Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim

Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim


Family Floater Health Insurance is a popular insurance scheme that provides coverage for multiple family members under a single policy. This type of health insurance offers a range of benefits to protect the insured individuals from medical expenses. However, like any insurance policy, there are certain exclusions that might restrict the claim process.

Coverage of Family Floater Health Insurance Scheme:

Family Floater Health Insurance is designed to provide comprehensive coverage for the medical needs of a family. Here are some of the key aspects of the coverage offered by this scheme:

1. Hospitalization Expenses: One of the primary benefits of a Family Floater Health Insurance policy is the coverage of hospitalization expenses. It includes room charges, nursing expenses, surgeon’s fees, anesthesia, and other related medical costs incurred during hospitalization.

2. Pre and Post Hospitalization: The policy usually covers medical expenses incurred before and after hospitalization for a specified period, typically 30 days before and 60 days after hospitalization.

3. Daycare Procedures: Family Floater plans also cover daycare procedures, which are medical treatments or surgeries that don’t require 24-hour hospitalization but are necessary to be performed in a hospital setup.

4. Ambulance Charges: The cost of availing ambulance services in case of an emergency is also covered under this policy.

5. Organ Donor Expenses: Expenses related to organ transplantation, including the donor’s medical expenses, are often covered by the policy.

6. Maternity Benefits: Some Family Floater policies also offer maternity benefits, including pre and post-natal expenses and delivery costs.

7. Domiciliary Treatment: In cases where hospitalization is not possible, the policy may cover medical expenses incurred for treatments taken at home.

8. Alternative Treatments: Some policies provide coverage for alternative treatments like Ayurveda, Homeopathy, or Unani, but the extent of coverage varies between insurance providers.

9. Critical Illness Cover: Certain Family Floater Health Insurance policies include coverage for critical illnesses such as cancer, heart diseases, stroke, etc.

10. Renewal Benefits: Policyholders may be entitled to renewal benefits like no-claim bonuses and discounts, encouraging healthy living and timely renewals.

Exclusions of Family Floater Health Insurance Scheme:

Despite offering extensive coverage, Family Floater Health Insurance policies have specific exclusions to prevent misuse and manage risk effectively. Here are some common exclusions found in such policies:

1. Pre-existing Diseases: Most policies do not cover pre-existing diseases at the time of purchasing the policy. These are medical conditions that the insured person had before buying the policy. However, after a waiting period, usually 2 to 4 years, some policies might start covering pre-existing illnesses.

2. Initial Waiting Period: There is an initial waiting period at the beginning of the policy during which certain illnesses or treatments may not be covered. This period is typically 30 days, and during this time, the policyholder cannot claim for any medical expenses except in case of accidental injuries.

3. Specific Waiting Period for Critical Illness: Some policies have a waiting period specific to critical illnesses, during which claims related to critical illnesses will not be honored. This period is usually 1 to 2 years from the commencement of the policy.

4. Non-Allopathic Treatments: Many alternative treatments like Ayurveda, Homeopathy, or Naturopathy might not be covered or have limited coverage under a Family Floater policy.

5. Cosmetic or Aesthetic Procedures: Treatments or surgeries done for cosmetic purposes, such as hair transplant, plastic surgery, or weight loss procedures, are generally excluded from coverage.

6. Self-inflicted Injuries: Injuries or medical conditions arising due to self-harm or attempted suicide are not covered.

7. Pregnancy and Fertility-related Expenses: While some policies offer maternity benefits, expenses related to fertility treatments or assisted reproduction methods are typically excluded.

8. War and Terrorism: Injuries or illnesses caused due to war, acts of terrorism, or participation in hazardous activities are generally not covered.

9. HIV/AIDS: Treatment for HIV/AIDS and related complications is usually excluded from coverage.

10. Substance Abuse and Addiction: Medical expenses incurred due to drug or alcohol abuse are not covered.

11. Non-Medical Expenses: Expenses that are not directly related to medical treatment, such as telephone bills, food, and other personal comfort items during hospitalization, are excluded.

12. Experimental and Unproven Treatments: Treatments that are experimental or not supported by established medical practices are typically not covered.

13. Dental and Vision Care: Routine dental and vision care, including dental surgeries, spectacles, or contact lenses, are generally excluded.

14. Congenital Conditions: Birth defects or congenital conditions might not be covered under the policy.

It’s essential for policyholders to thoroughly read and understand the terms and conditions of their Family Floater Health Insurance policy to be aware of the coverage and exclusions. Insurance providers may have variations in their coverage and exclusions, so it’s crucial to compare policies from different companies before making a decision.

Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim


Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim


Advantages of Family Floater Health Insurance:

Family Floater Health Insurance offers several advantages, making it a popular choice for families. Here are the key advantages of opting for a Family Floater Health Insurance policy:

1. Cost-Effective: Family Floater policies are more cost-effective than individual health insurance plans for each family member. Instead of purchasing separate policies for each person, a single premium covers the entire family, reducing overall costs.

2. Comprehensive Coverage: These policies provide comprehensive coverage for hospitalization expenses, pre and post-hospitalization costs, daycare procedures, and other medical expenses, ensuring that the entire family is protected.

3. Flexibility: Family Floater plans typically allow flexibility in terms of the number of family members covered. It is easy to add new family members, such as newborns or in-laws, to the policy without much hassle.

4. No Claim Bonus: Many insurers offer a no-claim bonus, which increases the sum insured or offers premium discounts for every claim-free year. This incentivizes healthy living and responsible healthcare usage.

5. Cashless Hospitalization: Family Floater policies often provide cashless hospitalization facilities, allowing the insured family members to avail of medical treatment without paying cash upfront at network hospitals.

6. Convenience: Managing a single policy for the entire family is more convenient than handling multiple individual policies, simplifying paperwork and reducing administrative tasks.

7. Tax Benefits: The premiums paid for a Family Floater Health Insurance policy qualify for tax deductions under Section 80D of the Income Tax Act, providing additional financial benefits.

8. Coverage for Critical Illnesses: Some Family Floater plans include coverage for critical illnesses, offering financial protection during challenging times.

9. Maternity Benefits: Certain policies provide maternity benefits, covering pre and post-natal expenses, and childbirth-related costs, easing the financial burden of pregnancy.

10. Renewal Benefits: Renewal benefits like cumulative bonus or discount on premiums for claim-free years encourage policyholders to continue their coverage and maintain a healthy lifestyle.

Disadvantages of Family Floater Health Insurance:

While Family Floater Health Insurance has its benefits, it also comes with certain disadvantages that individuals should be aware of before opting for this type of policy. Here are the key disadvantages of Family Floater Health Insurance:

1. Limited Sum Insured: The sum insured in a Family Floater policy is shared among all family members. In case of multiple claims or a severe medical condition requiring extensive treatment, the coverage may get exhausted quickly, leaving other family members with reduced protection.

2. Age Considerations: The premium for a Family Floater policy is calculated based on the age of the eldest family member. As a result, if the oldest member is elderly, the premium might be higher, making it relatively expensive for younger members.

3. Coverage Exhaustion: If a significant claim is made during the policy term, it can exhaust the entire sum insured, leaving the family without coverage until the policy is renewed. This can be a significant risk if another family member requires medical attention during that period.

4. No Individual Coverage: Unlike individual health insurance, a Family Floater policy does not provide separate coverage for each family member. If one member requires a higher sum insured due to specific health conditions, it may not be possible under a Family Floater.

5. Premium Hike with Age: As the age of the eldest member increases, the premium for the policy is likely to increase significantly during renewals, which can become burdensome over time.

6. Loss of Coverage for Dependent Children: When dependent children reach a certain age (usually 25-30 years), they might no longer be covered under the Family Floater policy, and they will have to purchase their individual health insurance.

7. No Portability for Senior Members: In the case of senior members who require continuous health coverage, portability to a new policy might be challenging due to age-related exclusions and waiting periods in other policies.

8. Exclusions and Waiting Periods: Family Floater policies come with exclusions and waiting periods, limiting coverage for pre-existing diseases, specific illnesses, and certain treatments.

9. Lack of Flexibility in Coverage: The coverage offered in a Family Floater policy might not be customizable for individual family members’ unique medical needs, potentially leaving some members without adequate coverage.

10. Policyholder’s Age Limit: Some insurers set an upper age limit for the policyholder, after which the policy cannot be renewed, leaving the family without coverage during critical years.


Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim


Businesses Offering Family Floater Health Insurance Plans In India:

Several businesses in India provide Family Floater Health Insurance plans to cater to the diverse healthcare needs of families. These insurance companies offer comprehensive coverage for medical expenses, making it easier for families to access quality healthcare without worrying about financial constraints. Here are some of the leading businesses offering Family Floater Health Insurance plans in India:

ICICI Lombard General Insurance: ICICI Lombard is a prominent player in the insurance sector and offers a range of Family Floater Health Insurance plans with various sum insured options and benefits.

Apollo Munich Health Insurance: Now known as HDFC ERGO Health Insurance, it offers Family Floater policies with cashless hospitalization, extensive network hospitals, and additional coverage for critical illnesses.

Max Bupa Health Insurance: Max Bupa provides Family Floater plans with attractive features like lifelong renewal, coverage for maternity expenses, and international second opinion.

Star Health and Allied Insurance: Star Health is dedicated to health insurance and offers specialized Family Floater policies with comprehensive coverage and a wide network of hospitals.

Religare Health Insurance: Now known as Care Health Insurance, it offers Family Floater plans with customizable options, including coverage for daycare procedures and international treatments.

New India Assurance Company: This public sector insurance company offers Family Floater policies with affordable premiums and various add-on benefits.

Bajaj Allianz General Insurance: Bajaj Allianz provides Family Floater Health Insurance with features like lifelong renewal, no-claim bonus, and a range of sum insured options.

ManipalCigna Health Insurance: ManipalCigna offers Family Floater policies with comprehensive coverage, easy claim settlement, and a vast network of hospitals.

United India Insurance Company: Another public sector insurer, United India, offers Family Floater Health Insurance plans with attractive benefits and affordable premiums.

National Insurance Company: National Insurance provides Family Floater policies with features like cashless hospitalization and coverage for pre-existing diseases after a waiting period.

These businesses, among others, cater to the diverse healthcare needs of families in India through their Family Floater Health Insurance plans. It is essential for individuals to compare policies, read the terms and conditions, and choose the one that best aligns with their family’s specific requirements and budget.

In conclusion:

A Family Floater Health Insurance Scheme offers comprehensive coverage for a family’s medical needs, including hospitalization expenses, daycare procedures, and pre and post-hospitalization expenses. However, certain exclusions are in place to prevent misuse and manage risk effectively. These exclusions may include pre-existing diseases, initial waiting periods, specific waiting periods for critical illnesses, non-allopathic treatments, and cosmetic procedures, among others. Understanding these exclusions is essential for policyholders to make informed decisions and ensure they have adequate coverage when they need it most.


Q1.  What is a Health Card?

A Health Card is a card that is issued at the time of issuing a health insurance policy. This card allows you to be identified so you can receive cashless hospitalization at their network facilities.

Q2.  Should I choose a separate family plan, if my office covers me?

It is always recommended to have a personal family health plan to be able to get the coverage you need. Your corporate plan may end if you leave your job. It is possible that your new plan doesn’t provide the coverage that you need.