Does Family Size Impact Your Health Insurance Cost?

Family health insurance is a type of health insurance that will cover your entire family against medical expenses under a single plan. However, your family’s size doesn’t necessarily determine your medical expenses. Medical expenses for a couple can sometimes come out to be more than what it looks like for a family of four or six. But the cost of a health insurance premium depends on the number of people that are insured. Let’s see how.

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    You can cover your entire family under the same plan. However, it depends whether you have opted for individual cover for each family member or a family floater policy that covers all the members under a single annual premium on a single sum assured. 

     

    The premium for health insurance plans for family is lesser than the combined premium of individual health insurance plans. By paying a nominal amount of extra premium, you can get new members included in a family health plan. Moreover:

    • You can increase the coverage for family member time of including a new family member. This will ensure adequate coverage for all the members.
    • The eldest member of the family is covered until he/she crosses the upper age limit as mentioned in the plan
    • You can even include children under the same plan up to a certain age

    If you want to include your elderly parents in a family floater plan then it will certainly increase your premium by 2 folds? Therefore, it is better to buy a senior citizen health insurance plan if your parents are more than 60 years old. It will further ensure maximum coverage benefits and reduce the total amount of premium.

    How does Family Health Insurance work?

    To understand the functioning of a Family Health Insurance plan, let’s assume a hypothetical situation.

    Mrs. Kher got her family covered under a family floater health plan for Rs. 10 Lakh. The policy covers Mrs. Kher, her husband, and two kids. During the policy term, she contracts Malaria and because of her severe condition, she was hospitalized. Her total medical expense incurred was Rs. 2 Lakh.

    She claimed the total expense from her insurance provider against her Family floater health plan. She got it reimbursed after the submission of the necessary documents. Now for the remaining term, the family is left with a cover of Rs. 8 Lakh. This amount can be availed by all four members of the family.

    Why are Family Floater Health Plans Beneficial?

    Hectic schedule, work-life imbalance, polluted environment, emerging health risks, accidental risks, lifestyle diseases, and many such circumstances, can wreak havoc in your life and bank balance but only if you do not have the best mediclaim policy for family. There are plans that can cover up to 15 members under your Family Health Plan.

    Addition of a new family member at ease:

    The plan allows you to add new members with ease. However, the premium is charged on the basis of the age of the eldest member. However, there are separate plans that cover 2 adults+ 1 children, 1 Adult + 1 children, etc

    Get additional cover for your elderly parents or in-laws:

    One of the major benefits is that you can secure the health of your parents (below 60 years) and that of your spouse’s parents less than one plan. All you need to do is pay some additional premium. You can also buy individual health insurance plans for parents, depending on your needs.

    What to Look For?

    To buy the health insurance plans for family, make sure that you take into consideration the following features -

    Policy coverage

    It is important that you go through the policy benefits and limitations. Look for certain things like pre and post-hospitalization cover, ambulance charges, critical illness cover, maternity benefits, cashless treatment, policy term, hospital cash, in-patient hospitalization, etc.

    The number of family members covered

    There are certain health insurance plans for family that provides coverage to the policyholder, their spouse and children only. If you want the coverage to be extended to other family members, look for family floater plans that offer coverage to parents, in-laws, siblings and other family members. You check online and find best family floater health insurance plans in India like Star health insurance etc. for your loved ones.

    Room Rent Limit

    Whether you will get a private hospital room, semi-private room or a shared room, it depends on the type of plan you choose. It’s always better to go for a plan that provides higher room-rent limit if you want to avoid paying extra from your own pocket.

    Co-payment Clause

    It is the percentage of the amount that you will have to pay from your own pocket. The remaining hospitalization expense is paid by the insurance company. For instance, if you have a policy with a 10% Co-pay clause, this implies that for a claim of Rs. 1 lakh, you will need to pay Rs. 10,000 from your own funds while the insurance company pays Rs. 90,000 as part of the claim. You can also go for a "no co-pay" clause.

    Waiting Period for Pre-existing Diseases

    Any illness or disease that has been diagnosed before the policy purchase date is considered as a pre-existing illness. Almost every health insurance plan covers them after a specified waiting period, which varies from one plan to another. For instance, maternity expenses are usually covered after a period of 2 to 4 years from the date of policy purchase. Make sure that you check the time duration after which the pre-existing diseases will be covered in your family health plan.

    Waiting Period in Family Health Plans

    • Initial waiting period clause - This is the waiting period from the date of policy purchase. Usually, it is for 30 days but some family health plans may have 90 days of a waiting period. It is not applicable to accidental damages.
    • Waiting period for pre-existing diseases - If any of the insured members are suffering from a pre-existing illness like cardiovascular diseases, diabetes, etc., at the time of purchasing the policy, it will not be covered until the waiting period is over. Waiting period for pre-existing illness usually varies between 1 and 4 years. It all depends on the family health plan you have purchased.
    • Waiting period for policy-specified diseases- In a family health insurance plan there are certain specific ailments like kidney stones, arthritis, etc. that are not admissible for a claim for the initial 1 or 2 years.
    • Waiting period for Maternity claims - If you choose a family health insurance plan with maternity benefits, usually the benefit is available after consecutive two years of coverage. This waiting period may vary from one insurer to another.

    Bottom-line

    As you can see how a family health insurance plan works and how the number of members affects the premium cost.  Now that you are clear you can buy a family health plan for your family as per your needs and requirements.  You can even add new family members at a nominal premium.

    Disclaimer : *Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

    Written By: PolicyBazaar - Updated: 29 July 2021
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    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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