A Buyer’s Guide to Family Health Insurance Plans in India

 

Family floater plans cover all the members in a family, unlike individual plans that cover only the policyholder. The basic premise of family coverage is that it is unlikely for all members in the family to fall ill simultaneously and they are unlikely to incur similar hospital expenses at the same time. Accordingly, if one member is sick the entire sum assured is available for him/her, while other family members continue to be covered.

The entire family enjoys larger coverage with a family floater plan. Generally, these plans cover the proposer, spouse, 2 to 4 dependent children, and the proposer’s parents. Some special plans may cover members within the extended family too.

The workings of a family health plan can be better illustrated with an example. Mr. Gupta avails a family floater plan for an amount of INR 5,00,000. Under this policy, the policyholder, his wife, 2 to 4 of his dependent children, and either one of his parents are covered. During the year, his wife is hospitalized and expenses amounting to INR 2,00,000 are paid by the insurer, as per the plan. For the remaining period, Mrs. Gupta and the other members are still covered for an amount of up to INR 3,00,000.

To determine the appropriate policy for your family, it would be a good idea to do a family health insurance plan comparison. Consider these factors to make a better choice:

 

Risks: In case of a family history of ailments like heart diabetes, cardiac disease, or a smoking habit, there is an increased risk of health expenditure. These risks increase the premium amount, even if the risk affects just one member who is to be covered. In such situations, it is best to opt for individual coverage for the person at higher risk, while covering other members under the floater plan.

For example, if Mr. Iyer has a history of heart disease, the premium on the floater plans increases. In addition to the waiting periods being affected for some ailments, there is a higher possibility that the majority of the floater coverage will be diverted to treatments for Mr. Iyer, leaving a smaller amount for the other members. It would therefore be advisable to cover Mr. Iyer under an individual plan.

 

Age: Younger individuals are assumed to pose lower risks in comparison to the aged. Covering seniors aged over 60 years under a family floater plan that includes younger people under the age of 35 is not feasible. This is because it is most likely that the bulk of the sum assured will be diverted to the aged person, leaving minimal cover for others. It is therefore best to choose a separate plan for the aged member.

For example, consider a case in which the proposer is 35 years old, his spouse is 32, their child is 12, and his mother is 60. In this case, there is a higher possibility that the proposer’s mother will require almost the entire sum assured under the plan, in a year. In such a scenario the best strategy would be to secure a separate health plan for the mother.

It is extremely important to choose medical insurance for family coverage wisely, as it could quite literally prove to be a life saver in difficult situations. Consider all the factors carefully and make an informed decision.

 

About HDFC Health:

HDFC Health is an initiative by HDFC Life, a life insurance company in India to help increase awareness, spread knowledge and enshroud myths surrounding the health insurance sector in India. As a wholly owned subsidiary of HDFC Life, HDFC Health offers health insurance policies in India that cover individual, family floater, critical illness and cancer care insurance plans.