How to File a Claim Under Family Floater Insurance?
Our quick and efficient claim management team helps us serve our customers with the best claim settlement experience!
In the event of emergency hospitalisation, you must inform your insurer via call or mail within 24 hours of hospitalisation. Whereas, in the event of planned hospitalisation, you must inform your insurer at least 48 hours before getting hospitalised. Hereafter, you can file either for a cashless or reimbursement claim.
| Cashless Claim Process |
Reimbursement Claim Process |
| Step 1: Find a network hospital near you. |
Step 1: Find a hospital near you and get the treatment at the earliest. |
| Step 2: At the TPA desk of the hospital, fill out the pre-authorisation request form. |
Step 2: Upon discharge, you must pay the bill and collect the original receipts. |
Step 3: Upon receiving the request from the network hospital, we will start the approval process and keep you informed on your claim status.
Alternatively you can track your claim status on Care’s Mobile App. |
Step 3: Login to www.careinsurance.com and fill in claim form and submit documents including bills, reports, etc. |
| Step 4: All the further documentation and coordination shall be done with the hospital TPA desk. |
Step 4: We will reach out to you in case we need any further documents/ information. |
| Step 5: We settle the bill directly with the hospital upon discharge. |
Step 5: We will release the approved claim amount to your bank account after completing the query.In case of claim rejection, we will inform you of the reason. |
Documents Needed to File a Health Insurance Claim
In order to raise a claim for a family health insurance plan, you need to present a few documents as well. To avoid any back and forth while filing a claim, keep these documents handy at the time of filing a claim.
The documents required for a reimbursement claim include:
- Duly filled claim form
- The original discharge summary from the hospital
- The original medicine bills, lab and diagnostic reports
- The original hospital bill payment receipt
In case of an accidental hospitalisation, you need to submit the following documents as well:
- MLC/ FIR copy (if applicable)
- Alcohol history (if applicable)
- Investigation reports (like X-Ray/MRI/CT Scan etc.)
- Attested copy of indoor case papers
- Invoice and the stickers required in case of implant surgery
- In case the claim amount ranges above ₹1 lakh, you must provide a copy of any one of the following KYC documents:
- Aadhaar Card, Passport, Driving Licence, and/or Voter ID
The address on the KYC documents must match the Policy address.
In case of a cashless claim, you need to present a few documents at the hospital desk, like:
- A copy of the patient's medical ID card
- A copy of the e-health card ( available at Care Health Customer Application)
- Pre-authorisation letter
- A valid government ID proof such as Aadhaar card.
Please note that your policy address must be same as the current residential address to avoid claim rejections.
Tips to Choose the Perfect Family Medical Insurance Policy
While choosing a family health insurance plan, you must look out for the following factors.
- Age Eligibility: Many health policies have age restrictions. We provide coverage at three months of age with lifetime renewals on a floater basis.
- Maximum Coverage: We cover expenses related to pre and post-hospitalisation as well. This includes tests, treatments, medication, and check-ups every year.
- Affordable Premiums: Our premium calculator helps you figure out your cost for the features you need in advance.
- Exclusions: Certain conditions can exclude claims. Look for a mediclaim policy for family that offers maximum coverage with the least exclusions.
- Co-Payments: Co-pay in health insurance is when the policyholder needs to pay a certain part of the claim amount as per policy terms. The insurer bears the rest of the claim expense. Check the co-payment percentage before signing up for family medical insurance plans.
- List Network of Hospitals: Easy access to our large group of in-network hospitals that provide cashless treatment in the least amount of time. Check the in-network hospital list to find the best hospitals in your area.
Factors Affecting Health Insurance Premium
You may have noticed that the premium charged for health insurance differs from one customer to another. This is because the premium for family health insurance is calculated based on various factors. These include:
Age of the Oldest Member
Age plays a crucial role in deciding the premium of a health insurance plan. In the case of family health insurance, the age of the oldest family member is taken into consideration. The older the member, the higher the premium will be. This is because as you grow old, the risk-appetite increases.
Pre-existing Diseases
The insurance premium is likely to go high in case any of the family members suffer from pre-existing diseases like diabetes, thyroid, hypertension, etc., Keep in mind that the waiting period for raising a claim against a pre-existing disease is typically 2 to 4 years.
Lifestyle Habits
The lifestyle habits of the family members are also determining factors. The premium charged is often high for a prolonged habit of smoking in the family. Again, the nature of occupation is also crucial since some professions with high health risk are likely to attract higher premiums.
Location
The location of your residence also plays a crucial role in determining the premium of a family health insurance plan. Locations with high calamity risks draw higher premiums, considering the chances of claiming the policy.
Type of Plan Chosen
The premium varies depending on the type of plan you choose. Although the premium goes up with more coverage and a higher sum insured, you get peace of mind that your finances will be protected even if multiple claims are registered in a policy year.
Add-ons
If you choose to increase the coverage of your plan, you may purchase various add-ons available. However, with each add-on, the premium also increases. So, pick only those add-ons that enhances the value for your coverage.
Co-pay/deductibles
Co-pay or deductibles are part of the claim that the policyholder has to pay. It may be in terms of a fixed amount or a percentage of the claim. If you choose a higher deductible/co-pay, you are charged a lower premium and vice-versa.
Duration of the Policy
The tenure of the family health cover plays a major role in determining the premium of the policy. If you opt for a longer policy duration, you will be charged a lower premium amount. Alternatively, shorter family health insurance plans have a higher premium amount.
Common Mistakes While Opting for Health Insurance
Are you opting the right health insurance for your family? This is one question that might pop up in your mind when you are planning a family mediclaim policy. Let's see what are the common mistakes that customers often make and how you can avoid them:
Low-sum Insured
When buying family health insurance, people often try to limit themselves to a low-sum insured in order to pay a low premium. This may help you with a lower premium now, but maybe in the long run, you will have to pay from your pocket in case of multiple health emergencies. The best mediclaim policy for a family is the one where you have sufficient coverage for all the family members.
The Right Approach
You need to assess the medical needs of your family and try to choose a plan with comprehensive coverage. A higher sum insured may charge you a slightly higher premium, but owing to the rising medical costs, it will definitely be worth it.
Limiting to Basic Coverage
The basic coverage of a family health insurance plan includes a range of benefits. A higher coverage means greater insurance benefits. However, sometimes it may be the reason for hike in premium, which is why people tend to limit the basic coverage, ignoring its long-term effect.
The Right Approach
The possibility of coverage amount being insufficient is considerably less if it is decided after analysing the family’s insurance needs only. Another way to increase the coverage amount is opting for add-on covers such as sum insured restoration, OPD cover etc. However, always be calculative while buying an add-on cover as it again draws an additional premium.
Communicating Wrong Information
In order to avail of insurance benefits, sometimes insurance seekers tend to furnish wrong information related to medical history. Little do they know that insurance companies do their verification for a proper background check. Thus, any miscommunication can lead to policy termination only.
The Right Approach
Maintaining transparency while dealing with your insurer is highly appreciated as hiding medical history or presenting wrong information can lead to health insurance policy cancellation.
You should be 100% truthful and honest with whatever information you are providing to your insurer. For instance, the smoking habit of any of the family members must be declared in the application. During the process, several tests are done at the insurers’ end to ensure genuine documentation.
Ignoring the Policy Fine-print
Reading the entire policy document may sound tedious, and many people tend to skip reading the policy documents while buying health insurance. Ideally, you shouldn’t skip it as it can affect your policy experience and may hinder you from availing the best of benefits.
The Right Approach
When you are done deciding on a health insurance policy for family, make sure you read the fine print before signing and making the payment. It gives you a complete idea of the plan you are purchasing. You may ask our executive for any doubts and clauses that you may not be able to understand. This way, you can make the most of a family health insurance policy.
Waiting for the Right Age
Certain diseases and health conditions develop with age. However, unforeseen medical emergencies can strike anyone. Hence, it is a mistake if you are waiting for the right time to secure your family, is a mistake.
The Right Approach
When planning to buy a health insurance plan for family, you need not wait for your youngest member to become old enough. The youngest member of as less as 91 days can join the family health insurance plan. Also, the premium increases with age. Make sure all your family members have access to the best medical facilities with a family health insurance policy.
Taxability on Health Insurance
A health insurance policy for family has dual benefits. On one hand, you get medical and financial coverage for all your family members under one plan, and on the other hand, you can enjoy tax benefits for premiums paid towards the health insurance plan. So, this way, you can enjoy dual benefits.
Under Section 80D of the Income Tax Act, 1961, the policyholder of a family health insurance can avail of tax benefits. Policyholders below the age of 60 can get tax deductions of up to ₹25,000 for premiums paid towards family health insurance plan. Those above 60 years of age can avail higher tax deductions. The following table will help you understand how can one make the most of the tax benefits:
| Category |
Amount of premium paid |
Deductions available under Section 80D |
| Self, family, and children |
Parents |
| Individuals and their parents who are below 60 |
₹25,000 |
₹25,000 |
₹50,000 |
| Individuals and their family who are below 60, but parents are above 60 |
₹25,000 |
₹50,000 |
₹75,000 |
Reasons to Buy a Family Floater Health Insurance Online
Below are the main benefits of buying a family health insurance policy online in India:
Secure Payment Modes
Secure payment options keep your bank data safe and help you complete the transaction in a few clicks from anywhere, any time.
Chat Option & Easy Policy Evaluation
We try to resolve all your queries instantly through our chat service. Also, policy evaluation is easy with our precisely spelt-out policy terms.
Instant Premium Quote Calculation
Make a calculated buying decision by estimating the premium of your policy online. It will help you plan finances and choose affordable coverage.
Convenient Policy Selection
The website lets you compare coverage, choose and pay anywhere at any time. Also, you can access policy documents online for quick verification.
Readily Available Value-Added Services
It's easy to add benefits such as OPD care, co-payment waivers, and pre-existing diseases while purchasing our health policy for your family online.
No Claim Bonus in Family Health Insurance
A no-claim bonus is a reward given to all those healthy members of Care Health Insurance who haven't raised any claims in a policy year. It is a way of appreciating the healthy lives of insured members for remaining healthy. In the case of family health insurance, if none of your insured family members raises any claim in a policy year, the no-claim bonus is accumulated.
The first year of the no-claim bonus gives you a 10% rise in the sum insured and a 20% rise in the next subsequent no-claim year. The maximum limit for no claim bonus accumulation is 50% of the original sum insured. In times of rising medical costs, it is a huge relief to see your sum insured getting increased by adding up the no-claim bonus.
Please note that at Care Health Insurance, we offer the benefit of No Claim Bonus on Care Advantage Health Insurance plan. Whereas, under Care Supreme, we offer Cumulative Bonus and Cumulative Bonus Super which work regardless of the claims made.
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