Health insurance is an important investment for each family, which provides financial security under medical emergency conditions. A family health insurance policy provides extensive coverage to all family members under a single policy, which ensures high-quality health services without financial stress.
However, although these health insurance plans provide great benefits, they also come up with some exclusions. Let's delve deeper to understand what is covered and what is not under a Family Health Insurance Plan.
What is covered under a family health insurance plan?
A family health cover provides several benefits, ensuring access to medical treatments without worrying about hefty hospital bills. Below are the key inclusions:
1. Hospitalisation expenses
One of the major benefits of a family health care insurance plan is the coverage for hospitalisation expenses. It includes:
· Cost of medical procedures, tests, and surgery
· Room rent, ICU charges, and doctor consultation fees
· Post-hospitalisation expenses (usually up to 90 days after discharge)
· Pre-hospitalisation expenses (typically 30-60 days before admission)
2. Daycare treatments
Many modern medical procedures no longer require many hospital stays. Family health insurance plans cover daycare treatments like:
· Cataract surgery
· Dialysis
· Chemotherapy and radiation therapy
· Angioplasty
3. Pre- and post-hospitalisation expenses
Health issues often require multiple doctor visits, tests, and medications before and after hospitalisation. A family floater medical insurance plan covers expenses incurred before admission and for a specific period post-discharge.
4. Maternity and newborn cover
Many health insurance plans for families include maternity benefits, covering childbirth expenses, prenatal check-ups, and postnatal care. Some health insurance policies also provide coverage for the newborn baby for a specified duration.
5. Domiciliary hospitalisation
In case a patient requires treatment at home due to the unavailability of hospital beds or medical conditions preventing hospitalisation, family health care insurance often covers such domiciliary expenses.
6. Ambulance charges
Various emergency medical transport is a crucial expense. Most family health cover policies reimburse ambulance costs up to a specific limit.
7. AYUSH treatment
Many health insurance plans now cover alternative treatments like AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) under some specific conditions.
8. Organ donor expenses
Various family floater medical insurance plans cover the medical expenses of organ transplantation, including the donor’s surgery costs. But post-surgery expenses may not always be covered.
What is not covered under a family health insurance plan?
Every family floater medical insurance policy comes with a specific set of exclusions. Here are some common ones:
· Pre-existing diseases
Most family health insurance policies do not cover pre-existing diseases immediately. There is usually a waiting period of 2-4 years before claims related to these conditions are entertained.
· Cosmetic and aesthetic treatments
Expenses related to plastic surgery, weight loss procedures, botox, and other aesthetic treatments are typically not covered unless medically necessary due to accidents or burns.
· Injuries due to self-harm or substance abuse
Medical conditions arising from alcohol consumption, drug abuse, or self-inflicted injuries are generally excluded.
· Infertility and IVF treatments
Many family healthcare insurance plans do not cover infertility treatments like IVF, IUI, or related medical procedures.
· Non-allopathic treatments (If not covered)
Some insurance providers do not include alternative therapies like Ayurveda, Unani, or Homeopathy unless explicitly mentioned.
· Waiting period for specific treatments
Many insurers impose a waiting period (1-4 years) on specific conditions such as:
o Hernia
o Joint replacements
o Cataract surgery
· War, nuclear threats, and terrorism injuries
Most insurance policies do not cover injuries or health conditions resulting from war, nuclear hazards, or terrorist activities.
How to choose the best family health insurance plan?
To ensure you get the most comprehensive family health cover, consider the following factors:
· Adequate sum insured
Choose a family health insurance policy that provides a sufficient sum to cover medical expenses for all family members.
· Coverage for critical illnesses
Opt for a family health insurance policy that offers coverage for critical illnesses as an add-on or built-in benefit.
· Low waiting period
Prefer insurance policies with a lower waiting period for pre-existing diseases and maternity benefits.
· Network hospitals
Check whether the insurer has a wide network of cashless hospitals in your area where you can avail of cashless hospitalisation benefits.
· No-claim bonus (NCB)
Many family floater medical insurance plans offer a bonus (increase in sum insured) if no claim is made during a policy year.
Wrapping up
A family health insurance plan is a crucial financial shield that adds protection against medical emergencies, ensuring quality healthcare for your loved ones. While these policies offer extensive coverage, understanding their inclusions and exclusions can help you make wise decisions.
By choosing the right family health care insurance, you can protect your family’s well-being without worrying about high medical costs. Secure your family's health with comprehensive family health insurance plans by Generali Central. Explore the best coverage options today!
Frequently asked questions (FAQs)
1. What is covered under a family health insurance plan?
A family health insurance plan covers hospitalisation, daycare treatments, maternity benefits, ambulance charges, domiciliary care, and sometimes alternative treatments like Ayurveda and Homeopathy.
2. What is not covered under family health insurance?
Exclusions include pre-existing diseases (within the waiting period), cosmetic treatments, infertility treatments, injuries due to self-harm, and experimental procedures.
3. How does a family floater medical insurance plan work?
A family floater medical insurance policy provides a single sum insured shared by all family members. Claims can be made by any insured member up to the total sum insured.
4. Is maternity coverage included in all family healthcare insurance plans?
Not all plans offer maternity benefits. Some policies include maternity and newborn cover but usually come with 2-4 years of waiting.
5. Can I include my parents in a family health insurance plan?
Most health insurance plans for family cover spouses and children. However, for parents, it is advisable to opt for a separate senior citizen health insurance plan for better coverage.
