All you need to know about Family Floater Health Insurance Plan

All you need to know about Family Floater Health Insurance Plan

Health insurance is an important necessity. With the rising cost of healthcare services and change in lifestyle, securing health has become the need of the hour. With the increasing awareness, there is more and more types of health insurance plans introduced in the market to cater to the unique healthcare needs of people. Family floater health insurance is one such health insurance plan that provides comprehensive health protection to the entire family in a cost-effective way. Let’s learn about family floater health insurance plan in detail.

What is a family floater health plan?

Family floater health insurance is a type of health insurance policy that secures all the members of a family with a single health insurance cover. It’s an umbrella cover that brings the entire family under one single policy with one sum insured. The coverage provided under the plan can be utilised by all the insured members of the family under the policy for the policy term. The family floater health plans come with numerous benefits to meet the healthcare needs of any age in the family.

Types of family health plans in India:

Health insurance coverage for the family is offered in two ways:

• Medical insurance:Family floater medical plan provides coverage for hospitalisation expenses related to medical treatment. Benefits can be claimed through cashless hospitalisation facility or through reimbursement
• Critical illness plan:It is types of plan that covers listed critical illnesses such as kidney failure, heart diseases and cancer etc by paying the lump sum on diagnosis of any such illness. However, critical illness cover needs to be bought individually for each member of the family.

Advantages of family floater health insurance plan:

Following are the benefits offered by family floater health plans:

• Healthcare umbrella for the entire family:The entire family is covered under one plan. Family floater health plan usually cover self, spouse, dependent children. Many policies extend the cover for dependent parents and dependent parents-in-law.
• Flexible:The new member can be easily added to the plan. Also, the sum insured can be restored in most of the policies. Also, family floater health plans offer the cashless facility.
• Cost-effective:As the plan covers all under one umbrella, it’s relatively cheaper than buying individual cover or every member of the family.
• Tax benefit:Premiums paid for family floater plan qualifies for tax deduction under Section 80D of the Income Tax Act, 1961

Coverages offered under family floater health insurance plan:

Family floater health plans come with comprehensive benefits. Some of the common coverages offered under family floater health insurance plans are:

1. In-patient hospitalisation expenses:
   Expenses incurred for medical conditions that require hospitalisation for longer than 24 hours are covered. These expenses include room rent, nursing charges, boarding charges, ICU room charges, doctors fee, anaesthesia, blood, operation theatre charges, diagnostic procedure cost, surgery and treatment expenses, cost of prosthetic if implanted during surgical procedures etc
2. Pre and post hospitalisation benefit:
   Medical expenses incurred for a specified number of days immediately prior to hospitalisation and post-discharge from the hospital are covered
3. Domiciliary hospitalisation:
   Cover for the medical expenses incurred by the insured person for domiciliary hospitalisation are covered up to the specified limit in the policy schedule. However, the benefit is applicable only in case the treatment continues for at least more than three consecutive years
4. Organ donor benefit:
   Medical expenses incurred for harvesting the organ for the use of the insured person who has been advised to undergo an organ transplant is covered under the policy
5. Ambulance cover:
   Policy covers the reasonable and customary charges incurred on ambulance during a medical emergency to shift insured to hospital or from hospital to home
6. Daycare procedures/treatments:
   Expenses incurred for certain treatments and surgeries that require less than 24 hours of hospitalisation are covered. List of daycare procedures and treatments included will be mentioned in the policy schedule
7. Added benefits:
   Most of the policies cover daily hospital cash allowance, the benefit of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy treatments) hospitalisation, restoration of the sum insured etc.
8. Free value additions:
   Many family floater health plans offer complementary benefits such as health check-ups, consultation with a specialist, second e-opinion and chat with a doctor etc.

Exclusions under family floater health insurance plan

Though family floater health plans secure the entire family against most of the health contingencies, Following are certain exclusions applicable under family floater health plans

Temporary Exclusions

1. Initial waiting period:
   Medical expenses incurred for the treatment of any illness/injury/ medical condition during the first 30 days from the policy inception date are excluded. However, the same is not applicable for renewal policies
2. Specific waiting period:
   Certain surgical procedures and treatment for illnesses come with specific waiting period (usually 12 months to 24 months) from the date of inception of the policy during which coverage is not provided. Treatments or illnesses generally included are – pilonidal sinus, haemorrhoids, calculus diseases of the gallbladder, stomach ulcer, Fissure in the anus, all forms of cirrhosis, Gastroesophageal Reflux Disorder, cataract, surgery in tonsils, fibroids, prostate surgery, Rectocele/hydrocele surgery, sinusitis and varicose veins etc.
3. Pre-existing illness waiting period:
   Pre-existing medical conditions like diabetes, hypertension, arthritis etc are covered only after a specific waiting period (generally varies from 12 months to 48 months) from the date of inception of the policy

Permanent Exclusions

1. Treatments received outside the geographical area:
   Expenses incurred for medical treatments received outside the geographical limits mentioned in the policy are not covered
2. Self –medication:
   Self-treatments and treatments taken from anyone other than a medical practitioner and complications arising out of it are excluded from the policy coverage
3. Non-medical expenses:
   Non-medical expenses such as admission fees, abdominal belt, air bed charges and ambulance equipment etc are excluded from the policy coverage
4. Unproven and experimental treatments:
   Medical expenses incurred for treatments that are experimental and unproven or complications arising out of experimental treatments are excluded from policy coverage
5. Sexually transmitted diseases:
   Expenses incurred for the treatment of any medical condition that is directly or indirectly associated with any sexually transmitted diseases such as Gonorrhoea, Chlamydia, Syphilis, Genital herpes, AIDS, HIV etc are not covered
6. Breach of law:
   Treatment cost for any injury or illness resulting while insured being involved in breach of law with criminal intent are excluded from the policy
7. Alcohol and drug abuse:
   Any medical condition resulting due to consumption of alcohol or intoxicating drugs are excluded
8. Self-inflicted injury:
   Any deliberate/self-inflicted injury, suicide or suicide attempts, the act of self-destruction is not covered in the policy
9. War and nuclear perils:
   Illness/injury directly or indirectly attributable to war, acts of foreign enemies, civil war, invasion, rebellion, insurrections, revolutions, mutiny, usurped power, seizure, nuclear weapons etc are not covered
10. Cosmetic treatments:
    Aesthetic treatments, plastic surgery or any such cosmetic treatments or complications arising out of these treatments are not covered
11. Mental illness:
    Medical expenses incurred for mental illness, stress or any psychological disorders are not covered
12. Pregnancy, childbirth and fertility treatments:
    Medical expenses incurred for any treatment arising from pregnancy, childbirth, miscarriage, abortion or any other complications related to this are not covered. Treatments related to fertility, birth control procedures, contraceptive supplies, sterilisation and complications arising out of any such treatments are not covered.

Best family floater health insurance plans in India

1. National Mediclaim Policy

National Insurance Company Limited is one of the oldest insurance company that operates in every corner of the country making insurance accessible for all. The company offers a wide array of health insurance products customers with 6000+ network hospitals for them to avail benefit easily. National mediclaim policy is one such plan offered by the company that can provide complete protection to the entire family with some amazing features. Following are the features of the plan:

• • The policy provides comprehensive protection with coverage for hospitalisation expenses, ambulance charges and Ayurveda and Homeopathy treatments etc
  • Policy provides cover for 140+ day care procedures
  • Cumulative bonus at 5% of sum insured for each claim-free year
  • Free health check-up benefit in a block of four continuous claim-free years
  • Family discount of up to 10%

2. ManipalCigna ProHealth Plan

ManipalCigna Health Insurance Company offers various health insurance plans with some amazing benefits. The company was earlier known as Cigna TTK Health Insurance Company. Let’s take a look at some of the unique benefits offered by the ProHealth plan.

• Flexibility to choose the cover in four variants –Protect, Plus, Preferred and Premier
• Comprehensive coverage offered by the plans includes in-patient hospitalisation cover, daycare treatments, pre hospitalisation and post hospitalisation cover and organ donor expenses etc.
• Sum insured can be restored up to 100%
• No claim benefit can be accumulated up to a maximum of 100% of sum insured
• Complimentary health check-up in a block of every three years
• The policy provides maternity cover and worldwide emergency benefit
• The option of healthy rewards and voluntary deductibles that can reduce your premium
• Family discount and long tenure discount on premium up to 10%
• Additional riders to enhance the cover – critical illness cover and waiver of copay.

3. Religare Care Policy

Religare Health Insurance is specialised in offering a variety of health insurance solutions. Religare follows a customer-centric approach with 4700+ network hospitals to provide hassle-free services. Religare Care is one of the best plans offered by the company with various amazing features. Let’s take a look at the salient features of the plan.

• The policy provides comprehensive cover including in-patient care, pre and post hospitalisation, daycare treatments, daily hospitalisation allowance, organ donor expenses and domiciliary hospitalisation etc
• No claim bonus of 10% on each claim-free year which can be accumulated up to a maximum of 100% of sum insured
• Long-term policy discounts
• Automatic restoration of sum insured up to 100%
• Complimentary health check-up once a year

4. Star Family Health Optima Plan

Star Health Insurance Company came into operation in the year 2006 which offers numerous variety of health insurance plans. With its largest network of 9600+ hospitals, the company makes benefits accessible easily. Star family health optima are one of the best plans offered by the company to secure your entire family under one umbrella. Following are the features of the plan:

• The policy offers comprehensive coverage which mainly includes, hospitalisation, pre as well as post hospitalisation, 405 daycare procedures, organ donor expenses and domiciliary hospitalisation
• No claim bonus of up to 35% of the sum insured
• Sum insured restoration benefit
• Sum insured can be enhanced by up to 30%
• Complimentary health check-up benefits

5. Apollo Munich Optima Restore Plan

Apollo Munich Health Insurance is one of the leading private health insurers in India with a wide range of health insurance products. The company has a wide network of 4500+ hospitals across the nation. Optima restore health plan is one of the popular offerings by the company with various amazing features.

• The plan offers comprehensive coverage for various expenses that include in-patient hospitalisation, pre hospitalization and post hospitalisation, daycare procedures, organ donor expenses and daily hospitalisation allowance etc.
• Automatic sum insured restoration benefit
• No-claim benefit for each claim-free year which is up to 50% along with multiplier benefit that can double the NCB benefit up to 100% of sum insured.
• Earn rewards in the form of 8% renewal discount by staying active
• Complementary health for every two years
• Enhance the coverage with an additional rider – ‘critical advantage rider’ that covers eight major illnesses. The policy also offers e-opinion facility post-diagnosis of critical illness.

How to apply for a family floater health plan?

Family floater health insurance plan of your choice can be bought online instantly. It is quite easy and simple to buy family floater health insurance through Turtlemint. Following are the simple steps to buy online:

• Log on to Turtleminthome page
• Choose the ‘health insurance’ in the category of insurance
• Under the ‘health insurance’ category click on ‘buy new policy’
• Provide your profile details such as gender, marital status, date of birth, income details and contact details
• Once you submit the profile details, all types of plans available under the health insurance category will be displayed
• You can compare the family floater health insurance plans of various insurance companies on the side by side on the basis of quotes and features
• Once you choose the right plan, provide the relevant details and continue to make payment

Documents required for buying a family floater health plan

Following are the documents required to be submitted with the filled application:

1. Proof of identity – PAN Card/Passport/Driving license/Voter’s ID card/Driving license
2. Proof of address – Aadhaar card/Passport/Driving license/Voter’s ID card/ latest utility bills
3. Proof of age – Birth certificate/Passport/SSLC marks card
4. Two passport size photographs
5. Pre-medical check-up report (if required)

Frequently Asked Questions (FAQs)

1. What is ‘cashless facility’ in health insurance?

A cashless facility is a form of benefit payment system wherein the insurance company compensates the treatment expenses by making direct payment to the network hospital where the treatment is availed.

2. What is domiciliary hospitalisation cover?

Domiciliary hospitalisation refers to availing treatment at home for the medical condition that would otherwise require treatment at the hospital. Coverage offered by the health insurance policy for situations is referred to as domiciliary hospitalisation cover. Usually, the insurer would cover the expenses if the treatment is availed for more than three days.

3. What is ‘health card’? How is it beneficial?

Health card is a document issued by your insurance carrying details of your health insurance plan, Third Party Administrators contact details etc. At the time of claim, you can produce health card to get the cashless benefit.

4. What is ‘cumulative bonus’ in health insurance?

Specified percentage increase in the sum insured for every claim-free year is referred to as ‘cumulative bonus’.

5. What happens to the policy if the primary insured expires in a family floater health insurance plan?

If the primary insured dies, other insured members of the family can apply for the continuation of policy with the new policyholder within 30 days of his/her demise.

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Courtesy Article: Supramind / October 10, 2019