Having a clear idea regarding what family health coverage plans include will help prospective policy buyers make an informed choice. Here are the standard inclusions in the medical insurance plans for family:
- Hospitalisation expenses: A family health insurance plan covers the hospitalisation expenses, including room rent, ICU charges, and doctor's fees, which can easily mount up and create a financial burden.
- Daycare procedures: Some insurance providers also cover day care procedures that don't require hospitalisation for 24 hours or more. These procedures include chemotherapy, dialysis, and cataract operations.
- Accident coverage: Family health insurance plans often include accident coverage, which provides financial protection for unexpected events. This coverage typically includes dental treatment in case of accident-related injury and compensation for vision damage due to accidents, ensuring comprehensive care for your family.
- Pre-and post-hospitalisation expenses: Family health insurance plans also offer critical illness coverage, which includes the costs associated with the treatment of severe conditions such as cancer, kidney failure, and heart ailments. These plans, under the umbrella of medical insurance for family, ensure that your family is financially protected against significant medical expenses during critical health situations.
- Maternity cover: Many family health insurance plans offer maternity coverage, which covers the delivery costs of a child. Some plans also cover newborn baby care for a specific period.
- Pre-existing diseases coverage: Certain family health insurance plans offer coverage for pre-existing diseases. However, coverage for these diseases may come with a waiting period, usually between one to four years, depending on the policy.
- Critical illness coverage: Family health insurance plans also offer critical illness coverage, covering medical expenses incurred during the treatment of critical illnesses such as cancer, kidney failure, and heart ailments.
- Alternative treatments: Some family health insurance plans include coverage for alternative treatments such as Ayurvedic, Homeopathic, and Unani treatments.
- Ambulance charges: Family health insurance plans may also cover ambulance charges, which can help take the financial strain off of you during an emergency.
- No claim bonus: Some policies offer a no-claim bonus, where policyholders get a discount on the premium amount if they don't claim for a certain period.
- Health check-ups: Some insurance providers offer health check-ups for free as part of a family health insurance policy, allowing you to stay on top of your health and detect any health conditions early on.
What is not covered in a family health insurance plan?
The following are a few expenses that a medical insurance policy for family may not cover:
- Any disease that occurs during the waiting periods mentioned in family health insurance policy.
- STDs (sexually transmitted diseases) such as herpes, AIDS, etc.
- Any disease caused due to substance abuse, including narcotics, drugs, alcohol, etc.
- Most family health insurance plans do not cover outpatient department (OPD) expenses, such as doctor consultations, diagnostic tests, or minor procedures that don't require hospitalisation, leaving these costs to be paid out-of-pocket.
- Cosmetic or plastic surgeries, unless medically necessary due to an accident or illness, are typically excluded from family health insurance plans, meaning expenses for elective procedures are not covered.
- Treatments received outside the country are generally not covered under family health insurance plans. If a family member needs medical care abroad, these expenses will likely not be reimbursed by the insurance.
- Routine dental procedures like cleanings, fillings, or cosmetic dental work are usually excluded, unless required due to an accidental injury.
Apart from these, there are a few health conditions that the insurance companies will cover after a specific time. These include prolapsed, bariatric surgery, joint replacement, and extruded intervertebral disc (PIVD) or herniated. A few others include:
- For cataracts, hernia, sinusitis, and piles, the insurer will accept claims after waiting period of two or more years.
- Insurers also have waiting period for pre-existing illnesses, maternity, and newborn baby expenses in a health insurance policy for family.
You should, however, remember that these exclusions are indicative and can vary from insurer to insurer. It's important to read the policy document for more details to understand the specific terms and conditions of family health insurance plans. This ensures you have utmost clarity about waiting periods and coverage details for your chosen insurer and plan.
Eligibility criteria to buy health insurance plans for family
While comparing different options, individuals must also consider the following eligibility parameters.
- The minimum age of the policyholder's family members should be between 18 to 65 years. In case of dependent children, the age limit is between 3 months and 30 years.
- You can opt for health insurance plans for family to cover yourself, spouse, and children. Also, for your dependent parents, and parents-in-law.
Most plans will have tenure of a year. You need to renew the family health insurance plan to keep the coverage active.
Should you include your parents in your family health insurance plan?
While it may seem convenient to cover your entire family, including your parents, under a single family health insurance plan, it may not always be the best choice. Parents, especially senior citizens, are more likely to have pre-existing conditions and may require frequent medical attention. Including them in your family floater plan could lead to quicker exhaustion of the sum insured, leaving other members under-covered. Instead, it’s often advisable to buy a separate senior citizen health insurance policy for your parents. This ensures they get age-specific benefits and adequate coverage, while keeping your primary family plan cost-effective and focused on your spouse and children.
Things to consider before buying a family health insurance plan
Before buying a mediclaim policy for family, read the pointers you must consider for maximum protection.
Sum insured
The sum insured in a policy must be sufficient to meet the entire family's medical expenses. Therefore, reputed insurance companies offer family plans with a sum insured between Rs. 1.5 lakh and Rs. 2 crore.
Premium
Evaluate the premium amount to ensure it fits your budget while providing adequate coverage. Consider factors like the sum insured, family size, and additional features, as these will impact your monthly or annual premium payments.
Pre and post-hospitalisation coverage
Covers medical expenses, such as tests or consultations, incurred before hospitalisation. Post-Hospitalisation: Includes follow-up treatments and medications needed after discharge. Pre and post-hospitalisation coverage helps manage expenses related to your treatment journey, offering financial relief beyond hospital stays.
Daycare coverage
Daycare coverage includes treatments that don’t require overnight hospitalisation due to advances in medical technology. These can include minor surgeries, chemotherapy, or dialysis. Ensure your family health plan covers a broad range of daycare procedures to minimise out-of-pocket costs.
Ambulance coverage
Covers costs for emergency transportation to a hospital. Many plans offer cashless ambulance services within their network. Ambulance coverage is essential, especially during emergencies, as it ensures immediate transport to healthcare facilities without the stress of payment.
Alternate therapies
- AYUSH treatment: Many family health plans cover Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
- Holistic care: Alternative therapies offer additional treatment options and are often included to ensure comprehensive health support.
- Check if your policy includes alternate therapies to give your family the flexibility of conventional and holistic care options.
List of exclusions
Family health insurance plans may exclude specific treatments, such as cosmetic surgeries, infertility treatments, or pre-existing conditions within the waiting period. Reviewing the exclusions will help you understand potential out-of-pocket expenses and coverage limits.
Reviews
Before selecting a plan, go through customer reviews and ratings. These provide insights into claim settlement efficiency, customer service, and reliability, helping you choose a family health insurance provider with a good track record.
Hospital network of the insurance company
Always buy a health insurance policy for family from a company with a vast network of hospitals. You have the advantage of availing cashless treatment.
Claim settlement ratio
Choose an insurance provider with a good claim settlement ratio in health insurance. The higher the ratio, the more streamlined the processes of accepting and settling the claims.
Waiting period
Often, insurers apply a waiting period from 2 to 5 years on certain facilities. You can check the waiting period in the policy terms and conditions. Mostly waiting period is applicable on pre-existing illnesses. Also, add-on covers like dental coverage, free annual check-ups, etc. During this period, individuals cannot file any claim.
Therefore, you must thoroughly go through the inclusions and exclusions of a family health plan. Know if the company extends any add-on covers to expand the coverage.
How has medical inflation impacted over the years making family health insurance necessary?
Medical inflation in India has seen a sharp rise over the past decade, with healthcare costs increasing at an annual rate of 10–15%. From hospital room rent to diagnostic tests, doctor fees, and post-operative care—every aspect of treatment is now significantly more expensive. Even a short hospital stay for a minor illness can cost tens of thousands of rupees. In case of critical illness or surgery, expenses can run into lakhs. This surge in medical expenses makes family health insurance not just a smart choice, but a necessity. A comprehensive plan shields your savings from sudden medical bills while ensuring access to quality treatment for every family member—without compromising on care due to cost.
How to save tax with family health insurance plans?
Investing in a family health insurance plan not only secures your loved ones but also helps you reduce your tax burden. Under Section 80D of the Income Tax Act, you can claim deductions up to Rs. 25,000 per year for premiums paid for yourself, your spouse, and dependent children. If you also pay for your parents’ health insurance, you can claim an additional deduction of Rs. 25,000—Rs. 50,000 if they are senior citizens. This means you can save up to Rs. 75,000 annually through health insurance premiums. Moreover, preventive health check-up costs (within the premium limit) are also eligible. By planning your coverage smartly, family health insurance becomes a dual benefit—financial protection and tax savings.
How to choose the best Health Insurance Plans for Family in India 2025
When selecting the best family medical insurance, consider coverage, premium affordability, and specific health needs to ensure comprehensive protection.
Understand your requirements
Identify what your family needs in a health plan based on factors like age, health history, and budget. Consider if anyone has pre-existing conditions or requires specific treatments. Ensure the plan covers all members, including dependents. Assess the premium and deductible affordability for long-term management. Understanding these needs helps in narrowing down the best options.
Look for options
Explore various plans offered by insurers to find the most suitable coverage. Review different plans' features, premiums, and network hospitals. Look for benefits like maternity, dental, or critical illness riders. Ensure the insurer has an easy, hassle-free claim process. Evaluating options ensures you select a comprehensive and beneficial family health insurance plan.
Make an informed decision
After comparing options, select a plan that best fits your family's needs. Understand policy inclusions, exclusions, and waiting periods. Look at customer feedback for claim settlement and service quality. Choose a plan that can accommodate changes in family health requirements.
An informed choice ensures a dependable and valuable family medical insurance policy.
How to apply for online family health insurance plans
Here are some steps for applying the best mediclaim policy for families:
Step 1: Click here to open our online application form.
Step 2: Fill in the application form with your basic details or the person that you want to insure. Provide your name, gender, and mobile number. Also, date of birth, and residential PIN code.
Step 3: Now click on ‘Get Quote’ to proceed.
Step 4: From the list of policies shown, choose your preferred family health insurance plan by clicking the ‘Buy Now’ button placed under each plan. You can further modify the insured amount, policy term, and plan-type to get a list of policies tailored to your preference.
Step 5: Based on the plan you choose, you may get the option to select the policy term and premium amount.
Step 6: Enter your email ID and check if all personal details shown are correct. Click ‘Next’ to proceed.
Step 7: Enter some additional details, such as height, weight, nationality, marital status, address, and nominee details (if applicable).
Step 8: Answer a few questions about your health and lifestyle by clicking the relevant checkboxes. Click on the ‘Next’ button to proceed.
Step 9: Verify if the previously filled details are correct. Click on the ‘Proceed’ button to visit the payment page.
Step 10: Make the payment through net banking, UPI, debit, or credit card to buy the policy.
After successful payment, your policy document will be available for you to download instantly. You will receive a copy of the policy document on your registered email ID within from 5 to 7 working days.
You will also receive an SMS confirmation immediately after the payment processed successfully.
You can also access your policy details through the My Account section within 5-7 days after purchase.
What documents do you need to buy family health insurance?
Here’s the list of documents that you need to buy the family health insurance plan.
- Proof of identity – passport, driving licence or Aadhaar Card.
- Proof of address – utility bill, ration card, or driving licence.
- Birth certificates of each family member enrolled under the plan.
- Medical history if any pre-existing conditions or surgeries undergone in the past.
- Income proof, a salary slip, or any other document that proves your income.
However, if you are buying health insurance from Bajaj Finance Insurance Mall, you can enjoy the convenience of purchasing health insurance for your family through a 100% paperless journey. This streamlined process makes it easier to secure comprehensive coverage for your entire family without the hassle of traditional paperwork.
How to file a claim for a family health insurance?
Go through the step-by-step guide to raise a claim against family health insurance plans:
For cashless treatment:
Step 1: Fax or email your pre-authorisation form collected from your insurer’s website or the hospital’s insurance department.
Step 2: Submit medical records, discharge certificate, or letter, receipts of the diagnostic test, etc.
Step 3: You will receive an approval letter from the claim management department after claim authorisation.
The hospital will contact the insurance provider if they have any related queries. Upon resolving all the queries, the insurer approves the claim and settles the bill directly with the hospital. Insurer would inform the policyholder if cashless claim not approved. You can then file a reimbursement claim.
For reimbursement claim:
Step 1: Submit the claim form and other necessary documents to the address provided when you obtained the insurance plan or many insurers have now made filing online the new norm.
Step 2: Address the questions the claim management team of your insurance company has raised.
Next, once you have resolved queries and shared the relevant documents, once your claim is accepted by the insurer, you will receive reimbursement for your expenses.
Documents required for family health insurance claim reimbursement
Below is the list of documents that you need to submit when filing for a medical reimbursement claim under family health insurance.
- Duly filled health insurance claim form
- Health card or policy number/document
- Investigation/test reports like X-ray, CT scans, blood reports, etc.
- Bills and prescriptions
- Hospital discharge summary
- Doctor consultation papers
- NEFT details
Individual Health Insurance vs Family Health Insurance
Here are the key differences between individual health insurance and family health insurance plans:
| Parameters |
Individual health insurance |
Family health insurance |
| Plan details |
One person or individual is insured under this policy |
Offers coverage for multiple family members under one plan |
| Coverage |
The sum insured covers the medical expenses of only the individual |
The sum insured is shared among the family members covered under the plan |
| Benefits |
Offers extensive coverage for the individual |
A more affordable option to cover multiple family members |
| Disadvantages |
Can be expensive to buy |
Offers limited coverage for family members since the coverage is shared amongst the family members |
Why choose family health insurance plans from Bajaj Finance
Bajaj Finance brings to you family insurance plans offered by best health insurance providers in the country. Here are some of the advantages of buying health insurance plans offered by Bajaj Finance.
Reliable brand name
Bajaj Finance is a name that inspires trust among customers. The company has consistently provided efficient and affordable insurance policies across various sectors, earning its reputation as one of the top distributors of the best health insurance plans for family in the country.
Digital process
Bajaj Finance’s online customer portal for family health insurance is quick, easy, and secure. This digital platform is informative and interactive with a customer-centric approach.
Conclusion
A family health insurance plan is essential to protect your loved ones from rising medical costs. To find the right coverage within your budget, use a health insurance premium calculator. It helps you compare plans, estimate premiums, and make an informed, cost-effective decision.
