What is covered & not covered in Family Medical Insurance Plan?
Choosing an appropriate family health insurance plan is an overwhelming task. You must double-check factors like ‘what is covered’ and ‘what is not covered’. Medical insurance for families must include multiple factors like pre-hospitalisation expenses, maternity coverage, ayurvedic treatments, and more.
Here are a few inclusions and exclusion of a family health insurance plan.
Inclusions |
Exclusions |
Complimentary health check-ups once in three years. |
Routine check-ups or OPD treatments are not generally covered unless specifically mentioned by the insurance company. |
Coverage for Pre and post hospitalisation expenses including ICU room rent, consultation, etc. |
Cosmetic treatments, plastic surgeries, etc. are not covered under family health insurance. |
Under the maternity care feature, the plan offers coverage for ₹25,000 for normal delivery and ₹35,000 for caesarean delivery. |
Any ailment or injury that can be categorised as intentional self-harm will not be covered under family health insurance. |
Treatment and medical expenses regarding organ donation are covered in the policy plan. |
Any ailment or injury caused while pursuing criminal or unethical activities will not be covered by the insurance plan. |
Reinstatement benefits can be availed on the same illnesses with 100% coverage of the sum insured. |
Pre-existing illnesses are those medical ailments that are existing before the purchase of the insurance plan. Generally, pre-existing illnesses are not covered under insurance plans. In case, the family health insurance policy offers coverage for a pre-existing illness, the policyholder will have to complete the waiting period. |
The family health insurance plan offers coverage up to ₹20,000 for Homoeopathic/Ayurvedic treatments. |
Ventilator or life-support machine expenses are not included in a family health insurance plan. |
For 10+ days of continuous hospitalisation, the policy plan offers convalescence benefits of up to ₹7,500. |
Coverage for overseas medical treatments are not covered, unless specifically mentioned in the policy. |
Points to Consider While Purchasing Family Health Insurance Plans
Before purchasing a family health insurance plan, there are certain pointers that one must take into consideration. A few of those vital factors are explained as follows.
Every family health insurance plan covers hospitalisation expenses, ambulance charges, etc. However, there are certain terms and conditions about coverage limits that people fail to read before purchasing the plan. Therefore, it is advisable to learn about policy coverage before opting for any family health insurance plan.
Insured Sum Enhancement Option -
Year by year, medical treatment and service expenses continue to increase steadily. In such a scenario, the insured sum enhancement option allows the policyholder to increase the insured amount during policy renewals. Some insurance companies offer a 100% appreciation in the insured amount as a cumulative bonus for claim-free years.
Insurance companies claim a wide network of hospitals where policyholders can opt for cashless treatment facilities to eliminate financial stress, especially during medical emergencies. However, one must locate and evaluate the services of the nearest network hospital before purchasing the family health insurance plan.
The policy premium and renewal of the family health insurance plan are influenced by the age of the eldest member of the family. Some insurance companies or vendors do not offer renewal facilities to policyholders if the eldest member of the family turns 60+. Therefore, one must check the renewal conditions and opt for a family health insurance plan offering a lifelong renewal facility.
Claim Settlement Procedure -
Insurance companies promise quick and hassle-free claim settlement procedures. However, one must check the claim settlement ratio and duration of the insurance companies before purchasing an insurance plan.
How to buy Family Insurance Plan Online?
Most insurance companies have now moved online. While you can still buy insurance policies by visiting the insurer’s office, the online process is more streamlined and quick. Here’s how you can purchase or renew family health insurance plans in India online:
1. Steps to Buy Family Health Insurance Plans Online
Step 1: Scroll up to the top of this page and click on ‘Check Plans’
Step 2: Provide the necessary details about the family members you wish to insure along with your personal information
Step 3: Choose from the list of available health insurance plans for families. You can also select add-on covers to enhance your coverage
Step 4: Finally, upload the required documents and make the health insurance premium payment online
Step 5: And voila! Your insurer will send the policy document via email shortly
Documents Required for Filing an Insurance Claim
Here’s a list of documents you need to submit for raising an insurance claim:
Duly filled claim form
Original copy of hospital discharge summary or card
Prescription and cash invoices from pharmacies and the hospital
An investigation report by the doctor
Medical Certificate
Family health insurance policy document
In case of an accident, FIR or Medico Legal Certificate (MLC)
Get to Know How You Can Save Tax on Family Health Insurance
Purchasing a family health insurance plan can help you save a bit from their tax liabilities. Here are certain tax benefits that one avail of family health insurance.
For single premium family health insurance plans, you can be eligible for annual tax benefits of up to ₹1 Lakh under the Income Tax Act of 1961.
Purchasing family health insurance plans that include parents comes with tax deductions of ₹25,000. If parents are senior citizens, you can apply for tax deductions of ₹30,000 every financial year.
Annual health preventive check-ups have tax benefits of up to Rs. 5,000.
Eligibility Criteria to Buy a Health Insurance Policy for Family
Every family health insurance plan comes with eligibility criteria. Although the eligibility parameters vary from one plan to another, the following table shows the common eligibility standards for family health insurance plans in India.
Categories |
Details |
Minimum Entry Age |
For Adults: 18 years For Children: 90 days |
Maximum Entry Age |
For Adults: 65 years For Children: 25 years |
Family Members Covered Under the Plan |
Self, spouse, dependent parents, dependent children, and parents-in-law |
Renewability |
Lifetime |
Family Health Insurance Claim Process
Now that you have a family health insurance plan, how should you raise a claim during medical emergencies? There are two types of claim settlement processes – cashless and reimbursement claims. Here’s a complete guide on how to file health insurance claim process.
1. How to File Cashless Claims
Step 1: Inform your insurer about the situation and visit a partner hospital
Step 2: Submit family health insurance plan details and take the pre-authorisation form
Step 3: The insurer then verifies the form, and the hospital is notified about the policy details
Step 4: Once discharged, the hospital will share documents like bills and discharge papers with the insurer
Step 5: The claim will then be directly settled with the hospital after reducing the co-payment (if any)
2. How to Get a Claim Reimbursement
Step 1: Share all original medical documents, hospital bills, and insurance claim forms with the insurer
Step 2: The insurer evaluates the details and may ask for any additional information if required
Step 3: Your claim decision is made post-verification
Step 4: You will receive the claim amount based on the policy terms and conditions
Why Choose Family Health Insurance via Bajaj Health Insurance
It is important to choose an insurance company where you can place your trust and faith during tough times. Bajaj Markets promises to deliver hassle-free services and seamless financial assistance to its policyholders so that they are not financially stressed during medical emergencies.
Here are the reasons why one must purchase family health insurance via Bajaj Markets.
Coverage on Medical Expenses -
The hospitalisation expenses, ICU room rent, daycare costs, ambulance charges, etc. are covered under Health Insurance for a family policy. Bajaj Markets will directly settle the medical bills at their network hospitals eliminating financial hassles in the hospital.
Coverage for AYUSH Treatments -
Health Insurance plans cover the expenses of Homeopathy, Naturopathy, Ayurvedic, Unani, Siddha, and various other treatments.
Wide Network of Hospitals -
Bajaj Markets have formed partnerships with great hospitals across the nation to ensure premium services and facilities to their policyholders during medical emergencies. You will no longer have to compromise with the medical facilities due to budget constraints.
Health Insurance offers coverage and compensation for a routine check-up that allows you to analyse your health and take precautionary measures.
Insured Sum Enhancement -
You can increase your insured sum amount to beat the inflation in the healthcare sector on health policy renewal.
Bajaj Health Insurance offers all the tax benefits mentioned in Section 80D of the IT Act of 1961 to its policyholders.
Discounts on Premium Payments -
No-claim bonus points can be redeemed in the form of discounts on premium payments, which eventually reduces the overall price of the family health insurance.