yes, you can purchase multiple family health insurance plans depending on your budget. 

  • What are the documents that are required to be submitted to raise a reimbursement claim?

    To raise a reimbursement claim under family health insurance plan, you need to submit the scanned copies of policy document, duly filled insurance claim form, medical reports and bills, and hospital discharge reports. 

  • What is the maximum age limit of a dependent child under a family health insurance plan?

    The maximum age limit of a dependent child under a family health insurance plan is 25 years. 

  • Is a cashless facility offered under a family health insurance plan?

    Yes, a cashless facility is provided under a family health insurance plan. 

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