|Step 1||Get admitted to any one of network hospitals of the respective insurance companies…you can also call the insurance company/TPA on their Toll Free assistance number.
Both these pieces of information are available on eindiainsurance
In case of emergency, you can contact the insurance company within 24 hours of admission to the hospital.
|Step 2||Your Identification : At the network hospital you will need to show your Health Insurance health card (nowadays insurers issue e-health cards) of the insurance company and valid photo ID*, along with your policy number, to be able to use your insurance. This will give the network hospital the details they need to contact us for the cashless hospitalization process.
* - Passport / PAN card / voter’s ID for identification purposes
|Step 3||Hospital sends cashless hospitalization request form to the insurance company with preauthorization request form which has details of medical history, line of treatment and estimated treatment cost.|
|Step 4||Wherever the information provided in the request is sufficient to ascertain the authorization, the insurer issues the authorization Letter to the network hospital. Wherever additional information or documents are required we will call for the same from the Network hospital and upon satisfactory receipt of last necessary documents the authorization will be issued.|
|Step 5||Hospital will send us the final request for authorization of any residual amount along with final hospital bill and discharge summary. You will be discharged from the hospital upon receipt of final authorization letter from the insurer. Any inadmissible expenses, copayments, deductions will have to be paid by you.|
|Step 6||Once the Hospitalization is done, hospital will send the original claim documents to us. The claim will be assessed by us and payment will be made to the network hospital|
|Step 1||Contact Toll free Healthline of the Insurance Company / TPA…same is available on eindiainsurance
Before you seek medical treatment we request that you contact the insurer atleast 48 hours in advance. This will the claims team to help you follow the next few steps. In case of emergency, you can contact the insurer within 24 hours of admission to the hospital.
|Step 2||You can avail treatment at hospital and settle all hospitalization expenses. Collect original hospital bill, receipts, discharge summary, investigation reports, pharmacy bills and other documents from hospital at the time of discharge from hospital.|
|Step 3||You have to download the claim form from the website eindiainsurance .Copy of this form is also included in the policy kit provided to you. Submit the claim documents at nearest branch or Corporate office of the insurance company. The documents should be submitted within 15 days from discharge from the hospital.|
|Step 4||Wherever the information provided in the claim documents is sufficient to ascertain the admissibility of claim, the insurer will approve the claim. Wherever additional information or documents are required , the insurer will call for the same from you and upon satisfactory receipt of last necessary documents the claim will be settled by the insurance company.|
|Step 5||Upon approval of claim by the insurer, payment of the reimbursement claim will be made to the policy holder either through EFT or through cheque/DD.|
|Company Name||Number of Network Hospitals (as on April 2020)||Maximum Coverage – Family Size for Floater option||Sum Insured Range||Number of Lives** Covered – Individual + Group (2018-19)||Incurred Claims Ratio **
(2018-19 as per data from IRDAI)
|9,900+||Self, Spouse + 3 dependent children||1lac – 100 lacs||1,16,17,000||63.00%|
Max Bupa Health Insurance
|4,500+||Self, Spouse + 4 dependent children||2 lacs – 300 lacs||54,33,000||54.00%|
|Care(formerly Religare) Health Insurance||7,400+||Self, Spouse + dependent children + dependent parents||4 lacs – 600 lacs||1,07,13,000||55.00%|
|Reliance General Insurance||7,300+||Self, Spouse + 6 dependent children||3 lacs – 130 lacs||2,74,64,000||94.00%|
|Bajaj Allianz General||6,500+||Self, Spouse + 4 dependent children||3 lacs – 50 lacs||2,46,85,000||85.00%|
Tata AIG General
|4,000+||Self, Spouse + 3 dependent children + 2 dependent parents||3 lacs – 20 lacs||22,48,000||78.00%|
|IFFCO Tokio General||5,000+||Self, Spouse + dependent children + dependent parents||1.5 lacs to 30 lacs||2,20,15,000||102.00%|
HDFC Ergo General Insurance
|10,000+||Self, Spouse + dependent children (upto 25 yrs) + dependent parents||3 lacs – 75 lacs||96,05,000||62.00%|
Royal Sundaram General
|5,000+||Self, Spouse + 4 dependent children||2 lacs – 150 lacs||14,06,000||61.00%|
Future Generali India (General)
|5,100+||Self, Spouse + dependent children + dependent parents||3 lacs – 100 lacs||48,38,000||73.00%|
Chola MS General Insurance
|6,500+||Self, Spouse + 4 dependent children||2 lacs – 25 lacs||18,06,000||35.00%|
SBI General Insurance
|6,000+||Self, Spouse + 2 dependent children (upto age of 23 yrs)||1 lac – 30 lacs||27,48,000||52.00%|
ManipalCigna Health Insurance
|6,500+||Self, Spouse + 3 dependent children||2.5 lacs – 100 lacs||11,01,000||62.00%|
Universal Sompo General Insurance
|4,000+||Self, Spouse + 4 dependent children (upto age of 25 yrs)||1 lac – 10 lacs||11,37,000||92.00%|
New India Assurance
|3,000+||Self, Spouse + dependent children + dependent parent||2 lacs – 100 lacs||8,75,61,000||103.74%|
Oriental Insurance Company
|4,300+||Self, Spouse + dependent children + dependent parent||1 lac – 20 lacs||3,03,25,000||108.80%|
HDFC Ergo Health (Apollo Munich)
|10,000+||Self, Spouse + 5 dependent children||1 lac – 50 lacs||51,16,000||63.00%|
|Kotak Mahindra General Insurance||3900+||Self, Spouse + dependent children + parents||2 lac – 25 lacs||4,39,000||47.00%|
Raheja QBE General Insurance
|5,000+||Self, Spouse + 2 dependent children (upto 21 yrs) + parents||1 lac – 50 lacs||135||33%|
Family floater is a health insurance policy that covers multiple members of the same family against payment of a single premium. Thus many individuals belonging to the same family can be covered for medical expenses following a sickness/accident at a reasonable cost.
A Family floater health insurance plan is ideal for a married person and his family, which includes his spouse and children. It can be used to also cover parents who are senior citizens. Overall, this offers a good option for insurance which is cost-effective and inclusive for all members of the same family.
Almost all family floater health plans offer in-hospitalization expenses, which include Room rent, ICU charges, Doctor’s fees, Ambulance charges, Pre & Post Hospitalisation Expenses, Daycare expenses etc. If one is planning for a child, they should invest in a family health policy that covers insurance for new born baby or simply add the baby as beneficiary to your existing family floater health plan. There are many add ons like Critical Illness, PA Cover etc that once could opt for. There are waiting periods applicable for Pre Existing conditions and other ailments as is the case in Individual plans.
Most of the health insurance companies limit the family member to the primary insured, his spouse and children. However, there are some insurers who even allow coverage for parents, parent-in law, siblings and other relatives under the same policy and hence cover a maximum of between 15-19 relationships who can be covered under the Family Floater plan.
Many of the family floater plans restrict the coverage of the sum insured upto the limit opted for by the family, in that particular policy period which is normally for a year. There are however some plans, which offer an Automatic restore/refill/reinstatement facility which tops up the sum insured to 100% of the Basic sum insured once during the policy year post a claim being reported and the initial sum insured being utilised.
Due to the unfortunate demise of the primary insured under a family floater policy, or on him/her reaching the maximum renewability age, the remaining adult members on the policy can continue with the policy and enjoy continuity benefits. For any addition or deletion of family members on the policy, the same can happen only at the time of renewal.
Yes, no claim discounts are available up to a certain amount (normally 50% of the base sum insured) are available from certain insurers. If there is no claim on a family floater policy, the insurer offers a premium reduction or an enhancement in the sum insured for the subsequent year as per policy terms and conditions defined in the policy wordings.
Yes, the insured is allowed to change the hospital on the grounds subject to better treatment and services facilities available at the second hospital, but the insured needs to inform the TPA first who will approve the request based on it’s merits.
While making an application for a Family Floater Plan, the documents to be normaly submitted include Age Proof, Identity Proof and Address Proof of all the insured members and Income Proof of the policy holder. Along with this the completely Filled Proposal Form will need to be submitted which has the medical history of all the family members. Some plans may require the some of the insured members to undergo Medical Tests depending on their age/pre existing medical condition/sum insured applied for.
One can add your family members only at the time of renewal of an existing policy and not during the middle of the policy year. Only a newborn baby can be added during the policy period.
A floater policy is one that is issued with a single sum insured covering number of individuals of a family. The cover can be used by any member of the family any number of times during the policy period. If a person wants a health insurance for himself, his spouse & their children, the Family Floater plan is ideal and offers insurance coverage to the entire family under one premium payment.
Let’s take an example wherein the person insures himself, his spouse & the two dependent children with the individual insurance plans with a sum insured of Rs 1 lac each, he ends up paying an average premium of Rs X for each family member, which amounts of Rs 4X. If the person opted for the family floater plan with the sum insured of Rs 3 lacs, the total premium would ideally be less than the separate premium payments in individual health insurance plans, ie less than Rs 4X. Moreover the individual plan has coverage of only Rs 1 lac for each member as against Rs 3 lacs in case of the Floater plan( in case the medical treatment exceed Rs 1 lac). This Rs 3 lacs is available for each of the family members individually as well as collectively.
It is recommended that as a general rule, at younger ages of all family members, opting for a floater cover is ideal. As the members grow older, they should go for an individual cover. But ultimately buying an individual cover or a floater cover is an individual’s preference.
There are some distinct advantages of one opting for a Family Floater plan, these include:
Comprehensive Coverage : This health insurance plan offers a comprehensive coverage for members of a family. It is similar to individual health plans in its benefit coverage added but the significant difference is that this is for covering the entire family under a single policy.
Complete Sum Insured available for Any member of the Family : A major advantage under the Family Floater plan is that, in case one of the family member gets sick and is hospitalised, the total sum insured of the policy can be utilised for treatment of the sick hospitalised member of the family. Also the family floater health insurance has options to opt for higher sum insured than individual health plans.
Tension Free Coverage : A significant advantage is that since all members of the family are covered under a single policy, and hence a single renewal date for the policy. Hence there is no requirement for keeping track of the renewal of individual policies which could be at different times in the year.
Cost Effective : A family floater health insurance is the ideal option when it comes to safeguarding the health of your family at an optimum cost. Family floater policies offer the benefit of a sum assured which can be shared across all members of a family and can come in handy because the chances of all members falling sick together is highly unlikely. But the premium has to be paid once and is cheaper than availing individual policies for each of the family members.
Coverage for Many Relationships : The scope of the family floater health insurance plans of some insurance companies are widened to include dependent parents, siblings and parents-in-law as well apart from one’s spouse and children.
Tax benefits : Premiums paid for Family Floater can benefit from tax deductions under section 80D of the Income Tax Act. Amounts up to ₹15,000 are allowed for deduction on health insurance premium for self, spouse and children. This gives additional exemption of ₹20,000 if senior citizens are covered. This means if someone takes family floater insurance covering his immediate family and parents who are senior citizens, he can save up to ₹35,000 in taxes.
Sum Assured Restoration/Refill : In case of a hospitalization to one family member resulting in the sum assured getting exhausted, some insurance plans offer automatic restore/refill/reinstatement of sum assured upto 100% of the basic sum insured. This takes care of worries about recurring hospitalization in the same year for the same or another family member. So the effective sum insured utilised could be double to original sum insured opted for.
Cashless treatment : Family floater also allows the insured to be treated cashless at any network hospital. Policyholders need not pay expensive consultation fees, diagnosis tests, room rent and so on. All these expenses, up to the sum assured, are automatically covered by the policy.
Addition of New family Members Hassle-free : In the family floater plan, it is easy to add a new family member whenever there is any such need, but one needs to be aware that such an addition can be done only at the time of the policy renewal. However in the case of a new born baby, the baby can be included during the policy year. Also, in case of the unfortunate demise of the senior most member of the family, other family members can continue with the floater without losing any benefit. This is one of the biggest benefits that a family floater health plan provides.
Extended Policy Period : Many insurers have now given an option of 2/3 years policy duration coverage. This allows a continuous coverage without any increase in the annual cost of premium for the second year.
Some of the key features of this plan include:
Some of the key exclusions under the Family Floater are below…kindly review the policy wordings which the insurance company provides with the policy kit for the entire list of exclusions:
Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans..Click here to read more