Family Mediclaim Policy

Family Mediclaim Policy- Overview

A family mediclaim policy is basically a healthcare plan that insures all the members in a family along with the insured. Now, the definition of family is different for various service providers. For example, certain organizations do not regard parents as family members.

Advantages of family mediclaim policies

The family mediclaim policies come with several advantages as may be enumerated below:

• Critical hospital expenses such as nursing fees, doctors, room charges, x-ray, anesthesia, pacemaker costs, medicines, implants, operation, stents, RMO fees, blood, and injection fees are covered in these plans

• These plans often provide cashless transaction facilities that let the insured avoid excess of paperwork especially in critical moments. These policies also provide coverage for post and pre hospitalization expenses as well.

• These policies provide half of the amount needed to insure a family. This allows the primary insured to avail other insurance policies as per his or her requirements

• They provide flexibility when it comes to utilizing the benefits for various members in a family who are insured in the plan

The family mediclaim policies provide benefits such as:

• Loyalty discounts
• Expenses of health check ups
• Income tax benefits

Disadvantages of family mediclaim policies

The family mediclaim policies normally do not cover the following:

• Ailments suffered within 30 days of availing the policy
• Vaccination
• Dental treatments with the exception of accidents
• War
• Plastic surgeries
• Nuclear reaction
• Sexually transmitted diseases such as AIDS
• Expenses incurred for contact lenses and spectacles

Following are some other contentious issues pertaining to the family mediclaim plans:

• The policy cannot be renewed before the oldest member of the family hits the upper mark of renewability specified by the company
• If the senior most member of a family passes away, majority of the family mediclaim plans make no changes to the coverage
• The policies may not cover children once they reach a certain stage

How to buy family mediclaim policies?

In order to buy a suitable family mediclaim policy the following basic factors can be considered important:

• Do proper research, both on the internet and in the insurance market
• Try to understand if you will be able to afford the plan
• Understand the guidelines mentioned in the policy properly so that you can make the most of it
• Try to understand if the plan is providing what you are looking for

Family Mediclaim Policies in India

United India Insurance

United India Insurance offers the Family Medicare policy that may be described as below:

Family Medicare

The scope of coverage of the Family Medicare policy may be explained as below:

Situations	Amount of coverage provided
Cataract	10 percent of sum insured - the maximum amount is INR 25 thousand
Hernia	15 percent of sum insured - the maximum amount is INR 30 thousand
Hysterectomy	20 percent of sum insured - the maximum amount is INR 50 thousand
Cardiac surgeries Pacemaker implantation Cancer surgeries Hip replacement Brain tumor surgeries Knee joint replacement	70 percent of sum insured - the maximum amount is INR 4 lakhs
Pre and post hospitalization costs in case of an illness	10 percent of sum insured

If the insured is diagnosed with the same illness after 105 days after being released from the hospital then it will be deemed as a new illness. The policy covers pre hospitalization costs till a maximum of 30 days and for post hospitalization costs the upper limit is 60 days.

New India Assurance

The family mediclaim plan of New India Assurance is referred to as the Family Floater Mediclaim Policy. It may be described as below:

Family Floater Mediclaim Policy

The Family Floater Mediclaim Policy can be availed by anyone between the age of 18 and 60 years. People who are older than 60 years can avail the policy if they have previously availed the policy without any disruption. The plan covers the insured, his or her spouse, and a maximum of two dependent children.

The policy does not cover the following even if they are staying with the proposer:

• Parents
• Siblings
• Parents-in-law

The minimum sum insured of this plan is INR 2 lakhs and the maximum amount is INR 5 lakhs. The policy covers hospitalization costs in case the insured has been hospitalized for more than 24 hours and is there to receive treatment for an illness or injury. The scope of coverage of this program may be mentioned as below:

Expenses	Amount/nature of coverage provided
Pre hospitalization expenses	A maximum of 30 days
Post hospitalization costs	A maximum of 60 days
Day care treatment	Medical expenses of technologically updated day care treatments that do not require 24 hour hospitalization
Ambulance costs	As specified in the policy
Treatment by Ayurvedic, Unani, and homeopathic medicine systems	25 percent of sum insured - treatment should have been done in a registered hospital
Pre existing ailments	After 4 claim free and continuous renewals
Pre existing conditions such as diabetes and hypertension	After 2 years of uninterrupted premium payment or if extra premium is paid

The plan also provides special benefits like income tax exemption as per Section 80D, loyalty discounts, and good health discounts.

Oriental Insurance

The family mediclaim plan of Oriental Insurance is referred to as Happy Family Floater Health Insurance Policy. The policy may be further described as below:

Happy Family Floater Health Insurance Policy

The plan provides a sole sum assured for a whole family that is staying in India and covers the policyholder, his or her spouse, the children, the parents, in addition to the parents-in-law. This plan is available in two versions - Gold and Silver.

A major benefit of this program is that it allows new users to buy and existing users to renew their policies by registering online at Oriental Insurance's portal. They can also make the payment through net banking or their credit and debit cards.

The chief features of the plan may be enumerated as below:

• Pre-acceptance medical examinations are not required for people till 60 years
• The Gold plan provides a daily cash benefit as well as attendant allowance but till a specified limit
• Pre-existing conditions are covered after four straight renewals with the organization
• In both the plans an additional personal accident cover is provided. The Gold plan also provides life hardship survival benefits
• The sum insured in the Silver plan is between INR 1 to 5 lakhs
• Discounts in OMP premiums are provided when the policy is availed
• The Silver plan has a co-pay of 10 percent
• Both non TPA and TPA services are available
• The sum insured in the Gold plan is within INR 6 and 10 lakhs
• Discounts on premiums are provided if the policyholder does not wish to avail the TPA services
• Coverage for hospitalization costs in case of specified accident and diseases is provided till a previously mentioned limit

The scope of coverage of both the plans may be explained as below:

Benefit	Coverage by Gold Plan	Coverage by Silver Plan
Room, nursing, and boarding costs as provided by the nursing home or hospital	Not more than 1 percent of sum assured on a daily basis	Same as Gold Plan
Intensive care unit costs	Not more than 2 percent of sum assured on a daily basis	Same as Gold Plan
Fees of surgeons, consultants, anesthetists, specialists, and medical practitioners	According to previously specified limits	Same as Gold Plan
Cost of anesthesia, diagnostic material and x-rays, blood, dialysis, oxygen, chemotherapy sessions, operation theatre fees, radiotherapy sessions, surgical appliances, pacemaker expenses, medicines and drugs, and artificial limbs	According to previously specified limits	Same as Gold Plan
Ambulance service fees	INR 2 thousand for each illness and restricted to a maximum of 1 percent of sum insured or INR 6000 - the lesser amount throughout the policy term	INR 1 thousand for each illness and restricted to a maximum of 1 percent of sum insured or INR 3000 - the lesser amount throughout the policy term
Hospital cash allowance on a daily basis	0.1% of sum insured per day for each illness - restricted to a maximum of 10 days - overall expenses will be limited to 1.5% of sum insured.	None
Allowance for attendants	INR 500 per day per illness - the maximum limit is 10 days for each illness; the total upper limit is 15 days	None

In case of domiciliary hospitalization the following benefits shall be provided:

Benefit	Coverage by Gold Plan	Coverage by Silver Plan
Fees of surgeons, consultants, medical practitioners, specialists, and blood, diagnostic material and dialysis, oxygen, chemotherapy session, surgical appliances, nursing, medicines and drugs expenses	INR 50,000 throughout the policy period	10 percent of sum insured - maximum amount is INR 25,000
Treatment for dog bites or of other rabid animals like cats or monkeys	INR 5000	INR 5000

Last Updated on 09/18/2012

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