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Health Insurance for Family of Four in India: Importance, Types & Factors to Consider

Team AckoNov 8, 2024

When you have a family of four, you need to be careful about financial planning and incorporate different aspects into it. In a country like India, where healthcare costs are rising and medical emergencies can come up unexpectedly, insurance remains a key consideration for financial planning.

Having the best health insurance plan for the family is extremely prudent and has also become a necessity. But with so many policies available, deciding which one would be the perfect choice for a family of four might be challenging. This article delves deep into the topic of "Health Insurance for Family of 4 in India," covering various aspects to help you make the best choices for your loved ones.

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Contents

Understanding Health Insurance
The Importance of Health Insurance for Families
Types of health insurance plans available
Factors to consider when choosing a health insurance plan
What is covered under family health insurance?
What is not covered under family health insurance?
Eligibility criteria for a family health insurance plan
How to file a claim for family health insurance plans
- Cashless claim
- Reimbursement claim
Common myths about health insurance
Frequently Asked Questions (FAQs)

Understanding Health Insurance

Health insurance is a contract between the insured individual and the insurance provider. It offers financial coverage for medical expenses, including hospitalisation, surgeries, medications, and other healthcare services. By paying a regular premium, you secure protection for yourself and your family, ensuring access to quality medical care without bearing the entire financial burden.

The Importance of Health Insurance for Families

Health insurance is particularly crucial for families, as it not only covers individual health needs but also safeguards the well-being of every family member. In a family of four, the comprehensive coverage provides peace of mind, knowing that all members are protected against unexpected health-related expenses.

Financial Security: In a country where healthcare costs are steadily rising, health insurance provides families with a crucial financial safety net. Medical emergencies or prolonged illnesses can lead to substantial expenses, and without insurance, families might face severe financial burdens. Health insurance ensures that families have the necessary financial support to cover medical bills and treatments, protecting their savings and preventing them from falling into debt.
Access to Quality Healthcare: India has a diverse healthcare system, with a significant contrast between public and private hospitals. Health insurance gives families access to private healthcare facilities, which often offer better amenities, specialised treatments, and shorter waiting times. This access to quality healthcare can significantly improve the chances of successful treatments and better health outcomes for family members.
Comprehensive Coverage: Health insurance plans offer comprehensive coverage, encompassing various aspects of healthcare needs. These include hospitalisation expenses, pre and post-hospitalization care, outpatient treatments, and coverage for critical illnesses. Families can avail themselves of a wide range of medical services without worrying about the financial implications, thus encouraging them to prioritise their health.
Cashless Treatment: Many health insurance policies come with the option of cashless treatment. This means that families can receive medical services without having to pay upfront. The insurance company directly settles the bill with the hospital, which is especially beneficial during emergencies when immediate medical attention is required.

Types of health insurance plans available

Here are the types of health plans in India.

Family Floater Plans: These plans cover all family members under a single policy with a shared sum insured. Usually, family floater health insurance plans have a lower premium than individual plans.
Individual Health Insurance: In contrast to family floater plans, individual health insurance provides coverage to each family member separately. While it might be more expensive, it offers higher coverage for each insured individual.
Critical Illness Plans: Critical illness plans provide a lump sum amount upon diagnosis of a specified critical illness, helping your family cope with the financial impact during such challenging times.
Senior Citizen Health Insurance: If your family includes senior members, opting for a senior citizen health insurance plan ensures specialised coverage catering to their unique medical needs.
Maternity Coverage: Some health insurance plans offer maternity benefits, covering pregnancy-related expenses, including prenatal care and delivery costs.
Preventive Health Check-ups: Certain policies include free or discounted annual health check-ups, promoting proactive health management.

Factors to consider when choosing a health insurance plan

Selecting the right Family health plan requires thoughtful consideration of various factors. Here are some crucial aspects to keep in mind:

Coverage Amount: Assess your family's healthcare needs and opt for a coverage amount that adequately meets those requirements.
Network Hospitals: Ensure that the insurance provider has a wide network of hospitals and healthcare providers near your location for easy accessibility during emergencies.
Waiting Periods: Check the waiting periods for specific illnesses and pre-existing conditions before finalising a plan.
Co-payment and Deductibles: Understand the copayment and deductible clauses, as they impact the out-of-pocket expenses during a claim.
Exclusions: Thoroughly review the policy's exclusions to know what medical conditions or situations are not covered.
Renewal Terms: Check the renewal terms and premium payment options to ensure continued coverage without any disruptions.

What is covered under family health insurance?

A medical insurance policy for the family will include the following:

In-patient Hospitalisation Expenses: Any healthcare expenses during a stay in the hospital longer than twenty-four hours as a result of a disease or unintentional harm will be covered.
Ambulance Charges: The expenses for ambulance services during a medical emergency will be covered.
Day Care Procedures: The best mediclaim policy pays for daycare procedures that need hospitalisation for less than 24 hours.
Pre and Post-Hospitalisation Charges: Medical expenses before hospitalisation, like diagnostic tests and after discharge, including follow-up consultation, will be covered for a few days.
Maternity Cover: Medical policies cover pregnancy-related and newborn-baby expenses.
Organ Donor Expenses: The best health insurance plan will also cover the cost of organ harvesting and other donor-related expenses.
Daily Cash Allowance: The policyholder will get a daily cash allowance to cover day-to-day expenses.
Domiciliary Treatment: The medical expenses for getting treatment at home under the advice of a doctor will also be covered.
Mental Illness Cover: Some health insurance companies also provide coverage for mental illnesses.

What is not covered under family health insurance?

You should check the terms of the family medical insurance carefully and figure out the exclusions. Usually, the policies won’t cover the following:

Medical consultations and regular check-ups at the hospital
Expenses related to cosmetic procedures or reconstructive surgeries
Costs associated with life-sustaining equipment
Medical care received abroad unless specified in the policy coverage
Illness or injury caused by war, nuclear events, civil unrest, or acts of terrorism
Harm or sickness resulting from engaging in illegal or immoral behaviors
Complications related to pregnancy or childbirth, such as abortion or miscarriage
Pre-existing health conditions are not eligible for coverage until after the waiting period has been completed.

Eligibility criteria for a family health insurance plan

Family medical insurance plans come with different eligibility criteria. But some common criteria include the following:

Minimum Entry Age	18 years for adults 90 days for children
Maximum Entry Age	65 years for adults 25 years for children
Covered Family Members	Self, dependent parents, spouse, dependent children, and parents-in-law
Renewability	Lifetime

Some key points to remember while buying family health insurance plans are as follows:

You can add new members to an existing plan by paying a health insurance premium.
The plan will expire after the eldest member reaches the maximum covered age.
Increase the sum assured after adding new members to get adequate coverage for every person.
A dependent child will no longer be covered once they cross their specified age limit in the policy document.
Don’t include your senior citizen parents in the same plan because it will make the premium too high. Buy separate medical insurance for parents who are senior citizens.

How to file a claim for family health insurance plans

Health insurance plans allow you to register claims in two ways.

Cashless claim

Notify your insurance provider about the medical emergency.
Complete the pre-approval form, which is available at the network's TPA or insurance counter.
Submit the pre-approval form along with other paperwork to the medical facility, who will then pass it on to your insurer.
The insurance company's claims team will send you an approval letter if your claim is accepted.
If there are any questions about your claim, the insurance company will reach out to the hospital for clarification. In case your claim is denied, you will have to apply for a reimbursement claim.
Once your claim is authorized, proceed with your treatment at the hospital and sign all necessary documents before leaving.
Your insurer will pay the medical expenses directly at the network hospital.

Reimbursement claim

Alert your insurance company about the medical emergency.
Seek treatment at a hospital that is not part of the network.
Settle the hospital expenses and gather all paperwork upon your discharge.
Complete the claim form and submit it along with the necessary paperwork to your insurance carrier.
The insurance company's claim department will assess your claim.
Once your claim is validated, you will be notified of approval or denial by the team.
If it gets approved, you will be reimbursed for the medical bills.

Also read: What are the benefit of ABHA card

Common myths about health insurance

Here are some common myths about health insurance.

1. Myth: Health insurance is unnecessary for young and healthy families.

Fact: Medical emergencies can strike anyone at any time. Having health insurance ensures financial security and timely access to medical care, regardless of age or health status.

2. Myth: Family floater plans are always cheaper than individual plans.

Fact: While family floater plans might seem cost-effective, they provide a shared sum insured. If one family member exhausts the coverage, the others will have limited protection until the policy renews.

3. Myth: Health insurance covers all medical expenses.

Fact: Health insurance has specific exclusions and limitations. It is essential to read the policy document thoroughly to understand what is covered and what is not.

4. Myth: I can only buy health insurance during the open enrollment period.

Fact: Many insurers offer health insurance plans throughout the year. However, buying early ensures you are covered without any gaps.

5. Myth: The premium amount is the only cost of health insurance.

Fact: Apart from the premium, health insurance might have co-payments, deductibles, and other out-of-pocket expenses during claim settlement.

6. Myth: I can't switch insurers once I purchase a policy.

Fact: You can switch insurers at the time of renewal if you find a better plan that suits your family's needs.

Frequently Asked Questions (FAQs)

Here are some common questions about Health Insurance for Family of Four in India.

What is the ideal sum insured for a family of four in India?

The ideal sum insured varies based on factors like family members' ages, health conditions, and location. Generally, experts recommend a sum insured of at least 5-10 lakhs for comprehensive coverage.

Can I include my parents in the family floater plan?

Yes, you can include dependent parents in a family floater plan. However, keep in mind that the premium might be higher, and the sum insured might be shared among more individuals.

Does health insurance cover pre-existing conditions?

Most health insurance plans have a waiting period for pre-existing conditions. After completing the waiting period, the coverage will be available for pre-existing illnesses.

What documents are required to file a health insurance claim?

The documents required for a health insurance claim include medical bills, discharge summary, claim form, and supporting documents for the diagnosis and treatment.

Should I buy individual or family health insurance plans?

For comprehensive health coverage, family health insurance is a superior option compared to individual plans. It covers all family members under one policy, eliminating the need for multiple individual policies. You only need to pay a single premium, offering both convenience and potential cost savings.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.