Family health insurance comes as the much-needed support to rely on during unexpected emergencies. It covers several things, from hospitalisation and daycare treatment to ambulance and surgery charges. However, the seemingly limitless coverage is restricted to some extent. An insurance company can deny taking responsibility for specific ailments or conditions. These are called exclusions. They are typically the services that a plan does not cover, meaning you will have to pay for them yourself.
It is vital to identify and be aware of such terms to save yourself from unpleasant surprises, especially if you have your whole family tied up in the plan. This article will give an insight into family health insurance plans and their stipulations. So read ahead!
Table of Contents
What Is A Family Health Plan?
A family medical insurance plan covers the entire family in a single health policy, and everyone shares a fixed insured sum with the assumption that not everyone will fall sick simultaneously. Best family health insurance plans cover parents, spouses, and children, and each member is the beneficiary and has access to the insured sum.
What Are The Exclusions In A Family Health Plan?
Here are some notable and most common exclusions in family health insurance plans:
1. Dental, Hearing, And Vision
Family health plans do not protect dental and vision procedures that often do not need hospitalisation. However, insurance plans will cover these expenses if the condition is severe. You can avail of this benefit by buying an additional coverage rider for your family.
2. Pregnancy And Related Conditions
Most policies do not cover childbirth-related expenditures, such as delivery charges, infertility, or abortion. However, a few plans offer maternity expenses after a fixed waiting period. You can check the inclusions and exclusions to be sure about the terms.
3. Cosmetic Surgery
Cosmetic treatments and surgeries have become common nowadays as many people turn to them. Medical insurance plans do not provide coverage against plastic surgery or any treatment to enhance appearance. However, insurers include medically-recommended surgeries to treat an accident or injury in the policies.
4. Pre-Existing Conditions
You must inform the insurer about pre-existing conditions your family has while purchasing the plan. Companies generally cover the specified conditions only after a lock-in period or waiting period, ranging from 2 – 4 years from the purchase date.
5. Lifestyle-Related Illness
Lifestyle disease entails conditions like immune deficiency, smoking-related lung problems, diabetes, cirrhosis, etc. Insurers list such ailments under exclusions unless you buy a premium plan or purchase additional riders for them.
6. Injuries Due To Suicide Attempt
Insurance plans do not cover injury caused by a suicide attempt or self-harm. It means the company will not accept claims if the policyholder harms themselves deliberately.
What are the Limitations of a Family Health Plan?
While you can expect nothing but good with the best family health insurance plans, they accompany a fair share of limitations. For instance,
1. Age Limit
Family insurance plans are only available for children older than 91 days. Further, it stops the coverage for children once they reach the age of 18.
2. Waiting Period
Even the best family health insurance plans come with a fixed waiting period, and you may have to wait for the specified years to take advantage of certain conditions.
3. Single Large Claim
A family member may exhaust the entire insured sum if suffering from a terminal disease, leaving no room for claims in the future.
4. Renewability
Some health insurance companies provide a maximum renewability age. It can cause older parents or members to lose coverage once they reach the mentioned age.
Conclusion
It is essential to note that policies vary based on the parties, companies, and policyholders. In addition to the given limitations and exclusions, there are a few permanent exclusions too. Insurance companies do not shoulder the expenses for intentional injuries, HIV, congenital disease, or war-related injuries. Hence, you should thoroughly read the fine print before binding your family with any health plan. Further, you can inquire with your insurance provider to be on the same page and avoid trouble when making claims.
Niva Bupa Health Insurance offers some well-positioned best health insurance plans in India. You can avail of a plan packed with several riders to ensure your family does not suffer in any way.
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