Health Insurance Plans For Family

Family health insurance is a type of health plan that covers the medical expenses of both you and your family members, who are insured under a single policy.

Health insurance plans for families function just like individual health policies, except in a family floater type of policy, the sum assured is shared among all the insured family members under one plan. This sum assured can be availed of as often as needed or until exhaustion.

At Tata AIG, our family health insurance plans offer benefits like pre and post-hospitalisation covers, cashless claim facilities, and several wellness services and programs.

Comprehensive Coverage for All Family Members

Some of the best health insurance plans for families allow you to include your parents and parents-in-law under the policy for no additional premiums. Moreover, if you have just had a baby, you can add the newborn under your existing plan instead of purchasing a separate one.

This allows your family members to access high-quality healthcare services regardless of age under a single policy.

Additional Benefits

In addition to their base covers, family health insurance plans offer add-on riders and other benefits like wellness initiatives under their policies. These add-ons can be critical illness covers, accidental death covers, maternity covers, etc.

Wellness initiatives included under plans allow family members to collect wellness rewards or points, which can be used to pay for healthcare services like medication, OPD (Outpatient Department) consultations/treatments, health supplements, and health checkups.

Stress-Free Hospitalisations

Hospitalisations can be stressful enough without having to add in the paperwork and the tedious fee payment processes. Under a mediclaim policy for your family, you can easily avail cashless treatment at network hospitals.

Your insurance provider takes care of hospitalisation costs while you and your family enjoy stress-free treatment and recovery. Family medical insurance is an excellent way to ensure that all your family members are afforded the same quality of healthcare services during hospitalisation.

Affordable Premiums

Since all your family members are insured under one policy, family health insurance plans often have cheaper premiums. Moreover, buying health insurance online allows you to access more discounts on your premium payments.

Tax Benefits

Expanding on the previous section, the premium payments on your family health insurance plan also make you eligible for health insurance tax benefits under Section 80D of the Income Tax Law. This makes family medical insurance an economic asset, and buying them a smart financial decision.

Under this section, you can claim deductions of up to ₹25,000, with additional deductions of ₹25,000 if you have included your parents (under 60 years) under the plan. For parents over the age of 60, the additional deduction is increased to ₹50,000.

Lastly, if both parents are over 60 years old, the maximum additional deductions available under this section is ₹1 lakh.

At Tata AIG, we offer four types of MediCare policies that can be modified to be family floater plans. These plans can be purchased online through our website or in person. We recommend buying them online as they make you eligible for discounts and offers on our site.

Here is a brief description of each health insurance plan offered**

MediCare

This standard health insurance for your family is a simplified plan with comprehensive coverage. It offers a sum insured of up to ₹20 lakhs so that you and your family members are covered for medical expenses and any medical emergencies.

Under the family floater option, you can get up to a 32% discount on premium payments and access to quality healthcare services. You can also opt for an optional accidental death rider under this plan.

MediCare Protect

This Medicare variant offers comprehensive health coverage for you and your family while maintaining an affordable premium rate. Under this policy, you get a sum insured of up to ₹5 Lakhs and an additional ₹5 lakhs as a death benefit if you have opted for an optional accidental death rider.

MediCare Premier

This is our best health insurance policy for your family, as it provides extensive coverage for you and your family. This MediCare variant offers you a sum insured that can be enhanced up to ₹3 Crores. This can be done on renewals and on new policy purchases before the commencement of the new policy term.

As a benefit of having an increased sum insured amount, you get access to several benefits like high-end diagnostics, death benefit cover (built-in), and emergency air ambulance, to name a few.

Criti MediCare

This is a plan specifically meant to cover critical illness. Under it, you can expect comprehensive coverage for up to 100 critical illnesses. You are paid a lump sum amount if you or any of your insured family members are diagnosed with a critical illness listed in this plan.

The Criti MediCare policy gives you critical illness coverage under three sections and an optional fourth section**

Section A Critical illness

You can opt for coverage under this section under either a** Smart Century Premier Plan (100 critical illnesses) or a Smart Half Century Plan (50 critical illnesses). Under both subsections, you can expect coverage for**

Critical Illnesses Treatment (for illnesses listed under the plan/subsection).

Health Checkups.

Smart Cancer Care.

Second Medical Opinion.

Section B Cancer 360 Degree Indemnity Cover

This section specifically covers medical expenses relating to cancer treatments. So if you or your family member has recently been diagnosed with cancer, opting for coverage under this specific section would be beneficial.

Section C Hospital Cash

As the name suggests, this covers hospitalisation expenses for treatments and emergency medical care for consecutive and completed (24-hour) hospitalisations with varying degrees of coverage.

Section D** Wellsurance Benefit (Optional)

This is an additional cover you can opt for to undergo medically necessary minor and major surgeries. Moreover, it also covers post-operative expenses like physiotherapy and ambulance expenses.

Section E Personal Accident (Only applicable for Section A** Critical Illness)

The benefit under this section is applicable if no claims are reported in the expiring policy year under Section A. It provides a sum insured of ₹3 lakhs if the insured individual suffers an injury due to an accident during the policy year, which is the sole cause of death within 12 months from the date of the accident.

A minimum of one section from the provided base benefit sections has to be opted for, and all family members will share the same plan coverage. You get ₹5 lakhs — ₹2 Crore sum insured (in multiples of ₹5 lakhs) in each category (sections A/B/C), which is given on an individual basis.

Covers Hospitalisation Expenses Hopsitlisations are never cheap and can lead to financial burdens that can be hard on your savings. A family health insurance policy covers these expenses. This extends to ICU charges as well.

Most family health plans also offer cashless facilities at network hospitals, which allow for stress-free hospitalisations during emergencies.

Quality Medical Care for All Family Members Family health insurance plans allow insured family members under a plan to share the sum insured. This means that all family members get access to quality medical care without compromising their savings.

In short, family medical insurance ensures that money is no longer an issue when it comes to getting the best medical care for you and your family.

Preventative Health Checkups These plans also offer coverage for preventive health checkups, which can improve your family’s overall health by ensuring that any underlying conditions are treated and diseases are caught in their early stages, making them easier and less expensive to treat.

These health checkups are eligible for a tax deduction under Section 80D for a maximum limit of ₹5,000, which is included in the overall tax deduction limit (₹25,000/₹50,000) under your medical insurance.

Helps You Beat Inflation The best health insurance policy for your family offers high sum insured amounts to counter rising medical costs, making it easier to plan and save for future medical expenses, shoutout stressing your savings.

Peace Of Mind With family medical insurance, you no longer have to worry about individual premium payments as all family members are covered under one plan, giving you peace of mind and allowing for a stress-free policy tenure.

Moreover, this type of payment setup makes them not only convenient but also affordable.

Coverage When buying family medical insurance, you must check the coverage benefits. Some of the best family health insurance plans in India offer coverage for**

• Pre and post-hospitalisation expenses.

• Day care expenses.

• Domiciliary treatments.

• Organ donor expenses.

• Ambulance cover.

• Other benefits can include tax benefits, lifetime renewability, no-claim bonuses and restoration benefits.

Sum Insured Enhancement The cost of healthcare is always rising. Hence it is important to buy family health insurance plans with flexible sum insured coverage so that you may opt for increased coverage on renewals.

At Tata AIG, we offer a cumulative bonus that can be applied to your sum insured to increase its coverage on policy renewals if you have not applied for claims during the previous policy year.

Renewability This is an important factor to consider, as policies that offer lifetime renewability are cheaper than policies that do not. This is because policy renewals offer more affordable premiums than new policy purchases.

Moreover, you must also check the renewability age, as some policies have a maximum renewability age of 60 - 65 years. Considering these factors can help save you a lot of money in the long run.

Cashless Facilities Cashless benefits keep you stress-free during hospitalisation as you do not need to manage any last-minute funds to get necessary treatments for you or your family members.

So when choosing your family medical insurance plan, ensure that your insurance provider has an extensive list of network hospitals or if they have tie-ups with hospitals close to your residence.

Easy Claims Process Convenience and accessibility are major factors when buying health insurance plans. Your plan may offer great coverage, but if the claims process is tedious or hard to navigate, it may discourage you from filing for reimbursement claims or renewal upon policy expiration.

Always check if the insurance company you are buying from offers online facilities or an easy claim process before buying your family health insurance plan.

Policy Inclusions and Exclusions While you may always think to check for policy inclusions when comparing health insurance policies, it is equally important to check the policy’s exclusions.

This allows for a better understanding of the policy’s terms and allows you to choose the best mediclaim policy for your family.

Cashless Services at Network Hospitals

At Tata AIG, we have 8000+ network hospitals pan-India that offer cashless facilities to our policyholders. We settle claims directly with the network hospital in your stead up to the extent of the liability so that you and your family can focus on treatment and recovery while we handle the rest.

To avail this benefit under your family medical insurance plan, you must notify us or our TPA (Third Party Administrator) 48 hours before planned hospitalisation or treatments. For emergency hospitalisations at network hospitals, we must be notified within 24 hours after the treatment or hospitalisation.

To check for network hospitals in your city or region, you can use our Network Hospital Locator to know their addresses.

Restore Benefits

Medical emergencies and the hospitalisation costs that come with them can be expensive. This is why our MediCare plans come with an automatic restoration benefit.

It enables the automatic refilling of your sum insured amount if you have exhausted your sum insured during a single policy year.

Wellness Programs and Services

At Tata AIG, we understand that nothing is more important than your health. Our wellness programs under our health insurance plans exemplify this and encourage you and your family to improve your health and fitness.

We do this by offering redeemable vouchers for fitness services and discounts on pharmacy and diagnostics.

You can also collect wellness rewards that can be accumulated through fitness activities and used as payment towards health checkups/diagnostics, medication/supplements, and OPD consultations/treatments.

Guaranteed Cumulative Bonus

Under our MediCare plans, you can get a maximum cumulative bonus of up to 100% of your sum insured. This bonus is available on consecutive renewals with Tata AIG without a break.

A 10% - 50% (depending on the policy) cumulative bonus will be applied to your sum insured for the next policy year after every claim-free policy year.

If you find these features to be helpful, it is time you browse our plans and purchase a health insurance plan for your family from Tata AIG.

Breaches of Law If you sustain an injury while committing a crime, your health insurance plan will not cover it. Any criminal activity or breaches of law requires an investigation and is out of the scope of your insurance coverage.

Rehabilitation Treatments for Alcoholism or Drug Abuse Rehab costs and other kinds of treatment for alcoholism and drug abuse are not included in a family health insurance plan and hence not covered.

Cosmetic or Plastic Surgery Cosmetic or plastic surgery expenses purely for aesthetic reasons and not medically necessary reconstructive surgery after an accident, for burns, or for cancer are not covered.

Unproven Medical Treatments Treatment, services, and supplies that lack significant medical documentation to support their effectiveness are not covered.

Sterility And Infertility Medication or treatments for sterility or infertility, like contraceptives, assisted reproduction services (IVF, ZIFT, GIFT, ICSI), surrogacy, and sterilisation reversal are not covered under a family health insurance plan.

Age The minimum and maximum age are primary factors that insurance providers consider before selling health insurance. This is because your family health insurance premiums are based on the age of the eldest family member insured under the plan.

Most plans also have a maximum entry age of 60 - 65 years, so when a family member crosses 60, the policy coverage will lapse, requiring you to buy a new family health insurance plan.

Pre-Existing Illnesses Some plans do not provide coverage for pre-existing illnesses during policy waiting periods and may require you to undergo pre-screening medical tests before policy purchase.

If you or your family member does have a chronic condition or a pre-existing illness it is best to opt for critical illness insurance instead as it provides more extensive coverage for pre-existing conditions.

• Visit the Tata AIG official website.

• Click on 'All Products' and click on 'Tata AIG MediCare'.

• Choose the family members you want to add to your plan and click on 'Get Plan'.

• Enter the required details and click 'See Plan.'

• Fill out the application form and upload any required documents.

• After submitting your application, an insurance agent will contact you to guide you through the process.

Reimbursement Claims Process

Visit the Tata AIG official website.

Click on 'Claims' on the top tab.

Click 'Initiate Claim' and choose your product; in this case, it will be 'Health.'

Log in to the site using your registered details if you have not already done so.

Fill out the claims form and upload the required documents.

After submitting your claim, an insurance agent will contact you to guide you through the process.

Cashless Claims Process

This facility can be claimed only in cases of treatment and hospitalisation at network hospitals and applies to planned and emergency hospitalisations.

To initiate a cashless claim, you must:

Notify the TPA/us through email or letter 48 hours before any planned hospitalisations/treatments. For unplanned or emergency hospitalisations, we must be notified 24 hours after the treatment/hospitalisation.

Upon notification, we will check your coverage and eligibility and send an authorisation letter to the provider.

You have to provide the ID card issued to you along with any other information or documentation that is requested by the TPA/us to the network hospital.

If approved, we will directly settle the bill with the network hospital.

In case of a rejection of the cashless claim, you can still apply for a reimbursement claim, as a rejection of cashless claims in no way indicates rejection of the claim itself.

Family members that can be included under a family floater policy include you, your spouse, dependant children, parents, and parents-in-law. The number of people permitted to be included under a policy will differ across insurance providers and plans.

Lastly, new family members can be included for an additional premium on purchasing a new plan or policy renewal. MId-term policy additions only allow newborns and a legal spouse upon marriage.

The Tata AIG Claim Form Can be downloaded from our website. It must be filled and signed on behalf of the insured person.

Original bills, receipts (pharmacy purchase bill, consultation bill, diagnostic bill), and any attachments like receipts or prescriptions supporting any amount claimed.

Regulatory Requirements KYC documents (recent ID/Address proof and photograph) and NEFT (to enable direct credit of claim amount in your bank account for cashless claims).

All medical reports, case histories, investigation reports, indoor case papers/ treatment papers (in reimbursement cases, if available), and discharge summaries. These include**

Medication prescriptions that name the insured person, their price, and a payment receipt. For pre/post-hospitalisation claims, the prescription must be submitted with the corresponding doctor/hospital invoice.

All pre and post-investigation, treatment, and follow-up/consultation records about the patient's present ailment.

Treating doctor's certificate regarding any missing information in case histories. For example, the circumstance of injury and alcohol or drug influence at the time of the accident, if available.

Copy of settlement letter from the other insurance company or TPA.

Stickers and the invoices of implants used during surgery.

In Case the Hospital Bill is not Available** A detailed list of the individual medical services and treatments provided with all of their individual prices.

For Claim Arising Out of Accidents** Copy of MLC (Medico legal case) records, if carried out, and FIR (First information report) if registered.

For Claims of the Same Event Covered by Another Insurer** Attested copies of the above-mentioned documents and a declaration from the other insurer detailing the availability of the original copies of the treatment documents.

Additional Documents

Legal heir/succession certificate, if required.

PM report (wherever applicable and conducted).

For Compassionate Travel Boarding Pass, railway ticket, or any other document to show proof of travel.

For Global Cover Proof of diagnosis in India and the insured's passport and visa.

All documents or medical or otherwise requested by us or the TPA must be submitted within 15 days or earlier from the date of treatment or discharge.

Failing to provide these documents within the given time frame is admissible if you can provide proof that it was not reasonably possible to provide them within this time. Moreover, claims where documents have only been provided after a delayed interval are only permissible in special cases.

Sum Insured This is the amount of money you are provided access to by your insurer on policy purchase which is used to cover your medical expenses.

Health Insurance Premium** A premium is a regular payment made to your insurer in exchange for the health insurance coverage they provide. This amount can vary depending on your policy type, your age and the sum insured amount.

Restoration Benefit This is a feature included in our health insurance plan that recovers your full sum insured upon exhaustion during the policy term.

For example, if you have a sum insured amount of ₹10 lakhs and it has been exhausted due to a medical emergency then, we will restore the amount up to the base sum insured (₹10 lakhs) upon exhaustion.

Cumulative Bonus This is a benefit offered to policyholders on renewal if they have not filed any claims in the previous policy year. It increases your sum insured amount by a certain percentage without the need for an extra premium.

Critical Illness Insurance This is a separate health insurance plan or add-on cover that provides coverage for critical illnesses like cancer. These plans have higher sum insured amounts and higher premiums as well.

Waiting Period This is a time frame within which you can not claim coverage under your health insurance plan. The waiting period is only waived in case of accidents or emergencies.

Most health insurance plans have a waiting period of 30 days from policy inception after which you can claim medical coverage.

Network Hospital This is a hospital that has a tie-up with the insurance provider to provide cashless claim facilities and lower fee rates to policyholders. Every health insurance provider has their own list of network hospitals.