Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.
The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
Most financial experts state that financial planning begins with purchasing a health insurance policy due to the burden associated with increasing medical expenses. With changing lifestyles and increased exposure to life-threatening diseases, today, you need to have adequate health insurance that covers medical expenses for you as well as your family members long before you start saving for your financial goals.
In this article, we will be discussing whether you should opt for group insurance or family floater health insurance. Towards the end, you will be able to determine which health plan best suits your needs.
So, let us begin!
A group health insurance plan provides coverage for a group of members. Such plans are usually provided to employees by a company. Most group health insurance plans also cover the employee’s family (dependants).
A health insurance plan for family is exclusively made to fulfil the medical needs of families and function as one health insurance for family as a whole. The plan, as the name suggests, is a type of health insurance policy that extends its coverage to the entire family.
The following table lists the difference between family floater insurance plans and group health insurance plans:
Parameter |
Group Health Insurance |
Family Floater Health Insurance |
Who is covered? |
Employees of an organisation (and their dependents) |
Immediate family members |
Who pays the premium? |
The premium of this plan is borne by the employer. However, the employee may have to pay a nominal amount for any additional coverages. |
The premium of this plan is paid by one member of the family. |
Who is eligible? |
An employee will be eligible to get the benefits of this plan till he/she is associated with the organisation. |
Anyone above the age of 18 years can buy this health insurance plan. |
What is the Claim Settlement Process? |
The claims for such plans are settled via a Third-party Administrator (TPA) appointed by the insurer. |
The claims for such plans are settled either via a TPA or directly through the insurance company. |
Advantage |
The organisation pays the premium for the base policy. |
It is easier to manage one health insurance plan for the entire family than to manage multiple policies. |
Disadvantage |
1. You cannot decide the type of coverage you get. |
The sum insured can get exhausted very soon if multiple members fall sick. |
Multiple factors are needed to be taken into consideration when health insurance plans. The task can be overwhelming, but don’t worry. We are here to help. Certain factors remain constant, irrespective of the type of health insurance plan. These factors are as follows:
When choosing a health plan, make sure that you are going through the features and benefits offered by different policies online. You can then select a plan that best suits your health needs. When it comes to family health insurance plans, it is highly advisable to decide on a policy that covers you, your partner, your dependent children, and your parents.
Health Insurance Premium amounts are based on parameters like sum insured, age, gender, lifestyle habits, add-ons, and more. Generally, the younger you are, the lower will be your premium amounts. Also, when conducting market research on family health insurance, check the sum insured and whether the coverage provided is sufficient for all the family members.
The claim settlement ratio tells you about the efficiency of the insurance provider in settling the claims. In other words, it will give you a fair idea of how the health insurance company pays the claims.
Every insurance provider has a list of network hospitals where you can receive cashless services upon hospitalisation. So, if the hospitals in your vicinity or that you often visit are listed in the network hospital list, it is a win-win situation for you.
If it is not stated in the policy paperwork, make sure you ask your insurance provider whether or not they offer a free look period. During this period, you can read through the policy paperwork carefully and get a deeper perspective on the features and benefits the plan offers. Later, if you feel that the policy does not comply with your needs, you can give up on the deal and claim a refund for the premiums paid.
Now that you know the difference between family floater health insurance and group health insurance, you will be able to choose a plan that is best suited for your needs. If you are looking for a plan with broader coverage at affordable premiums that also covers pre-existing ailments, then opting for a group health insurance policy is a wise choice. However, if you wish to get a plan that covers all the members of the family under one policy, you can opt for a family floater plan.
If you are looking for a health insurance plan for yourself and your loved ones, you can browse through different health plans available on Bajaj Markets. With these plans, you can benefit from features like swift claim settlement, reinstatement benefits, bespoke insurance plans, extensive coverage, tax benefits, and more.
Yes, you can receive cashless treatments at any network hospital under your family floater plan.
Yes, you can add family members to your family floater health insurance plan during policy renewal.
No. Your group health insurance will be discontinued when you retire from the job.
Yes. Most group health insurance plans cover pre-existing ailments.
Yes. You can purchase a health insurance policy online on Bajaj Markets through our website or our insurance app.