Family Health Insurance Policies in India – Inclusions and Exclusions


5 min read

Learn all about health insurance plans for families in India, what they cover and what is excluded under the policy.

Health insurance is one vital document that every person must possess. And not just for themselves but also for their entire family. This is because good health is valuable to everyone and it is essential that your complete family stays fit and healthy for a long time to come. Keeping in view its indispensable nature today, insurance companies issue health insurance plans for families to provide coverage and protection to the entire family.

These plans offer a number of advantages over single health insurance policies and are becoming widely popular among the population. Here we discuss family health insurance policies, highlighting what is covered and what not under these plans to help you make an informed decision before buying.

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What is Mediclaim Policy for Family?

As stated earlier, it is of vital concern to one that his/her family remains healthy at all times. This is why more and more people are opting for family medical insurance to help cover any emergency medical care costs of any family member in the future.

Health insurance plans for family are designed to provide cost coverage to your entire family under a specific predetermined sum insured. The plan covers an entire range of treatment options such as in-patient hospital stay, expenses incurred during pre- and post-hospitalization duration of the treatment as well as daycare costs, including OPD consultations.

Inclusions Under Health Insurance Plans for Family

Let us take a look at the various items covered under the family health insurance policy:

  • All daycare procedures, such as radiotherapy, balloon sinuplasty, chemotherapy, and the like, which can be performed without the need for stay at the hospital for at least 24 hours, are all covered under these plans.
  • Treatments that require hospitalization for at least 24 hours running are covered under family health insurance plans. The cost for such in-patient treatments are covered by the policy.
  • Organ donation expenses are also provided for under the health insurance plans for family.
  • All expenses incurred before and after the hospital stay, which include consultation with the doctor in the OPD, taking diagnostic tests/X-rays, and the like, are also covered by the plan.
  • The cost of transferring the patient in an on-road ambulance to the nearest hospital during a medical emergency is covered under family floater health insurance.

Exclusions Under Family Health Insurance Policies

There are some areas of medical treatment that may be left out or not covered under family health insurance plans. It makes sense to look at them before choosing to buy a health insurance plan for your family:

  • All costs incurred in the treatment of diseases like HIV/AIDS may not be a part of family health insurance coverage.
  • The insured may not be provided financial protection for any treatment undergone during the waiting period – the mandatory time duration that a policyholder needs to wait for before raising claims with the insurance company. This waiting period may apply in case of pre-existing illness or some particular diseases not covered under the insurance plan.
  • In case the insured gets injured due to causing harm to oneself, such as in the case of suicide, he/she may not be entitled to receive coverage for cost of treatment for such self-inficted injury.
  • Any cost incurred on minor/major injuries caused during participation in adventure sport activities like parasailing, rock climbing, and the like, are excluded from family floater health insurance plans.
  • If the insured is reported to experience a health condition or ailment on account of excessive consumption of harmful substances like tobacco, drugs, and the like, he/she may not be covered under the plan protection.

 Best Family Cover Health Insurance Plans

We talked about all that family health insurance plans cover and exclude from coverage. Now let’s look at some of the best mediclaim policy for family that you may consider buying:

Name of the Plan Total Sum Insured Under the Plan
Niva Bupa Heartbeat Family Floater Plan Max limit Rs. 50,00,000
Aditya Birla Activ Health Platinum Enhanced Plan Between Rs. 2,00,000 and Rs. 2,00,00,000
Manipal Cigna ProHealth Premier Plan Rs. 1,00,00,000
Care Advantage Plan Max limit Rs. 1,00,00,000
Star Family Health Optima Plan Between Rs. 3,00,000 and Rs. 25,00,000

 Who is Eligible for Family Floater Health Insurance Plans?

Anybody who is 18 years or above is eligible to apply for a family health insurance plan in India. The dependents provided coverage under the plan should ideally be between the age of 91 days up to the maximum age limit of 65-75 years. This essentially implies that both children and senior citizens can be provided financial protection under the plan.

The scheme has been designed keeping in view that both these members of the family need financial assistance at this stage of their life. Hence, family floater health insurance plans provide that much-needed assistance, helping these sections of the population to cover the high-rising costs involved in the treatment of certain health conditions.

Read More: Family Health Insurance Benefits and Advantages

In a Nutshell

Family health insurance serve as a huge relief for the primary earring member of the family on whom most of the family’s dependent members rely. With these insurance plans in place, the person can hope to relieve some financial strain off their shoulders. Make sure to check online which mediclaim policy is best for family, considering your individual family needs, and choose the one that serves your purpose better.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.



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Oct 20, 2022
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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