Insurance companies offer customizable health insurance plans for individuals and families in India. Family health insurance plans are much higher than individual health insurance plans as multiple members are covered by these plans. As the sum insured required to provide medical coverage to multiple members is higher, the premium amount will also be on the higher side. However, sum insured is not the only factor considered while deciding the cost of a health insurance policy. These are the other factors that determine the family health insurance cost:
Age of members
The age of members is analyzed to analyze the risk factor associated with each of them. If the number of elderly members is higher, the premium will naturally be on the higher side. Older individuals are at a higher risk of contracting infections, diseases, and other health risks.
Medical history
The medical history of the family members is also taken into account by insurers while deciding the premium of a family health insurance plan. If there are members in your family who have a history of illness like blood pressure, diabetes, or any other chronic illness, the cost to insure them would be relatively higher than the cost to insure a healthy person.
Therefore, many insurance companies require policymakers to undergo a thorough medical test before determining the policy features and premium.
Pre-existing illness
Family health insurance plans cover pre-existing illnesses after a certain waiting period. Suppose some family members suffer from medical conditions or illnesses before getting the plan. In that case, they will have to wait for a certain period to become eligible for the medical insurance coverage. This period can vary between 1 to 3 years, depending on your chosen family health cover plan.
Extent of coverage
The extent of coverage also plays a crucial role in determining the policy premium. The coverage offered by some health insurance policies is vast enough to cover the entire medical cost. On the other hand, some insurance policies don’t provide such extensive coverage.
For example, some health insurance plans do not apply a room rent cap. It means that the insurer will pay the entire room charge. Therefore, the premium of such policies will be naturally higher than the ones that come with a room rent cap.
Copayment & Deductible
If you agree to a higher copayment clause, the insurer will reduce the policy premium. On the contrary, if you choose a lower copayment amount, the insurer will charge a higher premium from you. The same rule applies to deductibles as well. A higher deductible ensures a lower premium, and insurers generally charge a higher premium if your chosen deductible is on the lower side.
Requesting a High Sum Insured
If the sum insured of your existing policy is not enough to cover all your family members, request the insurer to allocate a higher sum insured to your family. You can ask for a higher sum insured while renewing the policy. The insurer will charge a higher premium for it. However, if you have accumulated NCB in your account, you can get an insured higher sum without paying extra. The NCB will also help you cut down the insurance premium up to 50%.
Buy a health insurance plan after considering all the factors. The following benefits can be expected from a family health insurance policy:
- Coverage for preventive health tests and routine checkups
- Coverage for the vaccination expenses of the entire family
- A family health care plan includes coverage for pre and post-hospitalization periods.
- Some family health care plans also offer coverage against critical illnesses.
- Emergency assistance services might also be included in a family health cover plan.
- The family health care plan includes coverage for alternative procedures like Ayurveda, Yoga, Siddha, Unani, and Homeopathy.
- Cashless service in-network hospitals are offered by most family health care policies these days.
- A tax deduction on the premium paid against the family health insurance policy can be claimed.
- Such policies usually cover daycare treatments.
However, don’t forget to read the policy documents carefully to understand the things excluded from the policy coverage. These are some standard exclusions found in a typical family health care plan:
- Suppose that you or any family member is diagnosed with a disease within 30 days after subscribing to the health care policy. A family health care plan will not cover the expenses related to such conditions.
- Such policies do not cover sexually transmitted diseases such as HIV or AIDS.
- Medical conditions or ailments caused due to excessive consumption of drugs and alcohol are not covered by a family health care plan.
- Specific ailments like hernia, piles, sinuses, etc., are covered only after a particular waiting period.
A family health care plan might come with other inclusions and exclusions not mentioned above. Therefore, go through them before purchasing a health care policy for your family.
Find the best health insurance plans in the market on the portal of Bajaj Finserv. The family health insurance plans, individual health insurance policies, and other policies are available on their portal.