Inclusions of family health insurance plans
Having a clear idea regarding what a family health plan covers will help prospective policy buyers to make an informed choice. Here are the standard inclusions in the medical insurance plans for family:
- Hospital registration, room rent, service charges etc.
- Daycare treatment charges in hospitals
- Pre- and post-hospitalisation expenses anywhere from 30 to 60 days as per the policy
- Vaccinations and health check-ups for all family members
- Cashless transactions in hospitals
- Tax benefits on premiums of family health insurance plans
- Critical illness covers and additional services in emergencies
- In-patient treatment expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH)
Apart from these, policyholders can utilise additional services and expenses depending on their respective policy terms.
Exclusions of 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 the policy
- STDs (sexually transmitted diseases) such as herpes, AIDS, etc.
- Any disease caused due to substance abuse, including narcotics, drugs, alcohol, etc.
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 2 or more years.
- Insurers also have waiting period for pre-existing illnesses, maternity, and newborn baby expenses.
You should however remember that these exclusions are indicative. It varies from insurer to insurer. Read the policy document for more details. So, you have the utmost clarity about waiting periods 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.
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.
· 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. 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.
Why should you buy a health insurance plan for your family?
Family health insurance is crucial, especially to tackle the medical inflation. It gives coverage to the entire family against minor injuries, major illnesses, accidental injuries, and outpatient procedures.
You only pay a single premium for the family health insurance plan. The sum insured is divided among all family members enrolled in the plan. Here are some factors why you should buy a health insurance plan for family.
· One plan for all
Family health insurance policy covers your complete family. You can also add your extended family and in-laws in the policy. Therefore, it is easier to manage.
· Keeps your savings unaffected
Any medical emergency can affect your family's financial planning and dent your savings. A health insurance policy ensures that your savings remain intact. You can avail of the best healthcare services without worrying about the funds.
· Sun reinstatement benefit
Most health insurance plans for family provide 100% sum reinstatement benefit. If the sum insured gets exhausted, you can restore the amount with this benefit.
· Focus on treatment and recovery
The cashless treatment facility offered under family health insurance plans helps you focus on the treatment and recovery. You can access quality healthcare services without worrying about the availability of funds. The insurer settles the bills directly with the network hospital.
How to apply for online family health insurance plans
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.
Filing a claim for a family health insurance plan
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.
Which documents do you need to raise a reimbursement claim under family health insurance?
Below is the list of documents that you need to submit when filing for 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
Why choose family health insurance plans from Bajaj Finance
Bajaj Finance brings to you family insurance plans offered by top 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 provided efficient and affordable insurance policies in all sectors and consistently has been amongst the top distributors of health insurance plans in the country.
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.