A family health insurance policy protects all family members under a single sum insured. With this affordable plan, you get coverage for your loved ones during pre- and post-hospitalisation, AYUSH treatment, preventive health checkups, and so much more.
Consistently rising healthcare costs and awareness of the need to get financial protection against unforeseen medical emergencies have led to a significant increase in health insurance purchases in India.
Read on to learn more about the significance of family plans, their inclusions, exclusions and the claim process.
What is the Significance of a Family Health Insurance Policy?
Family health insurance, or a family floater plan, enables policyholders and their family members to receive financial coverage at an affordable premium against unexpected medical emergencies. Unlike an individual policy that covers one person, a family plan brings the policyholder, their spouse, children and parents under a single sum insured.
Here is why investing in a family health insurance plan is beneficial:
- One Cover for Whole Family
People prefer family health plans not only because they can bring all family members under a single cover, but also because they are easier to manage. Whether it is policy renewal or modifying the plan with an add-on, policyholders can do it all at once.
- High Affordability
Compared to individual health plans, family health insurance policies are more affordable. Whereas buying individual health plans for each member causes premiums to add up quickly, a family floater plan comes at a reduced premium.
- AYUSH Coverage
If you have a family floater plan, insurers such as Bajaj General Insurance offer alternative treatments of Ayurveda, Yoga, Unani, Siddha and Homoeopathy.
- Flexibility to Add New Members
Whether you are getting married or starting a new family, adding a family member within a family health insurance plan is seamless. You can add the member details to your policy at the time of policy renewal.
- Tax Benefits
Under the Income Tax Act, 2025, Section 126, health insurance policy holders are eligible for tax deductions up to ₹1,00,000 each financial year for paying premiums. Whereas, for self, spouse and children, the amount is ₹25,000; for senior citizens aged above 60, it is ₹50,000.
What is Included in a Family Health Insurance Policy?
Most common family health insurance policy inclusions are:
- Pre- and post-hospitalisation charges, including hospital room, daycare procedures and surgeries.
- In-patient hospitalisation expenses, including ICU, nursing, anaesthesia, and surgeon fees.
- Organ donor expenses while harvesting an organ for an insured individual.
- Reimbursement for road ambulance expenses during medical emergencies.
- Advanced treatment coverage such as robotic surgeries, immunotherapy, etc.
Please note: Check the waiting period and policy sublimits before choosing a plan.
What is Excluded in a Family Health Insurance Policy?
Standard family health insurance policies do not cover the following:
- Cosmetic surgeries or plastic surgeries.
- Self-inflicted harm or injuries.
- Substance abuse.
- Injuries caused due to participation in illegal activities.
- Accidents caused by taking part in hazardous sports.
How does the Claim Settlement Process work?
There are two types of claims available under a family health insurance plan. These are:
- Cashless Claim
A policyholder visits a network hospital associated with the insurer. After visiting the TPA desk at the hospital, they submit the health insurance card. The insurance authority contacts the insurer to get claim approval. After verifying the policy coverage, the insurer approves and directly settles the claim on behalf of the policyholder.
- Reimbursement Claim
This type of claim usually takes place after the patient has received their treatment and is discharged from the hospital. The policyholder needs to submit the claim form along with the treatment details, laboratory bills, and discharge certificate. After verifying the documents, the insurer settles the claim.
Final Words
A family health insurance policy or a family floater plan is a single policy that covers multiple family members using a shared sum insured amount. Unlike individual policies, these are more flexible and affordable. However, it is important to consider factors such as age, health condition of the members, premium payability, and the insurer’s claim settlement ratio before buying.
