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    Guide on Choosing Health Insurance for Your Family | PNB MetLife

    Overview: Choosing Health Insurance for Your Family

    Last Updated On 09-05-2023

    Do you want to protect your family’s health while safeguarding your financial security at the same time? With rising medical costs in India, knowing how to choose health insurance plan for family members has become essential for protecting your loved ones’ overall well-being. Keep reading to find out more!

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    Overview: Choosing Health Insurance for Your Family

    Primarily, health insurance policies cater to rising medical treatment costs associated with illnesses and injuries. A family health insurance plan is an umbrella policy that protects you and your loved ones in the event of a medical emergency.

    With medical inflation on the rise in India, families without health insurance struggle to pay for costly treatments, often having to dip into their personal savings. Choosing health insurance for your family can be mindboggling when you discover the options available. Understanding medical insurance terminology will help you make a well-informed choice when picking a family health plan.

    Common Health Insurance Plans for Family

    Individual Health Plans

    Health plans for individuals are single policies that offer the policyholder medical coverage. If you don’t have a group health plan or want additional coverage for medical bills and treatments, purchasing an individual insurance health plan is a worthwhile investment.

    Family Floater Plans

    Family floater plans are single insurance policies covering your loved ones’ health needs under one umbrella. Spouses, dependent children and parents, and the policyholder may all be listed under this type of health plan. Family floater plans are often cheaper than paying for an individual health plan for each member.

    Senior Citizen Plans

    Senior citizens’ health insurance plans provide coverage for members older than 60 years. This type of plan comes with a range of benefits applicable to older members such as coverage for outpatient treatment and pre-existing medical conditions. This is a good plan to take out for your aging parents if you don’t want to add them to your individual or family health policy.

    Specific Disease and Critical Illness Plans

    Disease-specific plans cater to policyholders looking for coverage for conditions such as cardiovascular issues or COVID-related problems. A critical illness policy covers specific illnesses such as diabetes, heart attacks, and cancer. Paid out as a lump sum, the sum insured can be used to cover medical bills or other costs that arise during treatment.

    How to Choose a Health Insurance Plan for Family in India

    Before purchasing a health insurance plan for your family in India, take into consideration the following factors:

    Step 1: Look for The Right Policy Coverage

    Having sufficient coverage is important if you want to prevent using your savings during a medical crisis. Looking for a plan that includes features such as pre-and post-hospitalization treatment, ambulance transport, and daycare procedures ensures you and your family get optimal health care.

    The right policy coverage should factor in each family member’s specific needs as well as features such as cashless claims and maternity benefits. However, the more benefits included in a plan, the higher the premium so when getting the right policy coverage ensure your budget can meet the payment requirements as well.

    If You Have Dependent Children

    When picking the best family health insurance plan for dependent children, getting the right coverage is essential to safeguard your savings. A comprehensive medical insurance plan should include benefits that’ll cover any costs related to your child’s health needs.

    If You Have Dependent Parents

    Ensure the plan covers health issues associated with aging members such as pre-existing medical conditions to get the best coverage when necessary.

    If You Need Critical Illness Coverage

    Critical illnesses such as heart attacks, cancer, and diabetes become expensive to treat. Adding critical illness coverage in the form of a rider to your health plan ensures you and your family are adequately protected in the event of a diagnosis. This does come with an additional premium.

    If You Need Coverage for Specific Diseases

    Coverage for specific diseases can be purchased as a rider to your existing family plan, giving you enhanced coverage for such circumstances. Similar to critical illnesses coverage, an additional premium will be charged for this benefit.

    If You Need Maternity Benefits

    Including maternity benefits is essential if you’re newlywed and intend to grow your family. This benefit covers expenses such as checkups, childbirth, and care for newborns and mothers after birth.

    Step 2: Check the Policy’s Flexibility to Add New Members

    If you intend to add new members to your family health insurance policy ensure this option is available and easy to do. Ensure your existing loved ones won’t be impacted if you need to list new family members.

    Step 3: Check the Waiting Period Clause

    Insurers often include waiting periods for certain conditions and checking for this clause is important if you want to avoid unpleasant and costly surprises down the line. Waiting periods as long as four years may be stipulated for pre-existing medical conditions. New policies could include an initial waiting period of 30 days for illnesses.

    Step 4: Choose a Plan With Your Desired Sum Insured

    Choosing a plan with your desired sum insured keeps you and your family protected against financial burdens in the event of a medical emergency. However, keep in mind that the higher the sum insured, the higher the premium. Determine what you can afford on your budget and remember that premiums do increase as you get older before deciding on your sum insured.

    Step 5: Check the Plan’s Limits and Exclusions

    Insurance companies include a range of limits and exclusions in health insurance plans. These must be noted to ensure you get the best policy coverage for your family’s health needs.

    Room Rent Limit

    Room rent limit is applicable especially if your policy has a lower sum insured. This impacts the type of room rented during hospitalization. If you opt for a single room that costs more than your insurance coverage, you’ll need to pay the balance of the rent out of your pocket.

    Exclusion List

    Policy exclusions prevent you getting coverage for medical bills related to self-inflicted injuries, alcohol or drug abuse, external congenital diseases, and war-or crime-related incidences. Perusing the exclusion list before signing a health insurance plan keeps you well-informed of what won’t be covered by the plan.

    Step 6: Check the Co-Payment Clause

    Co-payment refers to the amount of money you’ll need to pay out of pocket for medical bills and treatments and can be as much as 10 percent of the overall costs. Checking the co-payment clause prepares you in advance for financial implications not covered by your health insurance plan.

    Step 7: Check Premiums and Hosptial Network Coverage

    Every insurer has its own set of pricing policies and it’s worthwhile comparing the premiums of health insurance plans before choosing one. Depending on the features, benefits, and riders added to a policy, premiums will differ so factor this in when comparing plans.

    Checking hospital network coverage is equally important especially if you want to benefit from state-of-the-art healthcare in your location. A plan that offers a wider hospital network coverage gives you more options to pick from when picking a healthcare facility for your medical treatment needs.

    Tips and Other Considerations Before Purchasing a Family Health Insurance Plan

    Here are some other tips to help you decide if you’re purchasing the right health insurance plan for your family.

    Choose a Plan With Lifetime Renewability

    Some health insurance plans have a limited time period on the policy’s tenure, ending when you reach a certain age. Choosing a plan with lifetime renewability keeps you and your loved ones covered in your later years without having to purchase another policy.

    Check Available Discounts on Premiums

    Insurers offer premium discounts to make a plan more attractive and affordable for the policyholder. Look for premium discounts offered for features such as no-claim bonuses, adding more members, or buying the plan online.

    Choose a Plan With Value-Added Benefits

    Value-added benefits give you more coverage without the plan costing more. These could include features such as free health checkups, organ donations, and automatic recharge of the sum insured.

    Purchase Additional Coverage Riders

    For full coverage, family health insurance should include additional riders. These options give enhanced coverage for situations such as being diagnosed with a critical illness or specific disease. An additional premium is charged for optional riders but it’s often the cheapest way of getting extra cover on an existing health insurance plan.

    Frequently Asked Questions (FAQs)

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    What to do when I have a group health cover from my employer?

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    It’s important to check your group health cover extends to your family members and if it does, check what coverage is available. Group plans often offer standard coverage so taking out your own health insurance policy will give you and your loved ones additional protection in case of exclusions or limited cover.

    What are the tax benefits when I purchase a family health insurance plan?

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    Under Section 80D of the Income Tax Act, 1961 in India, policyholders benefit from tax deductions on paid premiums. Policyholders who are taxpayers can receive a savings of Rs. 25,000 per year if below 60 years while those over this age can save Rs. 50,000 annually on medical expenses. An additional deduction for insurance of parents is available up to Rs 25,000, if they are less than 60 years of age. If the parents are aged above 60, the deduction amount is Rs 50,000.

    What is a co-payment clause in a family health insurance plan?

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    A co-payment clause stipulates the percentage you need to cover towards hospitalization with the balance being covered by the insurance company. Some insurers waive a co-payment clause but this comes with a higher premium.

    Can you put non-family members on your health insurance?

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    Yes, you can put non-family members on your health insurance plan as long as you gain approval from the insurance company. Special circumstances for adding persons that aren’t immediate family members can be considered by the insurer but it’s not always guaranteed.

    Which health insurance is best for family?

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    The best health insurance for families in India should include a combination of essential features such as in-patient hospitalization, cashless a claims system, and pre-and post-hospital treatments. Benefits such as premium discounts, life cover, increase in sum insured, and flexibility to add new members and optional riders ensure your family’s health needs are well-covered.

    Disclaimer:

    The aforesaid article presents the view of an independent writer who is an expert on financial and insurance matters. PNB MetLife India Insurance Co. Ltd. doesn’t influence or support views of the writer of the article in any way. The article is informative in nature and PNB MetLife and/ or the writer of the article shall not be responsible for any direct/ indirect loss or liability or medical complications incurred by the reader for taking any decisions based on the contents and information given in article. Please consult your financial advisor/ insurance advisor/ health advisor before making any decision.

    PNB MetLife India Insurance Company Limited Registered office address: Unit No. 701, 702 & 703, 7th Floor, West Wing, Raheja Towers, 26/27 M G Road, Bangalore -560001, Karnataka
    IRDAI Registration number 117 | CIN U66010KA2001PLC028883

    Terms & condition apply, Benefits stipulated are subject to premiums paid and policies in-force. For more details on risk factors, please read the sales brochure and the terms and conditions of the policy, carefully before concluding the sale. Tax benefits are as per the Income Tax Act, 1961, & are subject to amendments made thereto from time to time. Please consult your tax consultant for more details. Goods and Services Tax (GST) shall be levied as per prevailing tax laws which are subject to change from time to time. The marks "PNB" and "MetLife" are registered trademarks of Punjab National Bank and Metropolitan Life Insurance Company, respectively. PNB MetLife India Insurance Company Limited is a licensed user of these marks. Call us Toll-free at 1-800-425-6969, Phone: 080-66006969, Website: www.pnbmetlife.com, Email: indiaservice@pnbmetlife.co.in or Write to us: 1st Floor, Techniplex -1, Techniplex Complex, Off Veer Savarkar Flyover, Goregaon (West), Mumbai – 400062, Maharashtra. Phone: +91-22-41790000, Fax: +91-22-41790203.

    Beware of Spurious Phone Calls and Fictitious / Fraudulent Offers!
    IRDAI is not involved in activities like selling insurance policies, announcing bonus or investments of premium. Public receiving such phone calls are requested to lodge a police complaint.

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