From Individual to Family Floater: Types of Health Insurance Explained

At a Glance

1. Introduction
    
2. Popular Types of Health Insurance in India 

2.a. Individual Health Insurance Plans

2.b. Family Floater Health Insurance Plans

2.c. Plans Covering Pre-existing Conditions

2.d. Multi-Individual Health Insurance Plans

3. Other Types of Health Insurance Plans in India

3.a. Senior Citizen Health Insurance

3.b. Critical Illness Insurance

3.c. Group Health Insurance

3.d. Top-Up Health Insurance

3.e. Maternity Health Insurance

3.f. Personal Accident Insurance

3.g. Disease-Specific Insurance

4. Considerations for Businesses
    
5. Conclusion

Introduction

Browsing through health insurance and choosing the right one can be tricky, considering all the available options today. It is essential for individuals, families, and businesses wanting to provide the best coverage for their employees to understand the different types of health insurance. This guide captures all the health insurance plans in India with a specific focus on individual and family floater policies, conditions regarding pre-existing illness, and the meaning of multi-individual plans.

Popular Types of Health Insurance in India 

Individual Health Insurance Plans

An individual health insurance policy covers only one individual. However, these provide financial coverage for medical expenses, including hospitalization, surgeries, and sometimes, outpatient treatments. The premium for these policies, which covers a single individual, is calculated based on one's age, medical history, and sum insured. For organizations, offering individual health insurance is a good facility for employees who want customized coverage for their individual health needs.

Family Floater Health Insurance Plans

Family floater health insurance plans provide complete coverage of the entire family under a single sum assured. In general, these plans make provision for the policyholder, the spouse, and dependent children, while some policies also cover the parents as well. As all members share the sum insured, any one member can make use of it up to the maximum limit available to him/ her. It is a form of health insurance that most families find very economical since it does not require a separate plan for each member of the family. For employers, offering them family floater plans will create employee satisfaction since the member will consider health security for his/her family.

Plans Covering Pre-existing Conditions

Existing conditions are defined as health issues or diseases that have been diagnosed before the person's health insurance coverage commences. In India, the waiting periods relate to these conditions, which are usually from two to four years, though in some cases, there are insurers with shorter waiting-period plans or those that cover certain pre-existing conditions immediately, albeit at a higher premium. Therefore, this factor becomes important when determining the health coverage for individuals with medically known histories.

Multi-Individual Health Insurance Plans

A multi-individual health insurance plan allows multiple individuals to be covered under a single policy but with separate sum insured amounts for each member. In contrast to family floater plans, where the sum insured is shared, in multi-individual plans, each member has a dedicated coverage limit. Thus, in cases when certain members may have higher health risks or specific medical needs, this type of structure proves invaluable. Concerning businesses, such plans offer equitable benefits to all employees, averting a situation where one member's huge medical expenses could deplete the coverage available to everyone else.

Other Types of Health Insurance Plans in India

Apart from individual and family floater plans, there are several other 7 Types of health insurance plans in India based on different needs. These include:

Senior Citizen Health Insurance

Senior Citizen Health Insurance is particularly customized for people aged sixty years and above to make them feel financially secure in situations of medical emergencies. The plan generally covers hospitalization costs, pre-existing diseases with a relatively shorter waiting period, and domiciliary hospitalization in case the member needs to be treated at home. Annual health check-ups, ambulance services, and alternative treatment procedures like Ayurveda or Homeopathy are also provided in some policies. Since medical treatment progresses at a faster rate for elderly citizens, it ensures they can manage their medical costs without worrying about financial pressure. By freeing them from anxiety regarding medical treatments in their golden years, this insurance ensures to provide them with peace of mind.

Critical Illness Insurance

Critical Illness Insurance is meant for lump sum amount payouts for critical diseases like cancer, heart attacks, kidney failure, and strokes. Unlike the normal health insurance plans that reimburse their holders for hospital bills, the cash provided under this policy may be used for the person's hospital treatment as well as rehabilitation, lifestyle adaptations, or normal expenses. They also cover multiple illnesses and allow customers to select the sums insured to meet their financial needs. Critical illness insurance offers relatively larger financial cover against the treatment cost due to some of these diseases; hence, the insurance policy helps people cope with expenses that may be unexpected without affecting their savings or pressuring their family members.

Group Health Insurance

Group Health Insurance is a type of insurance policy that covers all employees of an organization and is obtained by the employer to pay medical bills. Group health insurance provides extensive benefits, including hospitalization and maternity benefits, wellness programs, and, in some cases, coverage for dependents. A major attraction of such health insurance is its low premium in comparison with individual health insurance and a shorter waiting period for pre-existing disease coverage. Preventive health check-ups and mental wellness support are also options covered under some policies. Group Health Insurance boosts employee satisfaction and retention because very often health benefits offered at the workplace motivate the employee to think about his well-being and productivity. This insurance is an essential ingredient of employee benefits packages for corporate houses. 

Top-Up Health Insurance

However, this does not mean that the best topping health insurance scheme provides direct reimbursement of medical expenses incurred by the policyholder. It provides additional benefits where the cost of treatment gets increased after some level of benefits under an existing plan. If it covers the base coverage of the above policy at ₹5 lakhs, and if he takes an additional top-up policy of ₹10 lakhs with a deductible of ₹5 lakhs, the top-up plan will activate only after the ₹5-lakh base sum is exhausted. However, these plans are very cost-effective because they provide very high coverage at lower premiums as compared to increasing the sum insured of a regular policy.

Maternity Health Insurance

Maternity health insurance or maternity health cover refers to a type of policy that will cover medical expenses due to pregnancy. This policy pays the bills incurred during delivery, hospital stay, doctor consultation, and other services for newborn care. It may include treatments for fertility and complications arising from pregnancy. Generally, maternity expenses are quite high, while ordinary health insurance does not cover pregnancies, but with this insurance, all expenses can be managed without the hassle of financial strains. Most of the maternity policies will cover waiting periods from 2 to 4 years; hence the couple planning for children should ensure their planning for insurance even before they start thinking about starting a family.

Personal Accident Insurance

Personal Accident Insurance pays for accidental injury, disability, or death. In the event of an accident resulting in permanent disability or loss of income, the insurance grants a lump sum to cover medical expenses and loss of earnings. It covers accidental death, partial disability, total disability, hospitalization, and ambulance expenses. Should a person fall ill, health insurance offers only coverage for medical expenses, but this insurance could support further rehabilitation and daily expenditure along with medical claims. This policy is especially given to people working in high-risk jobs or people who travel a lot.

Disease-Specific Insurance

The Disease-Specific Insurance plans are different from medical insurance in that they cover specified illnesses like cancer, diabetes, heart disease, or even dengue. These policies will financially assist you in diagnosis, treatment, medication, and follow-up consultation for these illnesses. Some plans even cover preventive services for chronic conditions like health check-ups and lifestyle coaching. Most treatments for cancer, diabetes, etc. are expensive and ongoing, thus the plans liberate the policyholders from fear of having to pay for the required medical care from hard-earned savings. This insurance is best suited for persons at a higher risk because of family history or lifestyle.

Also Read: What is OPD Cover Health Insurance and Why Do You Need It?

Considerations for Businesses

It is highly significant for businesses willing to offer total health benefits for their workers to comprehend the health insurance plan details. The following are some considerations:

• Employee Demographics: Learn about the employee's age structure, family status, and health records so that an individual can appropriately design suitable plans.
   
• Budget Constraints: Find an appropriate balance between the cost of coverage and premium so as not to compromise on the planned health benefit program.
   
• Customization: Selecting insurers that enable customization of plans makes it easier for certain needs of the workforce to be fulfilled in the form of coverage.
   
• Network Hospitals: Look for an extensive network of hospitals where the company staff are positioned to utilize cashless treatment.

Conclusion

Choosing the right type of health insurance is an important decision that has the financial fortune and health security of the individual and family. Thereby, such health insurance plans will affect the employee satisfaction rate as well as the benefits they bring to the organization's employee population. Knowing the types of health insurance available in India from individual health insurance plans to family floater and multi-individual health plans allows individuals to make selections aligned with their requirements and circumstances.

At OneAssure, we provide 100% unbiased recommendations based on your individual requirements. Our professional experts advise on navigating your health insurance complexities and choosing the plan that suits you best. OneAssure would be the most suitable choice for an individual looking for personal health coverage or a business looking for comprehensive health benefits for all employees.  

Know our assortment of health insurance solutions and avail of expert advice to secure the best insurance for you and your employees.