Family Health Insurance

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Family health insurance enables people to cover all their children who are deemed eligible for receiving the benefit as per the insurance provider as well as the spouse.

The premiums for these policies are normally more than the single coverage policies but the advantage with these policies is that someone with 3 children will have to pay the same premium as someone who has only 1 child.

Structural differences with single coverage plans

The family health insurance policies are structurally different from the single coverage plans as well. The deductible in these policies is higher than the single plans but normally these plans have a maximum deductible for every family for a particular calendar year.

Coverage provided by family health insurance plans

The family health insurance plans offer coverage for the following:

  • Prenatal care
  • Routine yearly health check-up for children till a minimum age of 16 years
  • Well-child care
In majority of these plans a dependent child is deemed ineligible for coverage once he or she crosses the age of 18 years. However, in certain plans more benefits or exemptions are provided.

Employer backed family health insurance plans

If the employer of an individual sponsors the family health insurance the recipient employee does not have the option of deciding the coverage. But the employee does have the right to avail a group rate premium for the insurance.

In case a person and his or her spouse are both provided family insurance policies by their respective employers then it is advisable to do a comparison of the premiums and coverage of the same.

Normally families like to get insurance for their dependent children through one spouse and have another spouse avail the single coverage from his or her employer.

Under normal circumstances married couples should look to one spouse for getting the family insurance plan for dependent children if the number is more than one.

It is essential to compare the policies with proper care and judge the monthly premiums with respect to the co-pay and yearly deductible amounts. The situation of the family should also be seen in order to determine the eligibility for special circumstances.

If a company provides a combination of different insurance policies like homeowners, and life insurance along with family health insurance plans and offers good discounts on such plans, families can avail such benefits.

Things to do before buying family health insurance

In case a family needs to get health insurance the ones availing the policy should seek out a minimum of 3 companies. They should also write down the coverage and quotes before they come to a decision. This will help them make an informed decision.

Benefits of family health insurance

Generally speaking, the benefits of health insurance plans may vary from one plan to another. However, some of the advantages may be mentioned as below:

  • Tax saving as per Indian Income Tax Act's Section 80D
  • Cumulative bonus
  • Policy applicants who are younger than a pre-determined number of years are provided instant approval and they need not undergo medical tests or documentation procedures
  • Round the clock helpline
  • Coverage of pre hospitalization expenses
  • Ambulance referral service
  • Coverage of pre hospitalization expenses
  • Online tracking of claims
  • Cashless facilities
  • Online uploading of medical documents
  • Coverage for pre-existing ailments
  • Daily cash benefit
  • Certified claims procedures
  • Convalescence benefit
Types of family health insurance

There are various kinds of family health insurance plans - Preferred Provider Organization (PPO) plans, Point of Service (POS) plans, and Health Maintenance Organization (HMO) plans.

The PPO policies are provided on the basis of hospitals and doctors who are part of the list of the organization that is providing the plan. With these, patients have the luxury of opting for a doctor on the basis of their convenience. In case of specialist care, referrals are not needed if a doctor or hospital is included in the network. The policyholders in these cases can also avail the services of doctors and hospitals who are not in the specified network.

With an HMO plan, the focus is on a primary care physician or PCP who is supposed to act as a coordinator for all health related problems. In these plans, the patients initially visit the PCP if they face a physical ailment and the PCP then refers them to a specialist if the situation calls for such a decision. In case of emergencies, referrals are not needed.

Prior to opting for an HMO plan the patients should ask for a list of hospitals and doctors. If the HMO is unable to tend to the problem then the PCP needs to be visited. There are a few HMO plans that offer PPO facilities in addition to the regular facilities.

The POS plans are basically combinations of the PPO and HMO plans. The term POS implies that the policyholders can choose between PPO and HMO. The patient needs to designate a specific PCP but they are allowed to look for doctors or hospitals that are outside the network.

Family health insurance deductibles

Different family health insurance plans offer various levels of deductibles. Deductible is basically the amount the policyholders spend before their healthcare expenses are covered by the insurance. If the deductible is high then the premium will be lower as will be the coverage. But this will also mean that the patient will need to make a bigger payment before the plan actually kicks in.

National health care

In certain countries medical coverage is provided to residents without any fees - these plans are referred to as national health care plans. However, in most cases the benefits of these programs are not available outside the territorial jurisdiction of the country in question.

This implies that if a family that is receiving national health care benefits is visiting a country where such facilities are not available then any injury or illness will not be covered by that plan.

How to apply family health insurance

One of the most convenient ways to apply for a family health plan is to look for websites of companies that provide such services. Normally the following procedure has to be followed in these cases:

  • The applicants need to specify whether they are buying a new policy or renewing an existing one
  • They then need to select their city of residence
  • They need to specify if they already have a medical ailment or not
  • They have to mention if they smoke or not
  • They also need to say if their spouse will be included in the program
  • They have to mention the number of dependent children to be covered and state their respective ages
  • They have to mention the date of birth of the oldest person in the family
  • They are required to specify contact details such as e-mail address and mobile number
  • In case they are looking up an aggregator site they will be provided with options of banks and financial entities that provide such services

Family Health Insurance Companies

Following are the leading providers of family health insurance plans in India and the best plans being marketed by them:

CompanyPolicy name
Royal Sundaram Alliance Insurance IndiaFamily Good Health Plan
Life Insurance Corporation Ltd, IndiaHealth Protection Plus
Max BupaFamily Floater
Apollo Munich InsuranceFamily Health Insurance
Star HealthFamily Health Optima
Reliance GeneralReliance HealthWise
Last Updated on 30/07/2012

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