Family Floater Health Insurance

A Family floater health insurance plan is ideal for a married person and his family, which includes his spouse and children. It can be used to also cover parents who are senior citizens. Overall, this offers a good option for insurance which is cost-effective and inclusive for all members of the same family.

Almost all family floater health plans offer in-hospitalization expenses, which include Room rent, ICU charges, Doctor’s fees, Ambulance charges, Pre & Post Hospitalisation Expenses, Daycare expenses etc. If one is planning for a child, they should invest in a family health policy that covers insurance for new born baby or simply add the baby as beneficiary to your existing family floater health plan. There are many add ons like Critical Illness, PA Cover etc that once could opt for. There are waiting periods applicable for Pre Existing conditions and other ailments as is the case in Individual plans.

Most of the health insurance companies limit the family member to the primary insured, his spouse and children. However, there are some insurers who even allow coverage for parents, parent-in law, siblings and other relatives under the same policy and hence cover a maximum of between 15-19 relationships who can be covered under the Family Floater plan.

Many of the family floater plans restrict the coverage of the sum insured upto the limit opted for by the family, in that particular policy period which is normally for a year. There are however some plans, which offer an Automatic restore/refill/reinstatement facility which tops up the sum insured to 100% of the Basic sum insured once during the policy year post a claim being reported and the initial sum insured being utilised.

Due to the unfortunate demise of the primary insured under a family floater policy, or on him/her reaching the maximum renewability age, the remaining adult members on the policy can continue with the policy and enjoy continuity benefits. For any addition or deletion of family members on the policy, the same can happen only at the time of renewal.

Yes, no claim discounts are available up to a certain amount (normally 50% of the base sum insured) are available from certain insurers. If there is no claim on a family floater policy, the insurer offers a premium reduction or an enhancement in the sum insured for the subsequent year as per policy terms and conditions defined in the policy wordings.

Yes, the insured is allowed to change the hospital on the grounds subject to better treatment and services facilities available at the second hospital, but the insured needs to inform the TPA first who will approve the request based on it’s merits.

While making an application for a Family Floater Plan, the documents to be normaly submitted include Age Proof, Identity Proof and Address Proof of all the insured members and Income Proof of the policy holder. Along with this the completely Filled Proposal Form will need to be submitted which has the medical history of all the family members. Some plans may require the some of the insured members to undergo Medical Tests depending on their age/pre existing medical condition/sum insured applied for.

One can add your family members only at the time of renewal of an existing policy and not during the middle of the policy year. Only a newborn baby can be added during the policy period.

A floater policy is one that is issued with a single sum insured covering number of individuals of a family. The cover can be used by any member of the family any number of times during the policy period. If a person wants a health insurance for himself, his spouse & their children, the Family Floater plan is ideal and offers insurance coverage to the entire family under one premium payment.

Let’s take an example wherein the person insures himself, his spouse & the two dependent children with the individual insurance plans with a sum insured of Rs 1 lac each, he ends up paying an average premium of Rs X for each family member, which amounts of Rs 4X. If the person opted for the family floater plan with the sum insured of Rs 3 lacs, the total premium would ideally be less than the separate premium payments in individual health insurance plans, ie less than Rs 4X. Moreover the individual plan has coverage of only Rs 1 lac for each member as against Rs 3 lacs in case of the Floater plan( in case the medical treatment exceed Rs 1 lac). This Rs 3 lacs is available for each of the family members individually as well as collectively.

It is recommended that as a general rule, at younger ages of all family members, opting for a floater cover is ideal. As the members grow older, they should go for an individual cover. But ultimately buying an individual cover or a floater cover is an individual’s preference.

There are some distinct advantages of one opting for a Family Floater plan, these include:

Comprehensive Coverage : This health insurance plan offers a comprehensive coverage for members of a family. It is similar to individual health plans in its benefit coverage added but the significant difference is that this is for covering the entire family under a single policy.

Complete Sum Insured available for Any member of the Family : A major advantage under the Family Floater plan is that, in case one of the family member gets sick and is hospitalised, the total sum insured of the policy can be utilised for treatment of the sick hospitalised member of the family. Also the family floater health insurance has options to opt for higher sum insured than individual health plans.

Tension Free Coverage : A significant advantage is that since all members of the family are covered under a single policy, and hence a single renewal date for the policy. Hence there is no requirement for keeping track of the renewal of individual policies which could be at different times in the year.

Cost Effective : A family floater health insurance is the ideal option when it comes to safeguarding the health of your family at an optimum cost. Family floater policies offer the benefit of a sum assured which can be shared across all members of a family and can come in handy because the chances of all members falling sick together is highly unlikely. But the premium has to be paid once and is cheaper than availing individual policies for each of the family members.

Coverage for Many Relationships : The scope of the family floater health insurance plans of some insurance companies are widened to include dependent parents, siblings and parents-in-law as well apart from one’s spouse and children.

Tax benefits : Premiums paid for Family Floater can benefit from tax deductions under section 80D of the Income Tax Act. Amounts up to ₹15,000 are allowed for deduction on health insurance premium for self, spouse and children. This gives additional exemption of ₹20,000 if senior citizens are covered. This means if someone takes family floater insurance covering his immediate family and parents who are senior citizens, he can save up to ₹35,000 in taxes.

Sum Assured Restoration/Refill : In case of a hospitalization to one family member resulting in the sum assured getting exhausted, some insurance plans offer automatic restore/refill/reinstatement of sum assured upto 100% of the basic sum insured. This takes care of worries about recurring hospitalization in the same year for the same or another family member. So the effective sum insured utilised could be double to original sum insured opted for.

Cashless treatment : Family floater also allows the insured to be treated cashless at any network hospital. Policyholders need not pay expensive consultation fees, diagnosis tests, room rent and so on. All these expenses, up to the sum assured, are automatically covered by the policy.

Addition of New family Members Hassle-free : In the family floater plan, it is easy to add a new family member whenever there is any such need, but one needs to be aware that such an addition can be done only at the time of the policy renewal. However in the case of a new born baby, the baby can be included during the policy year. Also, in case of the unfortunate demise of the senior most member of the family, other family members can continue with the floater without losing any benefit. This is one of the biggest benefits that a family floater health plan provides.

Extended Policy Period : Many insurers have now given an option of 2/3 years policy duration coverage. This allows a continuous coverage without any increase in the annual cost of premium for the second year.

• One of the key features is the single sum assured can be extended to cover several members of the same family if the need arises. Ideally the proposer needs to review the age of the family members, their family medical history, pre existing conditions before arriving at the sum insured for this policy. If the average age of the family group is high, option for a higher sum insured may be ideal.
• The covered members of a family floater may go in for cashless hospitalization at any of the network hospitals of the respective insurance company. In some cases like emergency hospitalization or accidents or admission in non-network hospitals, insurers may allow treatment first and reimbursement later.
• Some family floaters work on the co-pay basis, where the insurers pays a percentage of the cost incurred and the insurer the rest and this co pay will be applicable of the elder family members in the group. Some insurance plans have the option of choosing a co pay to lower the premium payable.
• Most companies seek a pre policy check up (PPC) for senior family members, if a higher sum assured is chosen or have a unsatisfactory past medical history. For younger members of the family, a simple medical/health declaration is collected at the time of applying for the policy.
• Hassle-free Claim Settlement is also offered in case of a reimbursement claim, where the insured has availed treatment for a covered ailment and made payments to the hospital. They can submit all the medical bills, receipts and medical records of the treatment and seek a reimbursement.
• These plans also offer the flexibility to increase the Sum Assured of the Plan given the rising cost of treatment due to medical inflation in subsequent policy years. The Sum Insured can also be increased on addition of family members. Most insurers offer a No Claim Bonus, where the insured is automatically eligible for an increased sum insured for every claim free year. They may also instead offer a premium discount at the time of renewal.
• Many health insurance companies plans have a maximum entry age of 65 years whereas once the member is on the policy, they will be offered a lifelong renewal facility. Make sure to choose the family floater health plan that would protect you when you need it most.

• Pre-existing diseases are not covered up to a certain exclusion/waiting period under family floater plans – this can normally be 36/48 months
• Admission of senior citizens with an entry age beyond 60/65 may be a problem and may increase the premium substantially, as their risk is perceived to be higher. However once senior citizens are covered, then they have a lifetime coverage renewability
• Attempted suicide, nuclear attacks and so on.
• Experimental treatment, treatment for HIV/AIDS, congenital disease, non-medical expenses under their policies.
• Excess intake of alcohol or drugs that are not prescribed by any doctor.
• Sexually Transmitted Diseases (STDs) like AIDS or HIV are excluded from the Family Health Insurance Policy.
• Any treatment for complications in pregnancy like infertility, abortion or miscarriage or any treatment related to childbirth is not covered under any Family Health Insurance Policy.
• Non-allopathic treatments are not reimbursed or assisted under the Family Health Insurance Policy.
• Any assistance for dental or oral treatment is not provided.
• Any reimburse for any loss or damage caused due to mental disorder is not entertained by the Family Health Insurance Policy.
• No diagnostic fees will be reimbursed if the policyholder has no positive sign of the disease, but he or she wants to undergo the medical tests.
• Any harm or loss caused because of any suicidal attempt of the policyholder is strictly excluded from the Family Health Insurance Policy.