Family Floater
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Family Health Insurance
Family health insurance is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured.
What is a Family Health Insurance? How does it work? Should one buy an individual cover or a family cover?
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.
What the advantages of the Family Health Insurance Plan?
This health insurance plan, as the name suggests is a comprehensive plan that is customised for families. It is similar to individual health plans in its application but the significant difference is that this is for covering the entire family instead as an umbrella coverage.
A major benefit 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. One of the principles of this plan is that all members of a family are never found to fall sick at the same time. Also the family floater health insurance has options with higher sum insured than individual health plans.
A significant advantage is that since all members of the family are covered under a single policy, there is no requirement for keeping track of the renewal of individual policies which could be at different times in the year.
A family floater health insurance is the ideal option when it comes to safeguarding the health of your family at an optimum cost.
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.
What is a Family Health Insurance?
Claims Process for Family Health Insurance
Cashless Claims Process
Cashless Claims Process
Step 1
Get admitted to any one of network hospitals of the respective insurance companies…you can also call the insurance company/TPA on their Toll Free assistance number. Both these pieces of information are available. In case of emergency, you can contact the insurance company within 24 hours of admission to the hospital.
Step 2
Your Identification : At the network hospital you will need to show your Health Insurance health card (nowadays insurers issue e-health cards) of the insurance company and valid photo ID*, along with your policy number, to be able to use your insurance. This will give the network hospital the details they need to contact us for the cashless hospitalization process.
* – Passport / PAN card / voter’s ID for identification purposes
Step 3
Hospital sends cashless hospitalization request form to the insurance company with preauthorization request form which has details of medical history, line of treatment and estimated treatment cost.
Step 4
Wherever the information provided in the request is sufficient to ascertain the authorization, the insurer issues the authorization Letter to the network hospital. Wherever additional information or documents are required we will call for the same from the Network hospital and upon satisfactory receipt of last necessary documents the authorization will be issued.
Step 5
Hospital will send us the final request for authorization of any residual amount along with final hospital bill and discharge summary. You will be discharged from the hospital upon receipt of final authorization letter from the insurer. Any inadmissible expenses, copayments, deductions will have to be paid by you.
Step 6
Once the Hospitalization is done, hospital will send the original claim documents to us. The claim will be assessed by us and payment will be made to the network hospital
Reimbursement Claims Process
Cashless Claims Process
Step 1
Contact Toll free Healthline of the Insurance Company / TPA…same is available. Before you seek medical treatment we request that you contact the insurer atleast 48 hours in advance. This will the claims team to help you follow the next few steps. In case of emergency, you can contact the insurer within 24 hours of admission to the hospital.
Step 2
You can avail treatment at hospital and settle all hospitalization expenses. Collect original hospital bill, receipts, discharge summary, investigation reports, pharmacy bills and other documents from hospital at the time of discharge from hospital.
Step 3
Copy of this form is also included in the policy kit provided to you. Submit the claim documents at nearest branch or Corporate office of the insurance company. The documents should be submitted within 15 days from discharge from the hospital.
Step 4
Wherever the information provided in the claim documents is sufficient to ascertain the admissibility of claim, the insurer will approve the claim. Wherever additional information or documents are required , the insurer will call for the same from you and upon satisfactory receipt of last necessary documents the claim will be settled by the insurance company.
Step 5
Upon approval of claim by the insurer, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD.
The following table provides information relating to the Family Health Insurance member coverage offered by the respective insurance companies in India :
| Company Name | Number of Network Hospitals (as on April 2020) | Maximum Coverage – Family Size for Floater option | Sum Insured Range | Number of Lives** Covered – Individual + Group (2018-19) | Incurred Claims Ratio ** (2018-19 as per data from IRDAI) |
|---|---|---|---|---|---|
| Star Health | 9,900+ | Self, Spouse + 3 dependent children | 1lac – 100 lacs | 1,16,17,000 | 63.00% |
| Max Bupa Health Insurance | 4,500+ | Self, Spouse + 4 dependent children | 2 lacs – 300 lacs | 54,33,000 | 54.00% |
| Care(formerly Religare) Health Insurance | 7,400+ | Self, Spouse + dependent children + dependent parents | 4 lacs – 600 lacs | 1,07,13,000 | 55.00% |
| Reliance General Insurance | 7,300+ | Self, Spouse + 6 dependent children | 3 lacs – 130 lacs | 2,74,64,000 | 94.00% |
| Bajaj Allianz General | 6,500+ | Self, Spouse + 4 dependent children | 3 lacs – 50 lacs | 2,46,85,000 | 85.00% |
| Tata AIG General | 4,000+ | Self, Spouse + 3 dependent children + 2 dependent parents | 3 lacs – 20 lacs | 22,48,000 | 78.00% |
| IFFCO Tokio General | 5,000+ | Self, Spouse + dependent children + dependent parents | 1.5 lacs to 30 lacs | 2,20,15,000 | 102.00% |
| HDFC Ergo General Insurance | 10,000+ | Self, Spouse + dependent children (upto 25 yrs) + dependent parents | 3 lacs – 75 lacs | 96,05,000 | 62.00% |
| Royal Sundaram General | 5,000+ | Self, Spouse + 4 dependent children | 2 lacs – 150 lacs | 14,06,000 | 61.00% |
| Future Generali India (General) | 5,100+ | Self, Spouse + dependent children + dependent parents | 3 lacs – 100 lacs | 48,38,000 | 73.00% |
| Chola MS General Insurance | 6,500+ | Self, Spouse + 4 dependent children | 2 lacs – 25 lacs | 18,06,000 | 35.00% |
| SBI General Insurance | 6,000+ | Self, Spouse + 2 dependent children (upto age of 23 yrs) | 1 lac – 30 lacs | 27,48,000 | 52.00% |
| ManipalCigna Health Insurance | 6,500+ | Self, Spouse + 3 dependent children | 2.5 lacs – 100 lacs | 11,01,000 | 62.00% |
| Universal Sompo General Insurance | 4,000+ | Self, Spouse + 4 dependent children (upto age of 25 yrs) | 1 lac – 10 lacs | 11,37,000 | 92.00% |
| New India Assurance | 3,000+ | Self, Spouse + dependent children + dependent parent | 2 lacs – 100 lacs | 8,75,61,000 | 103.74% |
| Oriental Insurance Company | 4,300+ | Self, Spouse + dependent children + dependent parent | 1 lac – 20 lacs | 3,03,25,000 | 108.80% |
| HDFC Ergo Health (Apollo Munich) | 10,000+ | Self, Spouse + 5 dependent children | 1 lac – 50 lacs | 51,16,000 | 63.00% |
