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Healthcare costs in India have spiked over the last few years. Indian households spent a total of ₹120 billion on healthcare in November 2022, an increase of 22% over November 2021, per estimates by the Centre for Monitoring Indian Economy’s Consumer Pyramids Household Survey (CMIE-CPHS). While medicines accounted for over 42% of these expenses, Health Insurance premiums accounted for a mere 2%. Data compiled by the World Bank (as of 2020) shows that 50% of all healthcare expenditure in India is still financed out-of-pocket. The data highlights the rising need for Health Insurance.However, finding the right plan can be challenging, considering the number of Health Insurance products available in the market. For instance, if you have a large family, you may simply be worried about managing multiple health policies. In such a case, you can consider purchasing a Mediclaim policy for your family.This article can help choose the best Mediclaim plan for your family.
What is a Mediclaim policy for family?
Mediclaim policies for families are designed to cover your entire family under one policy. You can make a single premium payment for the entire coverage for you and your dependents, such as your spouse, children, parents, etc. The sum insured is usually larger than individual health policies and can be used by any family member covered under the policy.Your insurer covers a part or all of the medical expenses you incur, up to the coverage amount specified in your policy. Also read: Know all about Mediclaim policy for family
Things to keep in mind when buying a Mediclaim policy for family members:
Evaluate the required sum insured
It is important to note the total coverage amount offered by the Mediclaim policy. Any family member included in the policy can use it. However, every time a member makes a claim, the total sum insured is reduced by the claim amount, and the remaining balance is available for all the members covered under the plan for the duration of the policy. For instance, let’s say you have a five-member family and a Family Mediclaim with coverage of ₹5 lakhs. This means all five family members covered under the policy can claim medical expenses up to ₹5 lakhs.Now, suppose one family member needs hospitalisation, and the bill comes up to ₹2 lakhs. Once this claim is paid out, all five members will be left with a total coverage of only ₹3 lakhs. Therefore, you must choose a sufficient coverage amount that adequately covers all members.Tip: If one family member constantly needs medical care, buying an individual health cover for them might make more sense. This is because they may end up using the entire Family Mediclaim coverage, leaving other members without insurance.
Opt for flexible plans
When purchasing a Mediclaim plan for your family, check if you can add members to the plan later if needed. Also, the age limit for coverage of dependent children in Family Health plans typically ranges from 18 to 25 years. Depending on the cutoff age, they may have to be moved to individual plans. This feature differs from policy to policy, and that is why you should read the fine print before purchasing the plan.
Check for exclusions and waiting period
Depending on the terms, some expenses, such as those incurred on cosmetic procedures, alternative therapies, or self-inflicted injuries, among others, may not be covered by your policy. Similarly, if you or a family member has pre-existing diseases, the policy may require a minimum stipulated waiting period before the coverage kicks in. You must pick a Mediclaim policy for a family with the least exclusions and shortest waiting period to ensure immediate and hassle-free medical assistance.
Carefully assess sub-limits or co-payment clauses
Many plans come with sub-limits or caps on certain expenses incurred during hospitalisation. For instance, your policy may have limits on the room rent in case of hospitalisation. It is better to be aware of any such sub-limits . Similarly, co-payment is a clause that requires you to bear a part of the total expenses out-of-pocket. Be sure to check if your policy mentions co-payment.
Choose plans with lifetime renewability
Check the years your policy remains valid; choosing a plan that offers lifetime renewability is better. For example, if your family Mediclaim policy offers renewability until 65 years, you would have to buy a new policy after you cross the age limit, which will cost you more. But, with a lifetime renewability policy , you can continue it as long as you want.Understanding the renewability terms is also equally important. Be sure to check the potential change in premium on renewal, the possibility of revisions in riders or features, the availability and terms of the No-Claim Bonus feature for claim-free years, etc. Also, find out the grace period you have for policy renewal, so the policy does not lapse.
Check network hospitals and how smoothly claims work
This is one of the most important parts of your search for the best Mediclaim policy for a family. The insurer's track record in settling claims is crucial, as are its reputation and customer service reviews. Also, it is best to look for policies that offer cashless claims. This will ensure you remain stress-free as your insurer will settles the bills with the hospital directly. However, be sure to find a network hospital if any member needs hospitalisation. Ask your insurance company for a list of network hospitals.
Check the reputation of the insurance company
Customer ratings, feedback, and timely responses to grievances may differ from insurer to insurer. It is always advisable to opt for insurers who have a good reputation amongst their customers as they are more likely to swiftly respond to any queries you may have regarding your policy. Doing so will also help eradicate potential hassles you might face during the claim settlement process.
Go for a high Claim Settlement Ratio
You can also get deeper insights into your insurance provider by analysing the Claim Settlement Ratio (CSR) of its Mediclaim policies. In simple terms, CSR is the ratio of claims settled against claims made. Choosing an insurer with a relatively higher CSR ratio increases your chances of successfully settling a claim.
Opt for relevant riders
Riders or add-ons in insurance policies provide additional benefits you can avail of by paying a little extra premium. Some common riders are for critical illnesses, personal accidents, outpatient expenses, newborn cover, etc. You can choose the relevant rider you want to add to your policy to enhance coverage.
Compare multiple health plans
A significant benefit of living in the internet era is that you can find and compare features and prices of practically every available product and service in the market from the comfort of your home. Before deciding on your health plan, do not forget to compare a few available products to get a sense of the average premiums and product features offered across companies. Also read: 3 Assured Benefits of Cashless Mediclaim Policy for Family
Key Takeaway
- Family floater Mediclaim plans can be cheaper than individual insurance policies for each family member.
- Family plans save you time and effort for managing multiple policies.
- It is important to carefully examine the exclusions, waiting period, co-payment clause, sub-limits, etc., before finalising the best Mediclaim policy for your family.
- Using the old income tax regime, you can claim tax benefits under Section 80D of the Income Tax Act, 1961, for your premium payments.
FAQS - FREQUENTLY ASKED QUESTIONS
Can I change to another insurer for my Mediclaim policy ?
Yes, you can. The Insurance Regulatory and Development Authority of India (IRDAI) has established guidelines for allowing you to port your Mediclaim policy to another insurance provider without losing the benefits of the existing policy.
What is the difference between Mediclaim and Health Insurance ?
Mediclaim and Health Insurance plans are often confused for each other. However, a Mediclaim policy covers only hospitalisation expenses, whereas Health Insurance includes additional benefits such as outpatient treatments, preventive care, and more.
What are the waiting periods associated with Mediclaim Family plans ?
Most Mediclaim Family plans have waiting periods for pre-existing illnesses, typically ranging from two to four years. During this period, the policy may not cover expenses related to pre-existing conditions.
How can I choose the right sum insured for my Mediclaim Family plan ?
While choosing the sum insured, consider factors such as the number of family members, their ages, existing health conditions, and the cost of medical treatments in your city or region. Opting for a sum insured that provides adequate coverage for potential medical expenses is advisable.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
