Family Floater Health Insurance: Benefits, Coverage and Plans

  • postauthorOnsurity Editorial
  • postdateJanuary 24, 2025
  • postreadtime11 min read
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Family Floater Health Insurance

Having access to quality healthcare is a priority to many but the number of people who actually get to avail healthcare services in India is alarmingly low. On the other hand, the burden of diseases in India is increasing rapidly, causing a serious financial crisis in India’s low and middle-class income households. Additionally, the costs of medical care are also increasing by 14% annually.

Another concerning trend that has been observed recently is that India has a huge health protection gap, with more than 40 crore people not having health insurance coverage. India’s middle-income households which make up 70-80% of the population, display a 90% protection gap, which means that either they are not covered under any health insurance plan or are critically underinsured.

To mitigate the rising costs of healthcare and potential risks of diseases, individuals need to start relying on medical insurance policies. Not only do they help you cover unforeseen medical expenses but they also enable accessibility to quality medical care. Protect yourself and your loved ones against unpredictability with a health insurance cover that is made specially for families.

Let’s explore what a family floater health insurance is, how is it different from individual health insurance, what are the key features of a family floater plan, and whether or not you should buy it.

What Is a Family Floater Health Insurance?

Tailored to fit the needs of multiple members, family floater health insurance is a type of insurance policy that provides coverage to more than one person under a single plan. This policy “floats” the sum insured among all the covered members. So, instead of getting a single policy for each family member, you can get just one uniform coverage. It reduces the hassle of purchasing and managing multiple policies and is a cost-effective measure to get health insurance.

Additionally, this type of policy is most beneficial for young families with dependent children or for families where members do not have pre-existing conditions requiring individual coverage.

Mentioned below are some other notable benefits of a family floater health insurance policy:

  • A family floater plan is cost-effective compared to the individual health insurance policy as it covers multiple members under a single plan and offers the convenience of use
  • In addition to the hospitalisation benefits, the floater plan also offers comprehensive coverage, covering a wide range of expenses, like – maternity, ambulance charges, newborn care, pre and post-hospitalisation, and daycare treatments
  • Most family floater plans offer cashless treatment at network hospitals during emergencies
  • Another great assurance that a family floater plan brings is the lifelong renewability and ease of policy continuance through the years as your family ages

The COVID-19 pandemic was a critical time for families with multiple members falling sick and needing emergency medical care. The family floater plan is built for such unforeseen times, where every family member can have adequate coverage if needed.

So, if you are the primary caregiver of your family and wish to have a sense of security during medical emergencies then a family floater plan is for you. And while you are considering your options, let’s also take a look at some of the key features of a family floater plan that you ought to consider before buying a policy.

Also read: Top 10 Health Insurance Plans for Family

How Does a Family Floater Health Insurance Policy Work?

A family floater insurance is a singular financial safety net that can protect all your family members during medical emergencies. The sum you choose to insure your family against will be the total amount that you and your family can utilise for treatments during the policy period.

Let’s explain it using a real-life scenario…

  • Raman’s Family Floater Plan
  • Sum Insured: Rs. 10 Lakhs
  • Coverage: Wife and Children

Raman’s policy had a sum insured of Rs. 10 lakhs that could be utilised by him, his wife, and his children. Incidentally, both Raman and his wife had medical emergencies at different point of times during the policy period.

  • Raman was sick and needed to undergo immediate surgery. He availed cashless treatment with a total hospitalisation bill of Rs. 3.5 lakhs. Post his surgery, the family policy had an unutilised sum of Rs. 6.5 lakhs still.
  • Soon after Raman’s surgery, his wife suffered dengue and was kept under observation in the hospital for 3 days. The cost of her treatment was Rs. 1.5 lakh with Rs. 5 lakhs still left unutilised in their family floater policy.

Multiple members of Raman’s family were able to utilise the health insurance coverage under the specified policy period. This demonstrates how flexible is the family floater plan in tending to various healthcare needs of a family. Additionally, the sum insured was more than sufficient to take care of Raman’s family’s medical needs.

Now, you may be wondering how much would the premium be for a policy with a sum insured of Rs. 10 lakhs. Sum insured is just one of the many parameters that are taken into account while establishing the premium cost of a family floater health insurance policy. Let’s understand how the premium is calculated and how you can build your plan for optimal use and affordable premium.

Suggested read: How Is Group Health Insurance Premium Calculated?

How the Premium Is Calculated for Family Floater Health Insurance?

Various factors such as the age of the family members, the number of members to be covered, the sum insured, pre-existing conditions, and previous claims history are taken into account while determining the cost of the premium.

Although the age of the eldest member is the most significant factor because it can increase the risk for the insurer, and can also increase the premium. Apart from this, the geographical and residential factors can also have an impact on the premium.

Who Should Get Family Floater Health Insurance?

  • Younger families where the family members are healthy and less prone to health conditions should consider getting on a family floater plan as opposed to the individual health insurance policy. They will have the cost advantage with family floater plan.
  • If you have a senior family member who is a dependent then getting a family floater plan can turn out to be slightly more expensive. However, you can opt for basic coverage and claim higher tax deductions on the premium.

Key Features of a Family Floater Health Insurance Plan

1. Coverage

Comprehensive coverage is provided under most family floater plans but here are some of the more common plan inclusions that can be judicially utilised by all family members:

  • Hospitalisation expenses, including – ambulance charges, room rent, ICU charges, consultation fees, surgeries, and daycare treatments
  • In most plans, 30-60 days of pre-hospitalisation expenses and 60-90 days of post-hospitalisation expenses are also included
  • Alternative treatments like Ayurveda, Yoga, Unani, Siddha, and Homeopathy are also included

2. Cashless Hospitalisation

An essential feature of any health insurance policy is the availability of network hospitals offering cashless treatment. Cashless hospitalisation enables you to avail emergency care without having to pay upfront, as the insurer directly settles the bills with the hospital.

While comparing policies, it is strongly advisable to verify the list of network hospitals associated with the insurer, as you would not want to hassle about arranging cash during medical emergencies.

3. Co-Payment and Sub-Limit

Another important factor to consider while buying a family floater health insurance is the co-payment clause. Most insurers make it a mandatory addition to policy terms for senior citizens and high-risk individuals. Co-payment or co-pay refers to the percentage of the claim amount the policyholder has to pay out of pocket at the time of treatment.

Typically, for the policyholder, the co-payment limit is set between 10-50% of the claim amount and the rest is paid by the insurer. People opt for co-pay to reduce the premium cost without having to reduce the coverage or the sum insured.

Sub-limit is a policy feature that controls the upper limit on specific expenses or services covered under the policy. A very common application of sub-limit is seen in the room rent. Many insurers cap the room rent limit on a per-day basis.

For example, if the daily room rent limit is capped at Rs. 5,000 and your room cost is Rs. 7,500 then you’ll have to pay the difference amount out of pocket. It is therefore recommended to opt for a policy that does not have a sub-limit or has a generous sub-limit clause.

4. Maternity and Newborn Coverage

Maternity and newborn coverage is a common inclusion of a family floater plan but it is not mandatory. Maternity coverage caters to the expenses related to childbirth (both normal and cesarean delivery). It includes protection for – natal care, labour room charges, and delivery-related complications (if required).

Most plans have 2 – 4 years of waiting period on utilising maternity benefits. Some plans also extend coverage benefits to newborns till 90 days. Where expenses related to newborn complications, vaccinations, etc are covered.

5. Critical Illness Rider

A basic health insurance plan covers expenses for medical emergencies, not necessarily taking into account long-term and terminal illnesses like cancer, heart attack, kidney failure, etc.

Most of these illnesses require a long period of recovery and medical care which can potentially add a burden on out of pocket expenses. Therefore, a separate critical illness cover should be included in your family floater policy.

Now most insurance providers either have this as a complimentary addition to the policy or give critical illness cover as an add-on benefit, which means the policyholder can pay an additional sum to have this feature incorporated into their insurance policy. So, you should always review the inclusions and exclusions of critical illnesses in the policy.

6. Waiting Period

The standard waiting period for any health insurance policy is at least 30 days. This means that the policyholder will have to wait for 30 days from the period of purchase to avail of the policy benefits. However, different insurers have different guidelines on waiting periods for pre-existing conditions.

While opting for a family floater policy, you must take into account your family’s health history and accordingly get a policy with the shortest waiting period for any specific health conditions that you or your family might have.

Also read: Top 5 Group Medical Insurance for Family

What’s Covered in Family Floater Policy?

  • Hospitalisation expenses, AYUSH treatment, and daycare treatment
  • Emergency ambulance charges
  • Cashless hospitalisation
  • Maternity and newborn care (provided either as a complimentary benefit or as an add-on)
  • Preventive health check-ups (can be annually or at a pre-specified interval)
  • No claim bonus upon non-usage of policy during the policy period
  • Domiciliary treatment
  • Restoration benefits

What’s Not Covered in Family Floater Policy?

  • Pre-existing conditions during the waiting period
  • Cosmetic, elective, and aesthetic treatments
  • Dental and vision care
  • Self-inflicted harm and substance abuse
  • Unregulated or experimental treatments
  • OPD expenses like telemedicine (unless covered by the insurer)
  • Injuries from war or nuclear activity

Key Differences Between Family Floater and Individual Health Insurance

When choosing between getting a family floater plan and an individual plan for each member, it is important to consider the specific needs of your family and compare health insurance plans to find the one that is affordable and suits you best.

Here are some key differences to help make your decision easier.

Features Family Floater Health Insurance Individual Health Insurance
Coverage Shared among family members Separate coverage for each insured individual
Premium Calculation Based on the oldest member’s age and health profile Based on each insured person’s risk profile
Coverage for Dependents Spouse, children, and sometimes parents Only covers the insured individual
Price One premium payment for a policy covering all members is highly cost-effective Getting individual policies for each member can significantly increase the premium costs

Top 5 Family Floater Health Insurance Plans for 2025

We have listed down the 5 best family floater health insurance plans that you can pick from in 2025. These plans made it to our list as they have the shortest waiting period and the highest claim settlement ratio. These two parameters are extremely crucial when identifying a reliable and efficient insurance provider.

Insurance Provider Sum Insured Waiting Period Claim Settlement Ratio
Bajaj Allianz Health Guard Plan 1.5 lakh – 1 crore

Maternity – 6 years

PED – 3 years

93.54%
Digit Health Insurance Plan 2 lakh – 3 crore

Maternity – 9 months

PED – 3 years

84.6%
Niva Bupa Heartbeat Insurance Plan 5 lakh – 1 crore

Maternity – 2 years

PED – 3 years

85.18%
TATA AIG Medicare Premier Plan 5 lakh – 3 crore

Maternity – 4 years

PED – 2 years

86.5%
Care Health Insurance Plan 1 lakh – 6 crore

Maternity – 2 years

PED – 3 years

87.1%

 

We strongly recommend that you carry out a detailed comparison of these providers on their respective websites and carefully review their policy terms to make an informed decision. Having access to quality healthcare shouldn’t be difficult. And a family floater plan is a great way to ensure you and your loved ones remain protected through the uncertainties of life.

About Onsurity

Onsurity is a health and wellness benefits provider for small and medium enterprises. Just like how family members are to a household, employees are the same to a thriving business. And they too need protection from unforeseen medical emergencies. This is why Onsurity provides monthly healthcare subscriptions to business teams, with memberships starting at just Rs. 145 per month.

If you found this article helpful then do read our blogs about health insurance and wellness, to learn about how to make the most of your health insurance policy.

FAQs

1. Who can be included in a family floater policy?
The following family members can be included in a family floater health insurance policy – spouse, children, and parents
2. What are the benefits of choosing a family floater plan over individual plans?
A family floater policy is a practical and economical option for families seeking comprehensive health coverage. Getting individual policies for each member can be more expensive and difficult to manage.
3. What happens if one family member uses the entire sum insured?
The sum insured for a family floater plan is applicable for all members but in case the limit is reached during the policy period by one member then the other member can not use the coverage unless the policyholder renews the policy or gets a top-up.
4. How is the sum insured allocated among family members?
The sum insured is uniform for all family members and can be used flexibly during the policy period. For example – if a family gets floater health insurance with a sum insured of Rs. 15 lakhs, then this Rs. 15 lakh can be used as needed for the medical expenses of the members.
5. Can I add new members to my family floater policy?
Adding or removing members in a family floater plan is possible but is subject to the terms and conditions of the insurer
6. Can I convert a family floater policy to individual policies later?
Yes, depending on the insurer’s terms and conditions, a family floater policy can be converted into individual health insurance policies for the members covered under it.
7. Does family floater insurance cover maternity expenses?
The inclusion of maternity and newborn care is subject to the policy terms of the insurer. Although most family floater policies have a provision for maternity benefits or can be added as a rider.
8. Are pre-existing diseases covered in family floater plans?
Yes, however, the waiting period can be levied to specific conditions. Check with your insurance provider for the standard waiting period and the waiting period for pre-existing conditions relevant to your family’s health profiles.
9. What are the tax benefits of family floater health insurance?
Up to Rs. 50,000 can be claimed for deductions under section 80D of Income Tax

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