Family Health Insurance

Family health insurance is a type of health insurance policy that covers the medical expenses of individuals and their insured family members under one plan.

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 during the policy year.

Let us understand this using an example.

Suppose a person X buys a family floater medical insurance for himself, his spouse and dependent children with health coverage of ₹12 lakhs.

After a few months of policy purchase, Person X has to go for minor surgery. The medical bill during that time was ₹4 lakhs, which the insurance company has covered.

A few months after that, an emergency medical emergency occurred where Person X's child needed treatment. The hospital bill, in that case, was ₹4 lakhs – which was also covered by the insurer for their family floater plan.

Now, as per the family floater health insurance policy condition, Person X has medical coverage left of ₹4 lakhs for the remaining policy tenure.

Below are some reasons to buy the best insurance policy for your family:

Quality Medical Care - Many people tend to compromise on healthcare due to hefty medical expenses. However, with family health insurance, this is no longer an issue as most, if not all, of your family’s medical expenses will be covered by your insurer.

Preventive Health Check-ups - Many family health plans also come with free preventive health check-up benefits. With this benefit, you can keep track of and maintain your family's health by getting regular check-ups in the network hospitals.

Tax Benefits - A family health insurance plan makes you eligible for health insurance tax benefits under Section 80D of the Income Tax Law. You can claim deductions of up to ₹25,000/₹50,000 per year on your policy premiums.

Peace Of Mind - Knowing that your family's medical expenses are covered can allow you to lead a stress-free life. In fact, medical inflation is often the primary reason why most opt for family health insurance.

It is a cost-effective way to secure your family's health and ensure your peace of mind.

Hospitalisation Expenses - A single hospitalisation for a major accident can quickly leave you and your family bereft of your savings. Hence, securing your family members with family health insurance against these perils should be your number one priority.

It will cover most, if not all, of your hospitalisation expenses and mitigate any out-of-pocket costs on your end.

A health insurance plan for a family comes with some eligibility criteria. However, the criteria may differ from insurance company to company. Below are the general criteria for a health insurance plan for a family.

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 are not included in a family health insurance plan and, hence, not covered.

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

• Treatment, services, and supplies that lack significant medical documentation to support their effectiveness should be covered.

• 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.

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 Premier - This is our best health insurance plan 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 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 Check-ups.

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.

Below are some of the benefits of purchasing health insurance plans from Tata AIG.

Cashless Services at Network Hospitals - At Tata AIG, we have 12,000+ 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 of 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 check-ups/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 in health insurance 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

Below is the procedure to buy a health insurance policy for a family from Tata AIG. Step 1: Open the Tata AIG official website. Step 2: Click on 'All Products' and click on 'Tata AIG MediCare'. Step 3: Choose the family members you want to add to your plan and click on 'Get Plan'. Step 4: Enter the required details and click 'See Plan.' Step 5: Fill out the application form and upload any required documents. Step 6: After submitting your application, an insurance agent will contact you to guide you through the process.

Below is the procedure for Tata AIG health insurance policies.

Reimbursement Claims Process

Step 1: Visit the Tata AIG official website.

Step 2: Click on 'Claims' on the top tab.

Step 3: Click 'Initiate Claim' and choose your product; in this case, it will be 'Health.'

Step 4: Log in to the site using your registered details if you have not already done so.

Step 5: Fill out the claims form and upload the required documents.

Step 6: After submitting your claim, an insurance agent will contact you to guide you through the process.

Cashless Claims Process

Step 1: 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.

Step 2: Upon notification, we will check your coverage and eligibility and send an authorisation letter to the provider.

Step 3: 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.

Step 4: If approved, we will directly settle the bill with the network hospital.

Step 5: 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.

Below is the list of documents required for filing the family health insurance claims.

• Original health insurance policy documents.

• All medical reports, case histories, investigation reports, indoor case papers/ treatment papers, etc.

• Documents to prove policyholder identity, such as Aadhar cards, passports, etc.

• Document to proof address such as ration card, etc.

• Any additional documents needed by the insurance company representatives.

Here are some points you need to consider to ensure you buy the best health insurance plan for your family:

Plan Coverage - When choosing a medical insurance plan for your family, always check the coverage offered under the plan and if it applies to you and your family. It is best to choose a family health plan with extensive coverage options such as day care expenses, pre and post-hospitalisation expenses, etc.

Cashless Hospitalisation - Another thing to look for while purchasing an affordable family health insurance is cashless hospitalisation benefits. This allows you and your family members to claim cashless medical treatment at network hospitals, where the insurer directly settles the bill with the hospital.

Sum Insured Enhancement - Another thing you need to look for while purchasing a family medical insurance plan is sum insured enhancement.

A single hospitalisation can deplete your coverage amount. Thus, a plan that allows you to upgrade your sum insured as needed should be considered.

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.

**Claim Settlement Ratio (CSR) - It is best to choose an insurance company that offers a high settlement ratio and has an easy claim settlement procedure. While it should not be the only thing to look for, an insurer’s CSR can clue you in on the likelihood of your claims getting accepted and settled. So, a high CSR should be preferred.

Getting a medical insurance plan for a family is essential due to rising medical expenses. No matter how healthy our lifestyle is, unforeseen incidents can happen to anybody.

Hence, family health insurance policies are a much-needed asset when it comes to securing your family members at the time of a medical crisis.

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 a list of network hospitals.