Health insurance

A family floater plan secures the entire family during a medical emergency and ensures financial security. Before purchasing a family health insurance plan, consider the factors below and make an informed decision. 


Inclusions and exclusions


Before purchasing family health insurance , you should properly understand the inclusions and exclusions of the plan. Inclusions are the procedures and conditions for which the insurance provider provides coverage. Exclusions refer to cases against which a policyholder cannot file a claim. 


If you are not fully aware of them, it can lead to out-of-expenses and claim rejection. The most common exclusions of a family floater plan are self-inflicted injuries, congenital diseases, HIV/AIDS, adventure sports injuries, injuries in war, treatment for alcoholism, and drug abuse. You should select an insurance plan with minimum exclusions to get more comprehensive coverage. 


Waiting period


The waiting period or cooling period is when no claims are settled by the insurance provider. The waiting period for pre-existing diseases and maternity benefits ranges from 12 to 48 months and 9 to 48 months. Once the waiting period is over, an insured will get the promised coverage. The waiting period usually depends on the insurance provider and the plan you opt for. It is recommended to buy a family floater plan with a lesser waiting period to enjoy its benefits earlier. 


Network hospitals


Always check the insurance provider’s list of network hospitals in your vicinity, and then buy a family health insurance plan. Network hospitals offer cashless hospitalisation facilities and keep policyholders stress-free as they don’t need to worry about paying hospital bills. 


Co-payment clause


It refers to the fixed percentage of the claim amount a policyholder pays from his pocket, and the insurance provider settles the rest. The co-payment clause helps reduce the premium amount paid towards the policy. Some health insurance plans come with voluntary co-payment clauses, and others with mandatory ones. Due to high treatment costs, people in metropolitan cities generally opt for co-payment clauses in health insurance policies. 


Lifetime renewability

It is a clause in a health insurance policy that allows you to renew the coverage lifelong without any age limit or other restrictions. Look for a family floater plan with a lifetime renewability option, as it protects you during your old age and lowers the financial burden. 


Claim settlement ratio


It is calculated by dividing the number of claims settled by the total number of claims received by an insurer during a financial year. CSR indicates the reliability and efficiency of the insurance provider in settling claims. You should choose an insurance provider that ensures fast, accessible, and seamless claims settlements and has a CSR higher than 80%.


No claim bonus


No claim bonus is another crucial factor to be considered while buying a family health insurance plan. It is the reward provided to the policyholder by an insurer for staying fit and not filing claims during the policy period. NCB lowers the insurance premium and increases the coverage benefits. The health insurance companies in India offer NCB in the range of 5% to 20%. Any family member can avail of NCB in case of a family health insurance plan.


Add-on covers


Add-ons are the extra benefits available with the basic health insurance plan on paying an additional premium. Some popular add-ons include maternity health insurance cover, room rent waivers, hospital cash cover, vector-borne disease cover, critical illness cover, and OPD cover. Make sure to back your standard family floater plan with add-ons to reduce your additional expenses and keep your savings intact. 


Daycare procedures


Daycare procedures like cataract operations, corneal incisions, tear duct operations, and ectropion don’t require hospitalisation and can get over within a few hours. Looking for a family health insurance plan that offers coverage against daycare procedures is essential. 


Sum insured and premium


It is the maximum amount the insurance provider provides in case of a claim made by the policyholder due to a medical emergency. A sum insured that is adequate today may not be able to cover your future healthcare expenses. You should choose a sufficient sum insured coverage while investing in a family floater plan. The policyholders can also increase their sum insured amount at the policy renewal time. The lower the sum insured, the lower will be the insurance premium.


Pre-and-post-hospitalisation expenses

Pre and post-hospitalisation expenses are those which are incurred before and after hospitalisation. These are consultation fees, MRI scans, diagnostic tests, follow-up treatments, and drug costs. A family health insurance plan that covers these expenses is the right one for a policyholder. 


In conclusion


You must know what to consider while purchasing a family health insurance plan. So, you can use these parameters to choose your family health insurance plan wisely.