Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim
Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim.Medical insurance is extremely a crucial factor for protecting your family’s health and their wallet. With reference to the insurance products, there are different kinds of health insurance policies that are available to the public; one of which is the family floater. This type of policy covers the whole of an enclosed family in a single summed insured amount. However, as with any insurance plan, it is essential to know the benefits given by this plan as well as the lost claims that can negatively impact the process. Below are a step-by-step guide to assist you while choosing the right family floater health insurance plan particularly the coverage and exclusion section.
Coverage of Family Floater Health Insurance
The features of family floater health insurance are as follows and it provides a wide number of additional benefits to protect the expenses on medical treatment for the family. Here’s a breakdown of the typical coverage offered:Here’s a breakdown of the typical coverage offered:
1. **Hospitalization Expenses**
**Inpatient Care:** It refers to hospitalisation costs of an illness or accident that results in admission in a hospital. It comprises of accommodation fees, nursing charges and the price of the various operations that are offered.
**Surgical Costs:** It includes cost of surgeries such as the cost of the surgeon, cost of the operating theater and any charge for anesthesia.
2. **Daycare Procedures**
**Non-Hospitalization Treatments:** Most of the family floater plans include the daycare treatments that which do not require the hospitalization for twenty-four hours. This will involves treatment processes such as cataract surgery, chemotherapy, dialysis among others.
**Advanced Treatments:** This coverage has become more relevant as new technology in the health sector emerges making more operations to be done on an outpatient basis.
3. **Pre and Post-Hospitalization Expenses**
**Pre-Hospitalization:This setup covers the pre-admission expenses like diagnostic checks and consultations to a limited number of days before hospitalization.
**Post-Hospitalization:** This also entitle the patients to recover all the other expenditures which are in most cases after discharge as well as the follow-up treatments and medication for a a period of time.
4. **Ambulance Charges**
**Emergency Transport:** The expenses such as that of the ambulance services to transport the patients to the hospital and vice versa is included. This can be very useful in an emergency where early intervention is the key to overcoming the problem faced.
5. **Maternity Benefits**
**Childbirth Expenses:The existing family floater plans may also comprise maternity benefits which would entail costs to be borne in matters of childbirth such as antenatal and postnatal expenses.
**Newborn Coverage:** Depending on the insurer’s terms it may be possible to include the newborn baby under the policy for sometime or until the next renewal date.
6. **Critical Illness Cover**
**High-Cost Diseases:For example to supplement the basic costs some plans give extra coverage for severe ailments such as cancer, heart illness, or stroke. This can give a tax-free, one-off payment or pay for particular procedures such as radiation treatment and chemotherapy.
**Rider Options:** The optional/extra benefits which could ride the policy are CI cover which offers additional benefit in case of critical health conditions.
7. **Preventive Health Check-ups**
**Annual Check-ups:** Most policies cover you for regular check-ups which are important in keeping your health status close to optimal as possible and also serve to detect any complications at their infancy.
**Coverage Limits:** To these check-ups may attract certain limitations concerning their frequency and the amount they will cover.
8. **Cashless Facility**
**Network Hospitals:** Family floater plans also provide the cashless at networked hospitals, which means that, you do not need to provide any money but rather the hospital will bill directly to the plan’s provider. This means that the insurer pays for the bills out of their pocket to the hospital.
**Convenience:** This feature minimizes money worries whenever a patient has to go to hospital and makes claims easier.
Coverage Of Family Floater Health Insurance Scheme And Exclusions Of Claim
Exclusions in Family Floater Health Insurance
It is just as important to know what being excluded as much as it is to know what is being included. Exclusions are circumstances to situations that are not covered by insurance policies. Here are some common exclusions found in family floater health insurance plans:Here are some common exclusions found in family floater health insurance plans:
1. **Pre-Existing Conditions**
**Waiting Period:** Much as most of the family floater policies have been designed to suffice customer needs, they also come with a waiting period especially for pre-existing illnesses. According to this period, costs incurred towards pre-existing medical conditions do not get considered.
**Disclosure Requirements:** There are several drawbacks to this policy; it is essential to report any pre existing condition with the policy at the time of purchase to avoid disputes with the insurer in future should one wish to make a claim.
2. **Specific Diseases and Treatments**
**Excluded Diseases:** There can also be limitations of policies and they will not cover some diseases or treatments, for example, some types of plastic surgery or treatments that are considered experimental.
**Policy Terms:** Always read your policy document keenly so that you get to know which conditions or treatments are not covered.
3. **Cosmetic and Aesthetic Procedures**
**Non-Medical Treatments:** As for other treatments, even if they are needed for improving a person’s look, they are unlikely to be paid for; for example, plastic surgery for beauty purposes. This involves some surgeries such as face lift and tummy tuck among others.
**Medical Necessity:** It is normally restricted to only those procedures that are considered as medically necessary operations rather than aesthetic ones.
4. **SH and Accidents**
**Intentional Acts:Self inflicted injuries and injuries that arose out of an act of self harm or an act of crime are normally not covered. This also covers those injuries that are occasioned when engaging in unlawful acts or while in a state of intoxication.
**Policy Exceptions:** It is, therefore, important to read the specific policy terms relating to the exclusion of self-inflicted injuries.
5. **Alternative Therapies**
**Non-Allopathic Treatments:** Some treatments like homeopathy or Ayurveda or traditional Chinese medicine may not be included in a basic health insurance policy.
**Alternative Medicine Coverage:** In case, if you are interested in availing alternative therapy, find out whether the company has a special provision in the form of another plan or an endorsement for such treatments.
6. **Using The Waiting List for Certain Treatment**
**Waiting Periods:** Certain treatments or conditions may require the insured person to wait for a certain period before the insurance will cater for the same. What this implies is that, as a client who has bought the policy, you will have to wait for sometime before you can claim for those exact treatments.
**Annual Limits:** Remember the limitations and waiting periods of operations or treatments which each insurance company has in a year.
7. **Hospitalization Resulting from the use of Drug or AlcoholAbruse**
**Exclusions:Self inflicted illness due to drug or alcohol use is typically not paid for. This are treatment for substance or alcohol use disorders or rehabilitation services.
**Policy Clauses:** It also contains information and provisions about specific drug and alcohol related exclusions of which you should always familiarize yourself through a review ofcessedOff policy.
8. **Non-Medical Expenses**
**Non-Covered Costs:** Therefore only accommodation expenses of the patient necessary for the treatment are provided while other personal expenditure like personal effects, telephone calls, or a family’s accommodation will not be provided by the insurance company.
**Insurance Coverage:** Be sure to know what the policy will cater for and the things that you are expected to cater for yourself so that you can’t be surprised with lots of extra bills to pay.
Conclusion
This covers an entire family under one policy and gives a broad range of cover which includes hospitalization, critical illness coverage, maternity among others. It’s also relevant to understand the kind of services that are not covered so that there are no shocks when making claims. Understanding all the areas of coverage and exclusion is essential to help you make appropriate decisions that will improve protection offered to the family in case of health related costs. It is very important that you always go through your policy documents carefully and in case of any questions or uncertainties, you should discuss with your insurer in order to enrich your family floater health insurance benefits.