Family Floater Plans: An Overview of Inclusions and Exclusions

Inclusions in Family Floater Plans

The general inclusions in the family floater health plans by any insurance provider are governed as per the guidelines of IRDAI (Insurance Regulatory and Development Authority of India). The following are some of the common inclusions in the family floater plans:

In-Patient Expenses

Hospitalisation of more than 24 hours in case of an accident or illness, or any medical emergency, is considered in-patient expenses. This generally includes hospital boarding, room rent, nursing, doctor’s fee, diagnostic tests and procedures, intensive care unit charges, surgical procedure charges, etc.

It is important to note that some of these expenses, like room rent and ICU charges, may come with an upper cap, which will be mentioned in the policy document.

Pre- and Post-Hospitalisation Expenses

Generally, family floater plans provide cover for pre-hospitalisation expenses incurred for medical investigations and consultations before hospitalisation. Typically varies from 30 days to 60 days before admission to the hospital. Similarly, post-hospitalisation expenses are also covered for follow-up consultations and tests. This may vary from 60 days to 180 days depending on the insurer’s term.

Daycare Procedure Expenses

Any surgical procedure or medical treatment ( for example, cataract) carried out under anaesthesia requiring hospitalisation for less than 24 hours is covered under day care procedures.

Domiciliary Treatment Expenses

Any disease, illness or injury that requires hospitalisation, but was availed at home, as the patient is not under a condition to be moved to the hospital or due to non-availability of rooms. In this case, treatment expenses, along with pre- and post-treatment expenses, are covered under the policy.

Ambulance Cover

Expenses incurred for the transportation of the patient to the hospital for treatment under medical emergency are covered. However, there will be an amount limit mentioned in the policy.

Family floater plans also cover expenses incurred for emergency air ambulance services in case of a medical emergency.

Organ Donor Expenses

The policy covers the organ donors’ expenses related to surgical procedures in case of organ transplantation to the insured person. However, expenses incurred by the insured while donating the organ are not covered.

Daily Cash Benefits

Policies also pay daily cash benefits for a few days during the hospitalisation. However, the amount limits are mentioned in the policy documents.

Family floater plans also include coverage for COVID-19 treatments, AYUSH (Ayurveda, Yoga, Unani, Siddha and Homoeopathy) treatment expenses, maternity cover and newborn cover. However, the scope of coverage can vary from one policy to policy and from insurer to insurer. You can enhance the coverage by availing additional add-ons or riders that are needed to meet your insurance needs.

At Jio Insurance Broking, you can go through the features and scope of coverage offered by the family floater plans of various insurance companies, compare their quotes side by side and then make a rational choice.

Exclusions in Family Floater Plan

The following are some of the general exclusions under a family floater plan:

1. Breach of law or injury caused by to criminal act is not covered
2. Expenses related to treatment necessitated due to participation in adventurous sports or hazardous activities are not covered. For example, deep-sea diving, sky diving, scuba diving, horse riding, etc.
3. Pre-existing illnesses are excluded during the waiting period, which generally varies from 12 months to 48 months depending on the insurer’s terms. Specific treatments or illnesses are covered only after the waiting period of 12 to 24 months.
4. Self-inflicted injuries or intentional self-harm-related treatment expenses, alcohol and substance abuse are not covered.
5. Cosmetic procedures such as Botox, plastic surgery, etc., are not covered unless it is necessitated due to an accident.
6. Dental, vision correction and hearing aids are excluded unless the treatment is necessitated due to an accident.
7. Treatment for illnesses or injuries caused due to war and nuclear perils is not covered.
8. Infertility treatments like IVF, artificial insemination are not generally covered under the base health insurance plan.
9. Experimental treatments, unproven clinical trials are not covered.

Along with the exclusions, you also need to pay attention to various clauses, such as the waiting period clause, co-payment clause, etc., that will have an impact on your claim settlement.

Conclusion

To sum up, the right family floater health insurance plan is a valuable tool to protect your family financially during medical emergencies. To choose the right family floater plan, it is important to be aware of the scope of coverage, inclusions and exclusions under the policy. With a clear understanding and knowledge of the policy, you can make an informed choice that is suitable for your family’s specific health insurance needs.