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What is Family Floater Health Insurance Plan?

03 October, 2018

When it comes to your family’s health, nothing beats a regular health insurance plan. However, what does not make sense is to buy a separate one for each family member. What you should aim to do is to purchase one single policy for the entire family. Thus, buying a family-floater plan would be a better option. This plan offers a better cover for a lower cost than multiple individual plans.

 

A family floater health plan is a type of insurance policy that provides guaranteed coverage to more than one member of a family at the same time. Simply put, it’s a single insurance that covers the entire family. For example, both parents as well as children can be covered together and you only need to pay one single premium.

 

 

Here’s what you need to consider while buying this plan –

 

  • Consider family members:

A family floater insurance policy includes all your family members. There are plans that allow only immediate family members to avail the policy benefits and some which can accommodate up to 19 family members. Choose one that suits your requirements the best.

 

  • Consider the members’ health:

Once you’ve zeroed down on the family members, now it is time to consider their health status. It will help you calculate possible medical expenditures and keep aside charges for ailments and diseases which the insurance company will declare as pre-existing.

 

  • Decide the Sum Insured:

Whether you purchase a health insurance policy for yourself or for your entire family, choosing the right sum insured is vital. It is the amount against which your medical bills are paid. Go for a number keeping your family’s present and future health levels in mind. And yes, make sure you can afford the premium amount.

 

  • Examine the Cashless Network:

When it comes to your family, choose a hospital which is near and suits the sensibilities of all family members-child and adult. Thus, it makes sense to examine the health insurance company’s cashless network list. You get to pick hospitals and avail cashless treatments there.

 

  • Check for claim-settlement ratios:

When your family’s health comes into question, you need a health insurance policy to come to your aid. An insurance company’s claim settlement ratio will give you the answer. Expressed in percentage, the higher it is, higher are your chances of claim acceptance.

 

What’s covered under family-floater insurance policy?

 

A few inclusions:

 

  • Nursing expenses incurred during in-patient hospitalization
  • Pre and post hospitalization medical expenses
  • Ambulance charges
  • Room, boarding expenses as provided by the hospital
  • Anesthesia, oxygen, blood, and operation theatre charges, X-ray, dialysis, radiotherapy, chemotherapy, diagnostic materials, medicines and drugs, cost of pacemaker, cost or organs, artificial limbs, donors medical expenses towards organ transplant, etc.
  • Reimbursement of expenses up to a maximum of 1500/-

 

What’s not covered under family floater policy?

 

Here’s a list of few exclusions under this policy –

 

  1. 30 days waiting period
  2. Any pre-existing disease

 

  • First year exclusions:

Treatment of any type of migraine, stones in urinary or biliary system, surgery for tonsils, gastric or duodenal cancer, any type of cyst or nodules, any type of breast lump from the date of commencement of the policy under family floater insurance.

 

  • Two-year exclusions:

     

    1. Spondylitis treatment, any type of carcinoma, sarcoma or blood cancer, Hip joint replacement, end stage renal failure, osteoarthritis, heart diseases, benign prostatic hypertrophy, etc.
    2. Cost of spectacles, hearing aids, and contact lenses
    3. Dental treatment or surgery
    4. Hormone replacement therapy
    5. Outpatient treatment charges
    6. Any routine examination, vaccination or screening
    7. Sex change or treatment related to sex change
    8. Expenses on tonics and vitamins unless it forms a part of treatment for disease or injury

 

Claim procedure for family floater health insurance –

 

  The claim procedure is as follows:

 

 

  • For admission in the network hospital: Policyholder must call the helpline and get a membership number and policy number. This call should be made within 72 hours before submission to the hospital. In addition, you need to have details of hospitalization such as diagnosis, name of the hospital, and duration of stay in the hospital. In case of an emergency, the call should be made within 48 hours of submission to the hospital.

  • Ensure that you submit the duly completed claim form along with the following documents to the insurance company within 30 days of your discharge from the hospital –

     

    1. Test reports and prescriptions related to above
    2. Admission discharge summary/case history describing the nature of complaints as well as its duration
    3. Death summary in case of death of the policyholder at the hospital
    4. Original copy of hospital bills/receipts/cash memos
    5. All test reports for ECG, MRI, X-rays, Pathology, etc., including doctor’s prescription advising for such investigations and tests.
    6. Copies of health insurance policies
    7. Legal heir certificate in the absence of nomination under the policy
    8. Detailed self-description that states the time, date, and nature of injury/accident

 

How family-floater insurance policy works?

 

Under a family-floater insurance policy, more than one family can be covered under a single plan. In fact, the entire sum assured can be availed by all members of the family; it’s not restricted to just one person. A family floater plan takes benefit of the fact that possibility of all the members falling ill at the same time is low. Such a plan can be bought by a person who becomes a proposer along with dependent children (un married or up to 25 years of age), spouse, widowed, divorced, and dependent children. So, rather than buying an individual health plan of Rs. 2 Lakh for each member of the family, you can cover each member of the family in a family-floater plan of Rs. 8 Lakh. This says each person can avail benefits under it for up to 8 Lakhs as compared to Rs. 2Lakhs in the earlier instance.

 

A family-floater health insurance policy is the way to go for your family’s health. So, find the best family-floater plan for your loved ones online and protect your complete family.