Family Floater Health Insurance Policies

Family floater health insurance policies are a type of health insurance plan that provides coverage for the entire family under a single policy. Rather than individual policies for each family member, a family floater policy offers consolidated coverage for the primary policyholder, their spouse, and dependent children.

The main objective of a family floater policy is to provide financial protection against medical expenses arising from illnesses, injuries, hospitalizations, and other healthcare needs of the family members. It offers a comprehensive and convenient solution to manage the healthcare needs of the entire family under one policy.

Subas Tiwari

Here are some key features and benefits of family floater health insurance policies:

Coverage for the Whole Family: Family floater policies cover all the members of the family, including the policyholder, spouse and dependent children. Some policies may also allow coverage for parents or in-laws.

Sum Insured: The policyholder selects a sum insured, which represents the maximum amount of coverage available for the family members. This sum insured can be utilized by any member of the family as per their healthcare needs.

Premium: The premium for a family floater policy is based on factors such as the age of the eldest member, the sum insured selected, and the overall risk profile of the family. Paying a single premium for the entire family is often more cost-effective than buying separate policies for each member.

Cashless Treatment: Family floater policies usually offer cashless treatment facility wherein the insured members can avail medical treatment at network hospitals without paying cash up front. The insurance company settles the bills directly with the hospital, subject to policy terms and conditions.

Coverage for Hospitalization Expenses: Family floater policies typically cover expenses related to hospitalization, including room charges, doctor’s fees, surgical procedures, medications, and other necessary medical services. The coverage may also include pre and post-hospitalization expenses for a specified period.

Additional Benefits: Family floater policies may offer additional benefits such as coverage for daycare procedures, ambulance charges, maternity benefits, newborn baby care, alternative treatments, preventive healthcare services, and annual health check-ups. These benefits may vary across insurance providers.

Policy Renewal: Family floater policies are generally renewable on an annual basis. Renewing the policy ensures the continuity of coverage for the family.

How is it different from Individual policies?

Individual Policy	Family Floater Policy
Each one of the members have to take a policy for himself/herself.	There is only one policy under whom every member of the family is covered.
The sum assured is individually fixed depending on your requirements.	The sum assured on the policy is the same for each member.
The claim on the policy will be up to individual limit.	The claim can be on the whole sum assured on the policy or can be claimed by other family members also to that extent.
Premium is higher in this case.	Premium amount tends to be lower.
Premium is fixed according to the age of the individual.	Premium is fixed based on the age of the oldest member.
This policy suits only an individual who does not foresee any increase in family size.	This policy will suit any individual, whose family size is expected to increase either due to marriage/childbirth or in the unfortunate event of a sister becoming a widow or the dependent parents migrate from the native village & stay with the son.

Is Taking Health Insurance a Must?

While it is not legally required to have health insurance in all countries, having health insurance is generally considered to be a prudent financial decision and can provide several benefits.

Here are some reasons why having health insurance is often recommended:

Financial Protection:Health insurance provides financial protection against high medical costs. Medical treatments, hospitalizations, surgeries, and emergency care can be expensive, and having insurance helps mitigate the financial burden by covering a significant portion of these expenses. Without insurance, you may have to pay for medical bills out of pocket, which can be financially devastating, especially in case of major illnesses or accidents.
Access to Quality Healthcare:Health insurance gives you access to a network of hospitals, clinics, and healthcare providers. Many insurance plans have tie-ups with specific hospitals or a network of providers, allowing you to receive medical care at discounted rates or through cashless treatment facilities. This ensures that you can receive timely and quality healthcare services when needed.
Timely Medical Attention:With health insurance, you are more likely to seek timely medical attention for health concerns, as you have coverage for the associated costs. Regular health check-ups and preventive care can help identify and address health issues early on, increasing the chances of successful treatment and reducing the risk of complications.
Coverage for Major Illnesses and Accidents:Health insurance provides coverage for major illnesses and accidents, which can require extensive medical treatments, surgeries, or long-term care. These unexpected events can be financially overwhelming without insurance coverage. Having insurance ensures that you can receive the necessary medical care without worrying about the financial implications.
Peace of Mind:Having health insurance brings peace of mind, knowing that you are financially protected against unforeseen medical expenses. It allows you to focus on your health and well-being without the constant worry about how to manage healthcare costs.

However, the decision to take health insurance ultimately depends on your individual circumstances, including your financial situation, access to healthcare, and the healthcare system in your country. It is advisable to carefully assess your needs, compare insurance plans, and consider factors such as coverage, premiums, deductibles, and exclusions before choosing a health insurance policy that best suits your requirements.

Limitations

The family floater plans are priced based on the age of the senior most member; as he/she gets older, the flexibility in premium decreases & the cost of the premium increases significantly.
The family floater policy will be renewed only till the senior most member reaches the maximum age of the renewability as provided in the policy.
Children who reach the maximum age (normally it is 25 years or becomes independent on getting a job or is gainfully self- employed) will have to buy a separate policy for themselves.

IRDAI REVISES GUIDELINES ON STANDARD INSURANCE POLICY- COMMON WORDINGS & ENSURING SEEMLESS PORTABILITY

The standard health policy will have benefits of cumulative bonus.
Insurers will not be permitted to impose deductibles.
Customers will, however, be subject to a fixed co-pay of 5% of claim amount across all ages which will be clearly mentioned in the policy document.
All insurers to offer the above cover on indemnity (protection) basis only.
There cannot be any other add-on covers like critical illness or benefit-based covers.
Insurers will have the final decision on the premium price.
These rates would have to be uniform across India.
Insurers cannot have geography or zone-based pricing on these rates.
The “Arogya Sanjeevani” policy (which is a standardized & custom-built policy model brought out by IRDAI) based on which insurers could bring out their policies & the same can be availed as for both individual lives & family floaters basis on or before 1^stApril, 2020
The minimum will be Rs.1,00,000 & the maximum will be for Rs.5,00,000.
This policy will have no exit age.
For this policy, the minimum age required is 18 years & the maximum 65 years.
Under the family floater policy, children between 3 months to 25 years would be covered.
The standard policy will be offered with a policy term of 1 year.
The policy will allow all modes of premium payment, viz., monthly/quarterly, half-yearly & yearly.
Treatment for cataract & age-related eye ailments, ulcers, piles, sinus, benign ENT disorders, tonsillitis, adenoidectomy, mastoidectomy & all internal & external tumours will be covered subject to a waiting period of 24 months.
Treatment for joint replacement (unless arising from accident & age-related osteoarthritis) will have a waiting period of 48 months.

How is my Family Floater Health Insurance Premium Calculated?

The premium for a family floater health insurance policy is calculated based on several factors. While the specific methodology may vary between insurance companies, here are some common factors that influence the premium calculation:

Age of the Oldest Member:The age of the oldest member in the family plays a significant role in determining the premium. Generally, higher age is associated with increased health risks, leading to higher premiums.
Sum Insured:The chosen sum insured, which represents the maximum coverage amount under the policy, affects the premium. Higher sum insured amounts typically result in higher premiums.
Family Size:The number of family members covered under the policy can impact the premium. A larger family may result in higher premiums compared to a smaller family.
Zone or Location:The geographical location of the insured members can influence the premium. Insurance companies may have different premium rates for different regions based on factors like healthcare costs, infrastructure, and demographics.
Medical History:The medical history and pre-existing conditions of the insured family members can affect the premium. Certain health conditions may lead to higher premiums or exclusions from coverage.
Lifestyle Factors:Lifestyle factors such as smoking, alcohol consumption, or engagement in high-risk activities can impact the premium. These factors may increase the likelihood of health issues and result in higher premiums.
Deductibles and Co-payment:If the policy has a deductible or co-payment clause, where the insured has to bear a portion of the expenses, the premium may be adjusted accordingly.
Coverage and Add-ons:The extent of coverage and additional benefits chosen, such as maternity coverage, daycare procedures, or alternative treatments, can influence the premium.
Claim History:The claims history of the insured members may be taken into account. If there have been frequent or high-value claims in the past, it may result in higher premiums.

It’s important to note that each insurance company may have its own methodology for premium calculation, and the weightage given to each factor may vary. It’s recommended to reach out to insurance providers or agents for accurate premium quotes based on your specific family’s details and requirements.

Here are 20 tips to consider when buying a family floater health insurance policy:

Assess Your Family’s Healthcare Needs:Understand your family’s medical history, current health conditions, and anticipated healthcare needs to determine the appropriate coverage required.
Evaluate Insurer Reputation:Research and choose a reputable insurance company with a strong track record in providing quality coverage and prompt claim settlements.
Coverage Adequacy:Ensure the policy offers sufficient coverage to meet potential medical expenses for the entire family.
Network Hospitals:Check the list of network hospitals affiliated with the insurance provider to ensure convenient access to quality healthcare services.
Pre-Existing Conditions:Review the policy’s stance on pre-existing conditions and understand if there are any waiting periods associated with coverage for such conditions.
Policy Exclusions:Thoroughly read and understand the policy exclusions to know what conditions, treatments, or situations are not covered.
Room Rent Limit:Check the sub-limit on room rent and make sure it aligns with the cost of hospitals in your preferred location.
Co-payment:Understand if the policy has any co-payment requirements, where you need to bear a percentage of the medical expenses.
No Claim Bonus:Inquire about the availability of a no claim bonus, which rewards policyholders with increased coverage or reduced premiums for claim-free years.
Claim Settlement Ratio:Research the insurer’s claim settlement ratio to assess their efficiency in processing and settling claims.
Waiting Periods:Understand the waiting periods associated with specific treatments, maternity benefits, and other coverage aspects.
Daycare Procedures:Check if the policy covers daycare procedures that do not require 24-hour hospitalization.
Maternity Benefits: If you anticipate having children, evaluate the coverage for maternity expenses, including pre and post-natal care, delivery charges, and newborn baby care.
Policy Renewal Age:Check the maximum age up to which the policy can be renewed to ensure long-term coverage for your family.
Premium Affordability: Compare premium costs across insurers and assess the affordability of the policy in relation to your budget.
Claim Process:Understand the claim filing process and the ease of claim settlement, including the availability of cashless treatment facilities.
Additional Benefits:Consider any additional benefits offered by the policy, such as coverage for alternative treatments, preventive healthcare services, or annual health check-ups.
Customer Service:Evaluate the insurer’s customer service track record, including responsiveness, support, and grievance resolution.
Policy Flexibility: Assess if the policy allows for adding or removing family members during the policy period, considering potential changes in family structure.
Read Policy Documents:Thoroughly read and understand the policy documents, including terms, conditions, and limitations, before making a final decision.

It’s advisable to consult with financial advisors who can provide personalized guidance based on your specific requirements and preferences.