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Understanding Mediclaim Policy for Family
A family mediclaim policy, as the name suggests, is a type of mediclaim that covers your entire family under a single plan. When you buy a mediclaim policy for the family, the sum insured is shared among all the insured members. You can insure your spouse, children, and parents under a single plan, without purchasing separate plans for each of them. As the coverage limit is shared between all the insured members, such plans reduce the premium cost that would be spent on individual plans. Moreover, it helps you manage the health needs of the entire family at a time, enhancing convenience.
Who Should Buy a Mediclaim Policy for the Family?
Individuals with dependents should consider purchasing a mediclaim policy for the family. It helps cover the medical needs of all the members under a single plan. Here's a list of family types that should opt for a family mediclaim policy:
- Nuclear Family or Newly Married: Families that include only husband and wife can consider buying mediclaim for family. In this stage, they need coverage for only two members with lower health risks. This helps them secure mediclaim policy at lower premiums.
- Families with Kids: If your family includes an infant or kids, a family mediclaim policy is crucial. Young kids may require frequent doctor visits, vaccinations, and other childcare treatments. Having a family mediclaim helps you stay financially covered during the medical needs of your child.
- Growing Families: As your family grows, your financial responsibilities also increase. Moreover, with increasing age, the health risks for you and your family increase. Thus, having a mediclaim for family is crucial at this stage to cover your medical needs. Higher coverage can keep your family secured from medical emergencies.
- Families with Senior Citizens: If your family includes aged parents above 60 years, it is important to get insured with a family mediclaim policy. However, covering senior citizens translates to covering high-risk individuals, as they are more likely to have frequent health issues. Thus, you require higher coverage and need to pay a higher premium.
Benefits of having health insurance plans for family
While you can buy separate mediclaim policies for individual family members, it is typically a better option to purchase a family floater mediclaim policy. This type of mediclaim policy for family members ensured that all you and your dependants are all covered under a single plan. Here are some more benefits that mediclaim policy for family offers you:
1. Single Premium to Cover all Family Members
Mediclaim insurance policy for family covers all members of the family under one plan. You can insure yourself, your spouse, your dependent children, your dependent parents by paying a single premium. In fact, several plans allow you to include your extended family in your coverage. As a result, you do not have to keep track of due dates for payment of multiple insurance premiums, which will save you time and effort in the long-term.
2. Premiums are reasonable
When compared to individual plans for each family member, the premium for a family floater insurance plan is significantly lower. As a result, mediclaim policy for family provides reasonable coverage in case of medical emergencies while still being easy on your wallet.
3. Every person who is covered receives extensive coverage
Any family member who becomes ill can access the entire money insured under the family floater mediclaim policy. This ensures that you and your loved ones are adequately covered for medical expenses and your savings are protected no matter what the cost.
4. Coverage for Multiple Types of Medical Costs
A Mediclaim policy for Family offers coverage for multiple types of medical costs. These include pre and post hospitalization costs, hospitalization expenses, hospital room charges and day care expenses – to name a few. Getting this type of comprehensive coverage at a reasonable cost is definitely something you should consider.
5. Section 80D Tax Benefits
Another key advantage of mediclaim insurance for family that you should keep in mind is that they provide tax deduction benefits under Section 80D. When you acquire a mediclaim policy for yourself, your spouse and dependant children, you can get a tax deduction of up to Rs. 25,000. If you purchase a mediclaim policy for senior citizen parents, this tax deduction reduction increases to Rs. 50,000 annually.
As a result, mediclaim insurance for family policies are an excellent choice for your family's health insurance needs. These plan are easy to purchase, covers all members, and is reasonably priced. So, ensure your family's health by investing in a family mediclaim policy.
Family Mediclaim vs Individual Health Insurance
As already mentioned, a health insurance policy is a broader concept and mediclaim is one of its types. Thus, family mediclaim plans and individual health insurance come with some sets of differences. Though both cover your medical needs, they differ in some ways. The table below represents the differences between mediclaim for family and individual health insurance:
| Aspects | Family Mediclaim Policies | Individual Health Insurance |
|---|---|---|
| Coverage | Covers all eligible family members, including your spouse, parents, and children | Covers only a single individual |
| Cost | More affordable for families | More expensive because it covers every member individually |
| Ideal For | Suits families that need basic health coverage and do not have any chronic illnesses | Suits individuals who need extensive healthcare coverage |
| Risk Impact | As the same sum insured is shared by all the family members, one member’s claim can reduce the overall sum insured | Claims will affect the coverage of the insured individual only. |
Factors You Should Consider Before Buying a Mediclaim Policy for Family
It is critical to protect your family against financial hardships that may arise as a result of unforeseen medical expenses. It is possible to do so by purchasing a family floater mediclaim policy. Choosing the best mediclaim policy for family might be difficult. As a result, before you take on this obligation, you should consider the following:
1. Whether the amount insured is sufficient to protect your family
Before you get a family floater mediclaim policy, ensure that the sum of the coverage is enough to cover the entire family’s medical needs. Look out for pre-existing medical conditions, factor in the age of members covered and so on. In case your parents are senior citizens, their medical needs may be significantly more expensive than that of the younger members of the family. Hence, you have to consider a higher sum insured to cover their medical costs adequately.
2. Check the premium payable
The amount you must pay to your insurer to keep your insurance active is known as the insurance premium. The premium amount payable will rise in tandem with the increase in the sum insured. Aside from that, the premium for a family floater plan is determined by the eldest family member's age. Furthermore, if you choose add-ons, your family health insurance premium will rise once again. So, don’t forget to consider these factors when choosing a mediclaim policy for your family.
3. How extensive is the insurer's hospital network
Check the number of network hospitals included in the family floater mediclaim policy offered by different insurers. A greater number of network hospitals is preferable because it will be easier for you to receive cashless care at multiple hospitals. In the case of cashless treatment, your insurer will cover your bills with the hospital directly without any initial out-of-pocket expenses for you.
4. Check to see if pre-hospitalization and post-hospitalization charges are reimbursed
Ideally pre-and post-hospitalization charges should be covered in addition to hospitalization charges by your family mediclaim policy.
This will ensure that you do not have to pay out of pocket for expenses related to medical tests and doctor visits that might happen before or after hospitalization.
This will ensure that you do not have to pay out of pocket for expenses related to medical tests and doctor visits that might happen before or after hospitalization.
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Eligibility and Documents Required for Family Health Insurance
Eligibility requirements are part of any family health insurance plan. Although the eligibility conditions for family floater mediclaim policy in India differ from one to the next, the following information summarizes the most typical requirements:
- Entry AgeMinimum entry age for an adult family member is 18 years and maximum entry age is 65 years. Minimum entry age for a child is 90 days and maximum coverage age is 30 years.
- Number of family members CoveredSelf, spouse, dependent children, dependent parents and parents-in-law.
Documents required
When purchasing a mediclaim policy for family, the insurance company will often request the following documents:
- Proof of identification
- Proof of Address
- Records of pre-existing medical conditions, if any.
- Photographs
Best Mediclaim Policy for Family: Key Medical Benefits
Most insurance providers cover the following essential items as part of their mediclaim policy for family:
- Room Rent: These are frequently referred to as "room charges" or "bed costs."
- ICU fees: When a person is in critical condition, Intensive Care Unit (ICU) fees are necessary. The cost of an ICU stay is more than the cost of a standard hospital stay.
- Doctor Visits: Various sorts of professionals, such as a general physician, a specialist, an anesthesiologist, a nutritionist, a pediatrician, a lactation consultant, and others, may visit the patient while they are in the hospital.
- Charges for the operating room: These fees apply if the patient needs to have surgery.
- Daycare procedures: Daycare procedures cover operations and procedures that do not require hospitalization. Examples of such procedures are cataract surgery, tonsillitis eradication, and so on.
- Ambulance fees: Once or twice every claim, the insurance company will cover the cost of hiring an ambulance for transportation to the hospital.
How to Choose the Best Mediclaim Policy for Your Family?
Choosing the best mediclaim policy for the family requires some careful consideration. There are multiple providers with different attractive plans. So, you should select the right plan carefully. Here are some of the factors that you must consider before purchasing a mediclaim policy for your family
1. Sum Insured
Choosing the coverage amount randomly can leave you underinsured, and you may face challenges in covering medical needs during an emergency. It is essential to assess the increasing rate of medical inflation, expenses of treatment in your location, etc., before choosing the sum insured. Since the entire family shares this amount, you should ensure that you have sufficient coverage.
2. Checking the Inclusions and Exclusions
Before choosing a plan, it is crucial to understand what your policy covers and what it does not. Most family mediclaim plans cover hospitalisation costs, pre- and post-hospitalisation bills, accidents, organ donor expenses, domiciliary expenses, health checkups, etc. It may vary based on the insurance company you choose.
Besides, there are many exclusions such as cosmetic and weight loss treatments, self-inflicted injuries, etc. Consider checking the inclusions and exclusions before finalising a mediclaim policy for the family to avoid future claim hassles.
Besides, there are many exclusions such as cosmetic and weight loss treatments, self-inflicted injuries, etc. Consider checking the inclusions and exclusions before finalising a mediclaim policy for the family to avoid future claim hassles.
3. Check for Network Hospitals
While selecting a mediclaim plan, always check for the network hospitals available with your insurance company. Treatments from network hospitals allow you to get smooth cashless mediclaim. In such cases, your insurer settles the health-related expenses directly with the hospital.
4. Renewability
Mediclaim policies usually come with a lifetime renewability option. While choosing a mediclaim for the family, always check if your insurer provides a lifetime renewability option or not.
5. Check for Waiting Period
Mediclaim policies provide coverage for pre-existing diseases after a certain waiting period. The insured can claim their coverage once the waiting period is over. Make sure to check the waiting period beforehand to avoid claim rejections later.
Common Mistakes People Make When Buying Mediclaim
Individuals often miss some crucial factors while purchasing a mediclaim policy for the family. Such mistakes can affect their coverage and claims going forward. Here are some mistakes that you should avoid while purchasing a mediclaim
1. Not Disclosing Medical History
Hiding your and the insured family members’ medical history may help you secure mediclaim at lower premiums. However, it comes under fraudulent activity. So, when the insurer discovers it, they can reject your insurance claim and even charge penalties.
2. Choosing Insufficient Sum Insured
Some individuals select an inadequate sum insured just to save money, which leaves them underinsured. Further, there are people who purchase a mediclaim policy just to avail tax benefits and ignore the coverage amount.
However, this can challenge the family’s health coverage during emergencies. The purpose of a mediclaim policy for your family is to address your family's medical needs. Thus, it is essential to select the right coverage.
However, this can challenge the family’s health coverage during emergencies. The purpose of a mediclaim policy for your family is to address your family's medical needs. Thus, it is essential to select the right coverage.
3. Getting Confused Between Mediclaim and Health Insurance
You may mistake a mediclaim policy for health insurance like many others. Health insurance refers to a broad concept, offering comprehensive coverage. It includes hospitalisation expenses along with pre and post hospitalisation expenditure. These include diagnostic tests, consultation fees, follow-up treatments, and other medical expenses.
On the other hand, mediclaim is an aspect of health insurance policies that mainly covers hospitalisation expenses. It also includes the treatment of certain illnesses, up to a predefined limit. A mediclaim comes with several exclusions, such as dental procedures, administrative charges, non-medical expenses, service fees, etc.
On the other hand, mediclaim is an aspect of health insurance policies that mainly covers hospitalisation expenses. It also includes the treatment of certain illnesses, up to a predefined limit. A mediclaim comes with several exclusions, such as dental procedures, administrative charges, non-medical expenses, service fees, etc.
Step-by-Step Process to Buy Mediclaim for Family
Choosing the best mediclaim policy for the family becomes easy when you follow some necessary parameters. As the mediclaim covers crucial expenses, you should be careful while selecting an appropriate policy.
Check out the steps that you should follow to select the right family mediclaim policy:
-
Step 1: Know your Needs
The first step is to understand the coverage you need and the members you need to cover under a mediclaim. Usually, mediclaim policies cover the policyholders, their spouse, children, and dependent parents. Besides, you need to assess other factors like the age of the insured members, pre-existing health conditions, etc., to decide the sum insured. -
Step 2: Compare Plans
Several health insurance companies provide mediclaim for family. Each plan may differ in its pricing and offerings. So, it is necessary to compare different plans before finalising one. -
Step 3: Select a Mediclaim Policy
After comparing multiple insurers and their plans, choose the one that aligns with your family's needs perfectly. Follow the steps provided on the insurer's website. You can even contact their representatives if you face any troubles. -
Step 4: Make Payment
The final step is to make the premium payment. This way, you can complete buying the mediclaim policy for the family. Make sure to go through the policy documents carefully to avoid claim-related hassles in future.
Conclusion
Medical bills are a significant financial concern, prompting people to buy a mediclaim policy. In addition to this, people often buy a family floater mediclaim policy instead of purchasing separate plans for individuals. This type of policy is usually more affordable and ensures that you and your dependents are all covered under a single plan. With the help of this plan, you can claim reimbursement on your medical bills. However, it has its limitations as well. Critical illnesses can strain not only your body but also your finances. This is where a mediclaim policy might fail to adequately meet all your medical expenses.
One way to augment your medical insurance cover from a mediclaim plan is to purchase a Critical Illness Rider that is available with various Axis Max Life term insurance plans. This rider offers a lump sum payout if the life insured is diagnosed with life-threatening ailments such as cancer, stroke, kidney failure, etc. Such lump sum payout can help you cover various costs during treatment beyond just the hospitalisation cost covered by a mediclaim policy. What’s more you can also claim tax deductions of up to ₹1.5 lakh under Section 80D if you have opted for the old tax regime.
Health Insurance FAQs
Can I get a tax deduction if I purchase a Mediclaim policy for family?
Yes, tax benefits under Section 80D of the Income Tax Act is available for purchasing a family floater mediclaim policy.
What factors can impact the premium of a family mediclaim policy?
The cost of a mediclaim policy for family is affected by various factors like the type of health insurance policy, number of covered persons, sum insured, age of family members covered, pre-existing medical conditions of insured, etc.
In India, how do you choose the ideal health insurance policy for your family?
In India, how do you choose the ideal health insurance policy for your family?
How does cashless facility work?
When a health insurance policy that offers cashless facility, it means that the policyholder can take treatment in any of the network hospitals without having to pay the hospital directly. In this case, the payment is made to the hospital on behalf of the insured, directly by the insurer through a Third-Party Administrator (TPA).
Is there a waiting period to claim mediclaim policy?
Yes. When you get a new mediclaim policy, generally, there will be a 30 days waiting period starting from the policy inception date. Any medical costs during the waiting period will have to be borne by the insured and will not be payable by the insurer.
What is the difference between mediclaim and health insurance for a family?
Mediclaim is a type of health insurance policy that covers the basic healthcare needs of your family. It includes hospitalisation charges and the expenses related to some predefined illnesses.
On the other hand, health insurance for the family provides extensive coverage for critical illnesses, surgeries, and other major health issues. It also includes pre and post hospitalisation expenses.
Can I add elderly parents to a family mediclaim policy?
Family mediclaim policies usually cover elderly parents. However, senior citizens are at higher risk of health problems. So, adding them can increase the premium payable.
Can I have a mediclaim policy from my employer and buy an individual policy too?
It is possible to purchase an individual policy even if your employer covers you with a mediclaim policy. Employers offer group mediclaim policies which may have coverage limitations. If you need extensive coverage, purchasing individual health plans is an ideal option.
How are mediclaim premiums calculated?
Mediclaim premiums are calculated based on several factors, such as the insured's age, the type of plan chosen, pre-existing health conditions, the sum insured, family medical history, etc. All these factors are taken into account while calculating the premium. You can use health insurance premium calculators on the insurer's website and enter the necessary information to get instant premium quotes.
What documents are needed for mediclaim?
The documents required for mediclaim may vary depending on your insurance provider. However, the basic ones may include age, identity, and address proofs. Some of these are Aadhaar card, Voter card, PAN card, passport, driving license, etc. Other necessary documents include income proof, medical reports, passport-size photographs, and the filled proposal form.
Can I claim mediclaim if I'm treated at a non-network hospital?
Yes, you can claim mediclaim even if you get treatment from a non-network hospital. You can make upfront payment and seek reimbursement from your insurer.
Is maternity covered under family mediclaim?
Certain family mediclaim plans might include maternity benefit. However, you can avail of the benefit after the completion of the applicable waiting period. Consider checking the policy documents carefully while purchasing a plan to ensure if it includes maternity benefit.
Can I transfer my mediclaim policy to another insurer?
Yes, you can transfer your mediclaim policy to another insurer. This process is called porting. You should apply for portability 45-60 days before policy renewal after informing your previous and new insurance provider.
What's not covered under mediclaim policies?
Mediclaim policies do not cover accidents or injuries caused by adventure or sports, substance abuse or alcohol, self-harm or injury, etc. It also excludes cosmetic, dental, and weight-loss treatments.
How long does a mediclaim claim take to settle?
There are two types of claims in mediclaim: cashless and reimbursement. Usually, cashless claims are settled faster as the insurer deals directly with the hospital. However, in the case of reimbursement claims, the process takes longer.
It depends on the availability of the documents and the insurer's specifications. The timeline varies from one insurer to another.
Do mediclaim premiums increase with age?
Increasing age increases the risk of health issues. Therefore, the premium of your mediclaim policy becomes higher when you buy a plan at an older age. However, if you purchase a policy at a younger age, you can secure coverage at lower premiums.
What's the best time to buy a family mediclaim policy?
You should consider buying family mediclaim policy at an early age as it helps secure coverage for the entire family at affordable rates. As you get older, the premium increases due to rising health risks.
ARN: June23/Bg/21V
Sources:
www.coverfox.com/health-insurance/articles/why-mediclaim-policy/
www.insurancedekho.com/health-insurance/articles/mediclaim-policy-features-benefits-and-coverage-1319
www.livemint.com/brand-post/10-things-to-consider-before-buying-a-family-health-insurance-plan-11636959109544.html
www.policyholder.gov.in/whathealthinsurancetobuy.aspx
www.bajajfinserv.in/family-health-insurance
www.coverfox.com/health-insurance/articles/why-mediclaim-policy/
www.insurancedekho.com/health-insurance/articles/mediclaim-policy-features-benefits-and-coverage-1319
www.livemint.com/brand-post/10-things-to-consider-before-buying-a-family-health-insurance-plan-11636959109544.html
www.policyholder.gov.in/whathealthinsurancetobuy.aspx
www.bajajfinserv.in/family-health-insurance
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