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 FAMILY FLOATER HEALTH INSURANCE  PLANS  

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​No one should have to choose between medicine and other necessities. No one should have to use the emergency room every time a child gets sick. And no one should have to live in constant fear that a medical problem will become a financial crisis.
                                                                                 -   Brad Henry

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FAMILY FLOATER HEALTH INSURANCE PLANS

What is Family Floater Plan ?

   Family Floater is one single policy that takes care of the hospitalisation expenses of  entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Family floater plans are better than buying separate individual policies   as it will be cost effective   . The family floater   plans  normally come   with different sets of people in a family covered under the policy  . 

1. Covering Husband and wife only 
2. Covering  husband and wife with two minor children . 
3. Covering husband , wife , two  minor children along with parents of either husband or  wife 

Premium for each policy varies according to the ages of the people to be covered   , 
   

​ WHO ISSUES FAMILY FLOATER POLICIES IN INDIA ? 

There are 5 insurance companies   that issue health insurance policies exclusively . Other than these five compnies , most of the Life  Insurance compnies and General insurance companies also issue health insurance policies including Family Floater Plans  .  To go the website of  any of the health insurance companies  or insurance companies issuing health plan  , CLICK HERE    

To help our readers to undestand  the basic conditions for issue of health insurance plans , we have selected  ten different plans from array of insurance companies plans and you may go through the  table  . The terms  & conditions  vary from plan to plan  . One can chose most appropriate plan  useful  to their family  among hundreds of plans available   . Before  going through the table , one may go through the basics below to understand  the terms & conditions . 

What expenses  health  insurance policy normally covers ? 

A Health Insurance Policy would normally cover expenses incurred under the following heads in respect of each insured person subject to overall ceiling of sum insured 

a.     Room, Boarding expenses

b.     Nursing expenses

c.     Fees of surgeon, anesthetist, physician, consultants, specialists

d.     Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-ray, Dialysis, chemotherapy, Radio therapy, cost of pace maker, Artificial limbs, cost or organs and similar expenses.

Sum Insured

The Sum Insured    may   have a maximum amount for each of the insured under the policy or cumulative for all the insured  or a   fixed amount to be paid out  on particular type of disease or surgery needed  or  affixed amount per day for the period of hospitalization. 

 Pre and post hospitalization expenses

Expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.

Cashless Facility

Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange direct payment to the Hospital. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be settled by the insured direct to the Hospital. The insured can take treatment in a non-listed hospital in which case he has to pay the bills first and then seek reimbursement from Insurance Co. There will be no cashless facility applicable here.

CO-PAY CLAUSE  

If there is co-pay clause , insured have to pay  a portion the expenses incurred himself / herself either as a percentage of claim  or a fixed amount . In such  a policy , insured will not get reimbursement of 100 %  of expenses incurred  .  

DOMICILIARY  EXPENSE REIMBURSEMENT   

Many health policies  will provide reimbursement of expenses incurred  at home   for health conditions  which would  normally require hospitalization .   General conditions are 

1. The condition of patient is such that he cannot be removed to an hospital . 
2. The patient takes treatment at home on account of non-availability of a room in  a hospital .  

Some policies  would put  a maximum number of days of home treatments allowed and some would have clause that reimbursement would be provided only after certain initial number of days borne by the insured . 

Hence one has to go through the policy document to know exact  term of the policy . 


PRE-MEDICAL TEST 

Some insurance companies require a  health check up to be conducted for the persons to be covered under a health insurance policy   .  Some companies may  not insist for   people aged up to specific year  or if they don't have  any adverse  medical conditions  .  Normally  insurance companies    pay for such medical exam . Please  check with the insurance company about the condition before applying .  

PRE-EXISTING MEDICAL CONDITION 

While conducting medical exam before issuing a  health policy or   by declaration from the applicant ,  any adverse medical conditions  of the insured   may surface  to the knowledge of insurance company . Insurance companies  normally deny any reimbursement  for a specified period  for any hospitalization taken place on account of such pre-existing medical conditions . 
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    FAMILY FLOATER  PLANS

Insurance company / plan	​Maximum  ​Entry age	Maximum  exit age	Insurance amount  range   ( Rs in Lakhs )	Premium Range	Pre Medical test	​Waiting Period pre existing ​ (months )	CO -PAY ​	Domi ​-ciliary	Special conditions
Religare  care	No limit	Lifelong	4 to  600	You can calculate on the website	Required only for age > 50  ​cover > 25 lakhs	48	Nil  for age below 60 years 20%  for others	10 % of SI	12  CRITICAL GLOBALLY COVERED
Apollo Munich  Easy Health	No Limit	​Lifelong	5 to 65	Refer the Premium Card	Required	36	Not specified	covered ​	6 critical illness
HDFC Ergo Suraksha	No Limit	Lifelong	2 to 50	Refer the Premium Chart	Required​	​up to 48	10 % to 20 %	covered	-
ICICI Lombard	No Limit	Lifelong	3 to 50	Check with the company	Required	24	Not specified	Covered	-
Royal Sundaram	No Limit	Lifelong	2 to 150	​Check with the company	Required	36	​Not specified	Covered	-
Future Generali	No Limit	Lifelong	3 to 100	Rs 4,418 to 4, 78,455	Required	24	up to 40 %	covered	-
Star  Family Health  Optima	65	Lifelong	3 to 25	​Refer the Premium Chart	Not specified	48	20% for above 60 years	covered	-
IOB Easy Health	69	Lifelong	3 to 10	​Refer the Premium Chart	NO	36	Not specified	Covered	-
​LIC's Jeevan ​Arogya	65	80	1 to 4	​Check with LIC	NA	No claim allowed	NA	NO	​Fixed   payment per  day / per surgery  . special conditiona apply
​Bajaj Allianz	65	Lifelong	1.5 to 50	Check websitr	Required above 45	36	Optional	Covered	-

  To go to  the individual Insurance companies  listed above   , click on the name of the insurance company  / plan  below 

​1. Religare Care   
2.Apollo Munich  Easy health  PLAN  and  PREMIUM CARD    ​
3.HDFC Ergo Suraksha ​
4.​ICICI Lombard  
5.Royal Sundaram ​
6.​Future Generali
7. Star Family Health optima 
8.IOB Easy Health 
9. LIC'S Jeevan Arogya 
10.Bajaj Allianz  Family Health Guard  ​

NEW  BLOG  ARTICLE ON                                    
                                                         HEALTH INSURANCE  OPTIONS FOR RETIRED BANKERS 
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The article explores the alternative avenues for existing health insurance group policy for Retired Bankers 



TO  READ THE ARTICLE                                                         CLICK HERE ​

NEW ARTICLE PUBLISHED     :                     
​                                          PLANNING FOR CONTINGENCIES   
​                                                                                                                      CLICK HERE TO READ 

  TITBITS : From   a recent   report  of  Sample Survey Office ,  it is revealed that   80 percent of Indians , who mainly rely up on  private   health care ,   do not  have any medical insurance .  The government has brought   only about 12 %  of population under  health protection schemes like   Rashtriya Swasthya  Bima Yojana . In  the absence of health insurance  , 75 % of Indians  use their hard earned savings  while  18% have to borrow . In order to escape from financial gloom  in the events of  medical emergencies , one has to    definitely require some form of Health insurance .       

 

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 OTHER TERMS & CONDITIONS IN A HEALTH POLICY 

​Additional Benefits and other  Riders
Insurance companies offer various other benefits like  “ Health Checkup “. There are also  policies that  give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits”   etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.

Exclusions
The following are generally excluded under health policies: 

a.     All pre-existing diseases  or with waiting period  typically from 12 to 48 months . 

b.     Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. This is not applicable for accidental injury claims.

c.     During first year of cover – cataract, Benign prostatic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders.

d.     Circumcision unless for treatment of a disease

e.     Cost of specs, contact lenses, hearing aids

f.      Dental treatment / surgery unless requiring hospitalization

g.     Convalescence, general debility, congenital external defects, V.D., intentional self-injury, use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not consistent with the disease requiring hospitalization.

h.     Treatment relating to pregnancy or child birth including cesarean section

i.      Naturopathy treatment.

The actual exclusions may vary  on each policy terms . 


TAX BENEFIT UNDER HEALTH INSURANCE 

In India, as per Section 80D of the Income Tax Act, a deduction is allowed  in respect of the health insurance premium paid for up to  Rs. 25,000 p.a  when  you buy health insurance in India for  your family. For a senior citizen ,  deduction allowed is  up to Rs 50,000  from the financial year 2018-19    

TIPS FOR BUYING HEALTH INSURANCE FOR SENIOR CITIZENS

1.     Various Insurance companies offer health Insurance Policies . But the terms , diseases covered  and premiums vary . Hence   first write down your needs  and  Medical history of your  spouse / children  to be covered , and the amount of coverage you may require .  Please remember the medical costs are  increasing year after year and what looks like suffice today  may not cover fraction of  your requirement  after 5 years . Hence keep cushion  while having the  amount fixed .

2.     You check the hospitals in your city , especially which are convenient to you , are covered  under cashless  facility by TPA .

3.     Compare the premiums    from three or four insurance companies for the least  and you can find huge variation from company to company and chose   the one  which    suits your budget  and requirements .

4.     Floaters policies  covering all the members of your family are cheaper than taking individual policies  and hence get   a policy which can cover   your family members .

5.     Check whether premiums are kept at the same level as offered for at least   for few years . Otherwise every year you will have to  pay higher  demanded premiums .

6.     Check up to what your age the  policy will cover  . There are policies which cover  till lifelong .  Otherwise  at the ripe age when you require insurance , umbrella of insurance would be removed .

7.     Check  towards the conditions on pre -existing diseases . Lesser period will be better .   

8.  Even if pre-existing conditions  are covered after a  lapse  of waiting period , some insurance company will  charge as much as
 50 %  after the waiting period is lifted . Hence check 

9.    If you  have already covered  by   a health insurance policy taken by yourself or your employer  or any of your family members  and if you feel the amount covered is not sufficient , you may go in  for  a Top up Health Insurance or Super top up health insurance which will cover you beyond the amount covered by your initial policy .  
 
10. Health Insurance policies get income tax  rebates under  SEC 80D .  For details  ,  CLICK HERE 

 
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