How Family Floater Health Insurance Works: Coverage, Eligibility and Benefits
Sourav Banik
Author
What is Family Floater Health Insurance?
The family floater health insurance meaning is simple: it covers multiple family members under a single plan. This insurance plan covers various family members, and any family member can use it in health emergencies. If your health insurance comes with a family floater plan, it covers the health expenses of every household member. This is the reason the plan is called a floater, as it covers the entire house within one plan instead of covering only one individual.
Coverage Details of Family Floater Insurance
While insuring your entire family, you would need to understand the coverage details. Take a glimpse at the coverage details of a group family insurance plan.
Hospitalisation Expenses
The best family floater health insurance plans in India offer comprehensive coverage for every family member. This includes per day room rent, coverage for diagnosis expenses, doctor’s expenses, and nursing treatment.
Pre and Post-Hospitalisation Expenses
Family floater covers both pre-hospitalization and post-hospitalisation expenses. Depending on your insurance plan, you can get covered for 30 days before and after hospitalisation.
AYUSH Treatment
AYUSH treatment is included with a family insurance plan, where your family members can opt for coverage under all empanelled hospitals. Various therapies that include robotic surgeries, Ayurveda, Naturopathy, Unani, and Siddha are completely covered.
Daycare Treatment
Daycare treatments specified by the insurer that need less than a day can be covered with a family health insurance plan. Although it depends on the insurer to determine if a daycare facility is available, you need to connect with your insurance provider.
Co-pay Benefit
Co-pay benefit allows an insurer to not pay out of their own pockets, and makes the insurer entirely pay for the coverage. Co-pay benefit is completely dependent on the insurer’s terms and conditions, and may vary across different insurers.
Main Exclusions of Family Floater Plan
Family floater does not cover certain cases, which are:
- Treatment for sexually transmitted diseases
- OPD treatments
- Dental procedures
- Chronic health problems developed due to smoking and alcoholism
- Self-inflicted injuries
- Chronic kidney conditions
- Sinusitis condition
- Hernia or hydrocele surgeries
- Cosmetic surgeries
- Naturopathy treatments
- Artificial organ transplants
How does Family Floater Health Insurance Work?
Here are two real-life examples to explain how a family floater policy works.
Example 1
Mr. Sarvesh Pattanaik has been associated as a design engineer for the last 5 years with a Patna based aeronautics firm. Mr. Pattanaik has received a family floater health insurance worth ₹10 lakh.
Recently, Mr. Pattanaik’s wife was diagnosed with kidney failure that requires dialysis. Her kidney transplant procedure cost Mr. Pattnaik ₹2.5 lakh. Mr. Pattanaik’s father also underwent a stroke after 4 months and required a CABG surgery that cost him ₹5 lakh. The total medical expense of ₹7.5 lakh was compensated by the family floater health policy. Because the insurer covered the full healthcare expense, Mr. Pattanaik did not have to pay out of his own pocket.
Example 2
In March 2023, Nidhi bought the best family floater health insurance worth ₹5 lakh. Her monthly premium was at ₹6,000, which included a critical illness rider. Nidhi’s mother had to undergo a liver ailment treatment in June 2024, which cost her ₹1.2 lakh. The family floater plan covered both the pre and post-hospitalisation expenses.
In December 2024, Nidhi met with a fatal accident, which required her to undergo disc replacement surgery for her damaged spinal cord. This cost Nidhi ₹5 lakh. Since the original family floater policy consisted only of a ₹5 lakh coverage, Nidhi had to pay the remaining ₹1,20,000 from her own pocket.
Main Eligibility For Buying Family Floater Health Insurance
Before buying a family floater insurance, you need to know if you’re eligible to buy this policy.
Minimum 18 Years Age
The minimum age to buy a family floater health plan is 18 years of age. While 65 years is the maximum age for buying this policy. If you have children, they’re eligible to enroll in this plan as soon as they are 90 days of age.
Main Documents
Here is a list of all the required documents:
- Aadhaar Card
- PAN Card
- Electricity bills
- Latest medical prescription
- Health diagnosis reports
Eligible Members
All the members of the family are eligible for the policy. This includes your spouse, your children, your parents, as well as parents-in-law.
Also read to know if your insurer can reject porting of your health insurance.
Main Advantages of Family Floater Policy
The best family floater health insurance plans in India will provide multiple benefits to the policyholder, such as wider coverage, tax benefit, and more. Let’s glance at the top benefits of having a family floater cover.
Inclusive Coverage For Your Family
When you have a group health cover for a family, you can cover various members without paying a premium for individual members. This helps to save more, and take a financially economic decision when you have a large family.
Daycare Facilities
Many insurers also offer daycare treatments with a family floater plan. The insurance provides complete coverage for any family member who needs to stay hospitalised for less than 24 hours.
Room Rent Coverage
You can also get the benefit of per-day room rent coverage. Your insurer determines this coverage as per policy terms, and this may vary across several insurers.
Cashless Hospitalisation Benefit
One of the greatest benefits of hospitalisation is the cashless benefit. This offers instant hospitalisation in case of any health emergency of your family member, without worrying about cash payment.
Also read what is corporate buffer in health insurance.
Ways To Choose The Right Family Floater Policy
Buying the best family floater health insurance can be a bit challenging without the right guidance. Here are some of the best tips to choose the right policy for your family:
Check Reinstatement Benefit
Reinstatement benefit refers to the renewal of the insurance coverage amount in case you run out of your insurance amount. For example, if your health insurance is worth ₹5 lakh and your medical treatments have fully exhausted that ₹5 lakh, then some insurers may allow you to refill your insurance coverage. (source)
Always Check Sub Limits
Sub limits matter greatly in the case of family floater insurance, as you may have to pay out of pocket if your medical expenses exceed the sub limit. The best recommendation is to ask your insurer about sub-limits before choosing a policy.
Check For Renewability Age Limit
Before choosing the best family floater health insurance plans in India, always look out for the upper entry age limit. Check with your insurer to know if there is any upper cap or lifetime renewability.
Check For Add-on Benefits
Add-ons are a must-check before subscribing to a family floater insurance plan. Many insurers offer add-on options for a family floater plan, such as a critical illness rider and coverage for specific surgeries.
Also read to know if you should have a super top up or a critical illness rider plan.
Who Should Use Family Floater Health Insurance?
A family floater health insurance meaning group coverage for everyone within the family. Hence, there is no direct answer to which individuals should buy a family floater plan. The main reason for this is that various people have different family structures and varied disease histories. For example, a family of 2 members may not require a family floater, while a family of 4-5 people will find it economic to have a family floater plan. Considering buying a family floater if you are:
- Sole earning member of the family
- Have a large family of more than 3 people
- Your spouse/parents are financially dependent on you
- An individual health plan is not economical for your family
- Your family has a history of diseases that need frequent hospitalisation
Differences Between Family Floater and Group Health Policy
Here are the main differences:
| Coverage details | Family Floater Health Insurance | Individual Health Insurance |
|---|---|---|
| Coverage | Every family members receives the coverage amount and are insured | Only the policyholder is insured |
| Premium | The premium is higher compared to individual plan as under one plan the entire family is insured | The premium is lower as it covers only the policyholder |
| Benefits | Offers group health coverage for all the family members | Health coverage limited to only the policyholder |
| No. of members covered | 4-5 members of the family are covered | Only the policyholder is covered |
Conclusion
It can’t be concluded that a family floater health insurance is always more beneficial than an individual plan, as a family floater does not cover certain diseases that individual coverage may do. Moreover, the premium of family floaters is usually higher than individual plans, which is another demerit. However, if you have a larger family and older parents who are financially dependent on your income, you can consider a family plan.
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Frequently Asked Questions
Explore moreWhat is the age limit of children for family floater health insurance?
The minimum age limit is 18 years old to buy a family floater insurance. Children who are a part of the insured family need to be at least 90 days of age.
How many adults can be covered under family floater insurance?
This depends on the insurer, as some insurers allow 4-5 family members while some allow till 8 members to get covered.
Does family floater cover pre-existing diseases?
Coverage of pre-existing diseases varies from insurer to insurer as per their specific terms of coverage. Many insurance companies offer policies which cover pre-existing diseases (PEDs).
Which people are not covered under the family floater policy?
Family floater policy doesn’t cover Individuals who don’t have valid identity proof or age certificates. To get covered under a family floater, you need to have an Aadhar Card, and valid health certificates.
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