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Wednesday 22nd of January 2025

10 Essential Things Every Family Should Consider About Health Insurance Plans


As the world is changing constantly owing to technological advancements and unforeseen challenges, lifestyle shifts are happening. And, this emphasises the importance of health insurance that offers more than just medical expense coverage. 

Notably, having modern health insurance plans for family is no longer a luxury but a necessity to ensure financial stability during health crises. Read on to learn how these insurance plans covering modern-day healthcare needs are redefining protection for households.

What is the Need for Family Medical Insurance?

Nowadays, families have diverse needs and preferences. Owing to this, traditional medical insurance policies no longer serve the purpose. 

Considering this, the Insurance Regulation and Development Authority of India (IRDAI) rolled out significant amendments in 2019 by introducing modern health insurance plans that were more inclusive and also covered treatments related to mental or intangible health.

These days, insurers are designing medical plans that let families select benefits like maternity care, critical illness coverage or wellness incentives, as per their unique requirements. This flexibility not only empowers families to align their coverage with their lifestyles, but also ensures they get value for their premiums paid.

Benefits of Modern Health Insurance Plans for Families

Here are the benefits of getting a medical health insurance plan that also covers family members:

1. Cashless Treatment

Considered a boon of modern medical cover, cashless payments let policyholders get quality medical treatment during emergencies without paying any money from their pockets. They just need to share their policy number and the network hospital directly settles the bill with the insurance provider.

2. Customisable Coverage

Providing a high degree of customisation, health insurance policies allow policyholders to tailor their coverage considering their specific needs. They can add riders for additional protection or select specific coverage options to get the most relevant and effective insurance coverage.

3. No Claim Bonus

These days, many insurance providers offer a no-claim bonus, incentivising healthy living and prudent use of health care services. They reward policyholders who do not make any claim in the form of a reduced premium or an increased sum insured for the following year.

4. Health Insurance Add-ons

These plans provide additional coverage to policyholders once the basic sum insured is exhausted. Considered a cost-effective way to enhance coverage, add-ons are especially useful in covering specific medical expenses without significantly increasing the premium cost.

5. Preventive Care

Insurance providers are focusing on wellness and preventive care programmes that often include free health check-ups, diet counselling and gym memberships. Following a healthy lifestyle will help policyholders avoid serious health issues. And, this will ultimately lead to a dip in the number of claims, lowering cost for insurers.

Things to Consider When Buying Family Health Insurance

Let’s dive deeper to know about the things to consider when zeroing in on a family medical insurance plan:

1. Sum Insured

It indicates the maximum amount of money the insurer will pay during a medical emergency requiring hospitalistion. Some policies also provide 100 per cent reinstatement of the sum insured after it has been exhausted, offering peace of mind to families managing chronic health conditions or having multiple dependents.

2. Waiting Period

It is the time period for which the insurer does not process any claim. Generally, it is applicable to pre-existing illnesses like thyroid, blood pressure and diabetes, as well as certain medical conditions, such as arthritis, varicose veins and cataract. Depending upon the insurer, the waiting period can range between 24 months and 48 months.

3. Hospitalisation Cover

Most insurance plans cover medical expenses incurred during hospitalisation. However, getting a plan that also includes expenses incurred before and after hospitalisation like ambulance charges, medical tests, medicines and doctor fees, is the right thing to do.

4. Co-payment

It refers to the percentage of the amount that the policyholder would need to pay at the time of claim while the rest will be paid by the insurance company. Insurers prefer a co-payment clause for policyholders who have a pre-existing medical problem or crossed a certain age.

6. Specific Diseases and Treatment Options

Always check if the health insurance policy for family meets the needs of all the members included. If a family member is suffering from a chronic disease, then consider buying a related add-on to enhance the coverage in case it is not covered under the regular policy.

7. Room Rent Capping

It means the limit placed on the room rent amount that an insurer will pay during a policyholder’s hospitalisation. This affects the claim settlement and out-of-pocket expenses. 

8. Claim Settlement

Claim settlement ratio or CSR is the ratio between the number of claims resolved by the insurer and the total number of claims received by it in a financial year. The higher the CSR, the better it is.

9. Alternative Treatment

Check if the chosen family medical insurance plan covers alternate or AYUSH (Ayurveda, yoga, Unani, Siddha and homeopathy) treatments as they do not require hospitalisation.  

10. Insurer’s Reputation

This indicates how reliable an insurer is. Customer reviews and ratings can help gain insights into the insurer’s reputation.

To summarise, family health insurance ensures good health and financial stability for a comfortable and peaceful life. Medical insurance designed for modern needs not only covers expensive medical treatments, but also offers preventive care services. Also, they focus on providing convenience, greater flexibility and a better customer experience.


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