Insurance Purchase
Vineet compares offerings by different providers and settles on his preferred health insurance plan for his family with a coverage of ₹20 lakh. He chooses an annual premium payment, pays for the premium and activates the plan.
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What are Health Insurance Plans for Family?
Health insurance plans for family are comprehensive plans against health concerns requiring medical attention for multiple family members of a policyholder. Without purchasing multiple plans, you can secure your and your family's healthcare needs with one policy and its single premium. The sum insured is shared among all family members.
Similar to individual plans, it generally covers expenses for in-patient, pre- and post-hospitalisation expenses, day care treatment, ambulance and more.
As per recent news, medical inflation in India is around 12% to 14% and thus having health insurance plan in place protects your savings with a wide range of coverage for different healthcare needs.
How Do Family Health Insurance Plans Work?
The working of health insurance plans for family is quite straightforward. The primary policyholder pays a single premium and activates the cover for his/her family. When one or multiple covered members make claims, the healthcare costs are paid from this shared pool.
Each claim reduces the remaining sum insured available to the family. Other covered members can continue to make claims until the total sum insured is exhausted.
Let us understand how it works with a simple example. Here, Vineet, a working professional, wants to buy health insurance for his family. Here’s what follows next:
The First Claim
Suppose his spouse gets hospitalised and as the health insurance covers the cause of hospitalisation, it covers his spouse’s medical bill of ₹10 lakh.
A Further Claim
In the same policy year, Vineet himself needs hospitalisation, resulting in a hospital bill of ₹3 lakh. Upon claim, the policy covers these expenses from the remaining ₹10 lakh.
Remaining Coverage Amount
Now, the remaining coverage amount is ₹7 lakh, and the covered members can utilise it through the policy year until it is exhausted.
With Pluto, find the best health insurance plans covering you and your family members. Compare and purchase a plan completely online and secure your loved ones today!
Who Should Buy Health Insurance Plans for a Family?
Here is a glimpse of who should consider a health insurance policy depending on family size, earnings patterns and more:
Young Parents
Individuals who are parents must ensure a safety net against healthcare needs for themselves and their children. With health insurance for a family, they can ensure this while protecting their hard-earned money.
Families Supporting Parents and Children
If you are managing your children’s needs while also supporting ageing parents, unexpected medical expenses can strain your finances. A family health insurance plan can help you manage these healthcare costs under one policy.
Employed Individuals
As an employed individual, you may or may not have employer-sponsored health insurance or individual health insurance. For better coverage, higher customisation options, premium payment flexibility and more, a family health insurance policy can be more suitable.
Self-Employed Individuals
If you are a self-employed person, you may have variable earnings and sometimes may not have a lump sum amount at your disposal for sudden medical needs. Having a health insurance plan for family helps you deal with medical emergencies with confidence.
What is Covered Under Health Insurance Plans for Family?
Insurers explicitly highlight the healthcare expenses that they cover under their inclusion criteria. Although this may differ between insurers, here are some health incidents that most insurers provide coverage for:
Health insurance plans for family cover expenses that you or your family members incur for eligible surgeries, ICU charges, room rent, fees for doctors, nurses, etc. This applies if a hospital stay is for at least 24 hours.
What is Not Covered in Health Insurance for Family?
Also found in the policy brochure of your preferred insurer, the following are some instances where you do not get coverage:
Some insurers may not provide coverage for non-accidental dental treatment and thus list it under their exclusion criteria.
How to Choose the Best Health Insurance Plans for Your Family?
Here are some important aspects that you must factor in to efficiently secure yours and your family’s healthcare needs:
1.
Assess the Healthcare Requirements
The initial step is to assess healthcare needs, such as considering age, lifestyle and the medical history of you and your family members. Factor in pre-existing conditions or chronic illnesses (if any) and choose a plan with a shorter waiting period and wider coverage.
2.
Determine Your Sum Insured
Based on your annual income and its stability, you must choose a sufficient sum insured for efficient coverage. In metro cities, where treatments are expensive, an optimised sum insured as per your budget is much needed.
3.
Consider Add-Ons
Individuals planning for family expansion may opt for an add-on for maternity benefit if not included in the base policy. Families with aged parents requiring doctor visits should consider add-ons like chronic care, OPD visits, telemedicine and preventive care.
4.
Network Hospitals
Health insurance providers have tie-ups with quality hospitals across India. Take a look at the number of network hospitals in your locality to decide which provider to choose.
5.
Understand Co-Payments and Deductibles
Policies with co-payments require you to pay a portion of the treatment cost while your insurer covers the rest. Deductibles are fixed amounts that you must pay off before your insurer begins bearing costs. These vary between insurers, but you must look for these terms as they influence premiums and overall expenses.
6.
Understand Waiting Period
Depending on the insurer, there is an initial waiting period of 30 days after policy purchase. For pre-existing diseases, this can be up to 36 months and for specific diseases, it is generally 24 months. Since it applies to maternity benefits, you must understand these timeframes.
7.
Check Insurer’s Capability and Reputation
Assess the Claim Settlement Ratio (CSR) and solvency ratio to understand the capability of an insurer in terms of fulfilling claims. Reviews by their existing customers also provide insight into an insurer.
Factors Affecting Premiums of Health Insurance Plans for Family
Understanding these factors can help you make an informed decision and optimise the cost of health insurance plans for family:
Sum Insured
A family health insurance policy with a higher sum insured costs more as it covers higher medical expenses. For example, a sum assured of ₹20 lakh costs more than a plan with ₹10 lakh coverage or less
Number of Family Members
An individual covering their spouse and children in a family health insurance plan may find the premium less costly than the one covering spouse, children and aged parents.
Age of the Eldest Member
The age of the eldest member covered under a family health insurance plan also affects the premium. Generally, a family with a 55-year-old eldest member may pay a higher premium than one where the eldest member is 35.
Medical History of Family
Multiple pre-existing diseases (PEDs) of family members increase the premium amount. Suppose a primary policyholder has chronic hypertension while one of their covered parents has a heart ailment. Here, the premium may increase due to such health complications.
Smoking or Drinking Habits
Smoking or drinking are primary causes of complicated illnesses requiring hospitalisation and expensive treatments. Hence, individuals with such habits may need to pay a higher premium.
Choosing Add-Ons
Add-ons extend the coverage scope of health insurance plans for families. As they cover additional costs and provide added benefits, including them in your base plan slightly increases the overall premium. Hence, keeping your budget in mind, choose add-ons that you may need.
Documents Required to Buy Health Insurance Plans for Your Family
The following are some key documents that insurers generally ask for while purchasing a health insurance policy for your family:
Identity Proof
- ✓
Produce a copy of your and your family member’s (if required) updated Aadhaar Card, PAN card or Driving License.
Address Proof
- ✓
Provide a copy of your passport or utility bills as your address proof.
Proof of Age
- ✓
Furnish a copy of your birth certificate or any other valid documents supported by your insurer. You may need to produce the age-related documents of the family members you are covering as well.
Income Proof
- ✓
You may also need to produce your latest salary slip, ITR filing or bank statements as your proof of income.
Medical Reports
- ✓
In case of PEDs or other health concerns, you or your family member may need to produce medical reports for policy purchase.
How to Buy a Health Insurance Plan for Family with Pluto?
Pluto makes your insurance purchase journey seamless. After comparing plans and choosing the one that suits your needs, you can complete the purchase entirely online with us.
Here is a step-by-step guide to buying health insurance for your family with us:
Step 1
Decide which family members you want to cover alongside yourself and click on 'Get Quote'.
Step 2
Enter basic details like your name, contact details, location, your age and the ages of the members you want to cover and proceed.
Step 3
Provide details of PEDs accurately that you or your chosen family members may have to view available plans.
Step 4
From the list of insurance options, compare plans from different insurers. Check the coverage amount, choose add-ons if required and get the ultimate premium amount.
Step 5
Once you have the premium amount displayed, you may need to fill out a proposal form by your chosen insurer. Accurately fill out the details, upload documents (upon request) and pay the premium amount.
How to Claim Health Insurance for Your Family?
You can make a cashless or reimbursement claim when you or a covered family member requires hospitalisation for medical treatment. Here’s what you need to do:
Cashless Claim
For this, you or your family member can visit a network hospital of your insurance provider. Share policy details, fill out a pre-authorisation form or complete any other formalities at the hospital. Now, your insurer deals with the hospitals and covers expenses up to the coverage of your plan.
Reimbursement Claim
Here, you or any of your insured family members get treated at a hospital first, pay the bills and preserve the original invoices. After discharge, you must share those invoices and treatment documents with your insurer and receive the claim amount into your bank account upon successful verification.
How to Save on Taxes with Health Insurance Plans for Family?
Under Section 126, you can save up to ₹25,000 on premiums of health insurance plans for family. If you cover your parents who are over the age of 60 years, the limit is ₹50,000. This way, you get the scope to save up to ₹75,000 in a financial year while filing your tax return.
The limit for a Hindu Undivided Family (HUF) is ₹25,000. You can also claim benefits for preventive checkups of up to ₹5,000, included in the mentioned limits.
Frequently Asked Questions about Health Insurance plans for family
Can I add family members to my existing health insurance policy?
Yes, depending on the insurer, you may add family members at the time of its renewal.
Under which tax regime do I get the tax benefits on health insurance plans for family?
You can claim tax benefits on health insurance if you opt for the old tax regime while filing your tax returns.
How do I increase the sum insured if I need more coverage from health insurance?
You can increase your sum insured amount at renewal. However, depending on policy terms, the increased sum insured may come with additional waiting periods for some benefits and PED conditions.
Can I have health insurance for my family and an individual plan at the same time?
Yes, if your budget supports it, you may purchase both types of policies at the same time, increasing overall coverage.
How long is my child eligible to be a part of the family health insurance plan?
The eligibility age for children varies by insurer and policy. Generally, children can remain covered until 25 years of age.
Can I remove a family member from my health insurance plan during the policy period?
Generally, members cannot be removed from a family health insurance policy during the policy period, except in cases such as death. Such changes are usually processed at the time of policy renewal.
Can I add my newborn to a family floater health insurance policy?
Yes, you can add your newborn to a family floater policy. Many policies allow coverage after a specified age, often 90 days. Some plans may cover the newborn from birth if they include maternity cover or a day-1 newborn benefit. You must check the policy terms to understand when the coverage begins and how the newborn can be added.
Will other family members still have coverage if one member exhausts the sum insured?
Since a family floater policy has one shared sum insured, the amount used by one member reduces what is available for everyone else. If the entire sum insured is exhausted, further claims may not be covered during that policy year. However, a restoration or refill benefit, if included in the policy, can reinstate the available cover for subsequent claims.
Can health insurance plans for family be renewed if the primary insured member dies?
The surviving adult members can continue the health plan after the primary insured’s death. However, they must inform the insurer and update the proposer details.
What happens to the family health insurance coverage once my daughter gets married?
Your daughter generally cannot continue under your family health insurance policy after marriage, as dependents are typically required to be unmarried and financially dependent. She may need to get an individual health insurance policy to ensure continued coverage.