Family Health Insurance Plan & Mediclaim Policies in India

A trustworthy Health Insurance plan is crucial in a country like India, where healthcare costs are always rising. They provide comprehensive coverage for the entire family under a single policy. For this reason, Family Mediclaim policies have grown in popularity in recent years.

Comprehensive coverage:

A Family Mediclaim policy covers a range of medical expenses for every family member, including:

• Hospitalisation expenses
• Pre- and post-hospitalisation costs
• Doctor consultations
• Diagnostic tests

Cost-effectiveness:

You can save more if you choose a Family Mediclaim policy over an individual Health Insurance policy . It provides a total insured amount that any family member may use for medical expenses under one plan and is more cost-effective than buying multiple separate policies.

Convenience:

Keeping track of and managing your family's Health Insurance needs becomes simpler as everything you need is in a single policy for your entire family. You need not remember different policies, renewal times, and claim procedures.

Add-ons and riders:

You can enhance your policy's coverage by choosing riders or add-on covers such as Critical Illness, Personal Accident cover, maternity benefit, etc. For instance, you can add a maternity rider to your Family Mediclaim plan if you and your spouse plan to have a child in the next few years. But remember, you need to pre-plan any specific additional coverage as this policy may have a waiting period clause.

No-claim bonus:

Family Mediclaim policies frequently offer a No-Claim Bonus , meaning the insurer decreases the premium amount for the next year if you do not file any claims during the policy year. It motivates policyholders to live healthily and stay out of the hospital whenever possible.

Tax benefits:

You can claim tax deductions under Section 80D of the Income Tax Act on your Family Mediclaim premiums. The maximum deduction allowed under Section 80D is as follows:

• For self, spouse, and dependent children: Up to ₹25,000 per year.
• For parents (whether dependent or not): An additional deduction of up to ₹25,000 per year.
• For parents who are senior citizens (above 60 years): Maximum deduction increases to ₹50,000 per year.

Ease of insuring new members:

One major benefit of Family Mediclaim is the ease with which you can add an extra member to the plan. All you need to do is pay an additional premium. This differs from individual Health Insurance plans, where you must buy a new plan for every additional member. Also, if one of the members under Family Mediclaim coverage becomes ineligible for any reason, the medical cover for other members continues. Also Read: Benefits of cashless Mediclaim policy for family

Coverage amount:

• Assess your family's healthcare needs.
• Choose a coverage amount that is adequate to cover medical expenses.
• Consider factors such as the number of family members, their age, any pre-existing medical conditions, etc.

Network hospitals:

Verify the insurance company's affiliations with reputable hospitals in your area. A large hospital network ensures hassle-free claims processing and cashless hospitalisation.

Waiting periods:

Know the waiting period for pre-existing conditions, maternity coverage, and particular illnesses. Knowing the specifics of waiting periods before purchasing a policy is essential because they can vary between insurers. More importantly, you should know whether you can make a claim for a certain medical expense during this period.

Premium and renewal:

Choose a policy that offers a balance between affordability and coverage. Additionally, consider the renewal procedure and any age-related renewal restrictions.

Flexibility to increase Sum Assured:

While buying a Family Health Insurance Policy, you should consider the rising cost of living. Check with the insurer whether it allows you to increase the sum assured. At times, insurers hike the sum assured as part of the No-Claim Bonus clause if you have made no claims during the policy.

Conditions to add new members:

Check if your insurer allows easy addition of new members to your Family Floater plan. For instance, if you are planning a baby, you should check whether the existing plan lets you add your newborn as a beneficiary under your Family Mediclaim policy. Alternatively, you can consider buying a separate Maternity Insurance plan .

Hospitalisation costs:

Family Mediclaim typically covers the expenses you incur on room rent, nursing and doctor charges, surgical fees, etc.

Pre- and post-hospitalisation costs:

Family Mediclaim plans usually cover pre- and post-hospitalisation costs for a set amount of time, usually 30 to 60 days.

Day-care procedures:

These plans provide insurance coverage for specific medical procedures that do not require a 24-hour hospital stay.

Ambulance fees:

Family health plans also compensate you for any expenses you may incur on ambulance services during a hospital emergency. Also Read: Tips to choose the best Mediclaim policy for your family

Pre-existing conditions:

Most policies have a waiting period for pre-existing medical conditions before the coverage kicks in. Reviewing this provision in the policy and checking the pre-existing condition exclusions is important.

Cosmetic procedures:

Family Mediclaim policies typically do not cover solely cosmetic procedures, such as plastic surgery or hair transplants.

Non-allopathic treatments:

Unless stated otherwise, the insurance plan may not cover alternative or non-allopathic treatments like Ayurveda, Homoeopathy, and Naturopathy.

Self-inflicted injuries:

Usually, Family Mediclaim plans also do not cover injuries that individuals intentionally cause themselves, those sustained while engaging in risky activities, or under the influence of alcohol or drugs.

The eligibility criteria for purchasing a Family Mediclaim policy may vary between insurance policies. However, common factors include:

Age:

The minimum and maximum age limits for you and your children are mentioned in the policy.

Family members:

Policies usually cover you, your spouse, children, and dependent parents. Some policies may also include dependent siblings.

Medical check-up:

Some insurance providers may require medical check-ups, especially if you are above a certain age or with pre-existing conditions. Also Read: What Aspects are Excluded in Health Insurance Plan?

Check the key differences to decide on Family Floater or Individual Health Insurance - which is better

• Claim forms
• Medical records
• Discharge summaries
• Original invoices
• Make copies of every document for your records

• The insurance provider
• Assesses the claim.
• Confirms the documentation.
• Resolves it by following the terms and conditions of the policy.

1. Intimation: Inform the insurance company about the hospitalisation or upcoming procedure. Most insurance companies have a hotline which is responsible for handling claim notifications.
2. Cashless or reimbursement: You can receive cashless hospitalisation if the hospital is a part of the insurance provider's network. You can do this by presenting your Health Insurance card .
3. Documentation: Submit all required paperwork, such as
4. Claim settlement:

Following up with the insurer is crucial if there are any delays or questions.

• Hospitalisation costs
• Pre- and post-hospitalisation fees
• Doctor visits
• Diagnostic tests
• Critical illness treatments

• The coverage amount is based on your family's healthcare requirements.
• Network hospitals for simple claims processing.
• Waiting periods for pre-existing conditions and specific illnesses.
• Premium and renewal terms.

• Hospitalisation costs
• Pre- and post-hospitalisation costs
• Nursery procedures
• Ambulance fees

• Pre-existing conditions
• Cosmetic procedures
• Non-allopathic treatments
• Self-inflicted injuries

• Age restrictions
• Coverage for you, spouse, children, and parents who are dependent
• The requirement that certain people undergo medical examinations

• Notifying the insurance provider
• Selecting a claim type—cashless or reimbursement
• Submitting the required paperwork
• Following up with the provider to have the claim settled.

• All family members are fully covered by family Medical Insurance policies, including:
• Comparing a Family Mediclaim to individual Health Insurance policies can help you save money as it provides a total insured amount that any family member can use for medical expenses.
• Managing a single policy for the entire family is more convenient since it simplifies Health Insurance administration by making Health Insurance administration simpler. It removes the need to keep track of various policies, renewal dates, and claim processes.
• Family Mediclaim policies frequently provide a No-Claim Bonus that lowers the premium if no claims are made throughout the policy year, promoting a healthy lifestyle.
• Consider the following factors when you purchase a policy:
• Family Mediclaim policies usually cover the following expenses:
• Family Mediclaim policies usually do not cover the following:Review the pre-existing condition exclusions and waiting period provisions of the policy.
• Eligibility requirements for purchasing a Family Mediclaim policy include the following:
• You can raise a claim by: