HDFC Family Health Insurance

Family Health Suraksha Gold Plan

HDFC ERGO not only cares for an individual but also for their loved ones whose protection is also important. We all share a healthy bonding with our close family members and also pray for their sane health. This is health insurance becomes when planning to our loved safety from future medical.

HDFC ERGO is joint venture financial institution HDFC and a based insurance unit called ERGO. Both of the companies partnered to form different health insurance plans for individuals and family. One of such plans is Health Suraksha Gold Insurance for Family which was designed to meet the requirements of family members and provide constant benefits during a term of the policy. Though Health Suraksha Gold Insurance for individuals today we are going to highlight the family plan.

Features of Family Floater Coverage

• It was formed by keeping the health expenses of the family in mind.
• Sum Insured available is Rs 5 Lacs, 7.5 Lacs 10 Lacs.
• The maximum number of members which can be included in the plan is four where 2 adults and 2 children can be involved at most.
• The benefits and features are same as the individual coverage like cashless treatment, tax benefit, pre and post-hospitalization, no claim bonus, ambulance cover, daycare treatment etc
• Additional benefit options which can be availed on the payment of the premium for the same policy. This includes an accidental benefit, dental treatment, critical illness benefit, co-payment etc.

Eligibility Criteria

In an urge to purchase the policy, the policyholder has to check the eligibility criteria before entering into an agreement-

1. Anyone above the Age of 18 years is eligible to enter into the terms and conditions of the policy. There is no maximum age limit as determined by the company.
2. If parents want to add their children into the policy, then the child age can vary between 91 days to 21 years.

Coverage Offered

1. In-Patient Hospitalization

This offer medical coverage caused due to temporary illness or accident in the shape of nursing expense, medicines, doctor fees, intensive care expense, surgeon fee, operation theatre charges, single private room accommodation, etc.

2. Pre-Hospitalisation

When a person falls ill, the primary thing he does is to consult a doctor or a physician before going for hospitalization for in-patient treatment. This involves a chunk of expenses such as doctor fee, medical test, diagnosis, injections etc named as pre-hospitalisation expenses.

3. Post-Hospitalisation

After you get out of a hospital you still need care and proper supervision to ensure good health. You may need extra financial aid to meet the post-hospitalization expenses like medicines, pharmaceuticals, therapies, laboratory reports, consultation fees etc. The expenses cover after 60 days of discharge are named.

4. Room Rent

The need for room arises when any family member got hospitalized. In this case, there no sub-limits imposed on the room eligibility by the insurer and the insured is free to choose any hospital room according to their comfort.

5. Emergency Ambulance

This will facilitate the insured in case of a medical emergency which requires on-demand service of the ambulance to get the insured safely transported to the hospital without any delay.

6. Domiciliary Hospitalisation

Domiciliary hospitalization is required either in two cases -

• The insured situation is highly critical which demands complete hospitalization at home OR
• There is no empty room available in the nearby hospital to carry on the operation The expenses will be entirely borne by the insurer.

7. Day Care Treatments

Some illness or ailments require less than 24 hour time to get perfectly cured. These kinds of treatments are covered under Day Care Treatments. It includes eye surgery, tonsillectomy, chemotherapy, skin transplantation, orthopedics etc.

8. Maternity Expenses

If you are planning to give birth to a child, the plan will cover your delivery charges and post-natal care expenses after four years of the waiting period. The insured can use up to Rs 15000 as normal delivery expenses and up to Rs 25000 for Caesarean section delivery.

9. Newborn Baby

In-patient treatment expenses occurred within 90 days after the birth of a newly born baby will get coverage after a waiting period of 4 years.

10. AYUSH Treatment

If in case the policyholder or any family member avails a non-allopathic treatment or commonly known as AYUSH treatment, then the insurer will reimburse a specific percentage of sum insured for the expense incurred only if you claim. The medical expenses covered happen due treatment under Ayurveda, Unani, Siddha, and Homeopathy are settled by the insured.

Benefits

1. No Age Limit - Age is no barrier while purchasing this policy as there is n maximum limit. However, if the primary policyholder wants to include children, then the child should fall between the 3 months to 21 years.
2. Convalescence Benefit – This benefit is to ensure extra financial safety to the insurer at the times of prolonged stay, let's say for 8 to 10 days. So, this feature helps in providing the lump sum payment to cover the income loss due to a long stay at hospitals. This will provide the facility of lumpsum payment to cope with the medical expenses.
3. Cumulative Bonus - In health insurance, the cumulative bonus comes with the rise in the sum insured after every claim free year. If you haven’t registered for any claim in a year, then you will be given 5% increase in the sum insured. If you didn’t claim for five persistent years, you will earn a 25% increase in the sum insured.
4. Free Health Checkups – This benefit becomes active after the 4 claim free years which is also counted as the waiting period. The insured will get the free facility of checkups up to Rs 5,000 once.
5. Lifelong Renewability – You may need to renew your existing policy after every one or two depending on the tenure of the policy. This plan gives you choice to renew the policy when its expiry date comes closer.
6. Tax Benefit – Investing in health insurance is one of the best ways to get relief in tax payment on the income received. Under Section 80D of Tax Act, the policyholder can get several tax benefits-
   

   Situation	Premium Paid		Benefit of Tax deduction
   	Family	Parents
   Family and parents below 60	Rs 25,000	Rs 25,000	Rs 50,000
   Family below 60 but parents above 60	Rs 25,000	Rs 50,000	Rs 75,000
   Family and parents above 60	Rs 25,000	Rs 50,000	Rs 1,00,000

7. Cashless Treatment – This gives you cashless claim settlement by the insurer where the company will pay directly to the network hospital. In order to avail this facility the insured needs to get treated only in Network hospitals as listed in the policy.
8. Discount – You will receive a fraction of discount if you include more than 2 family members into your policy coverage plan and also when you select coverage for two or three years. The discount can be a reduction in the premium amount when paid for two-three years.
9. Smooth Claim Settlement – HDFC ERGO has established a claim settlement ratio in past years through which policyholders can easily claim their compensation with the proper supply of required proofs.

Add on Covers

The add-on coverages will give the additional benefit on the payment of premium. Some of them are-

• Critical Illness Cover - Critical illness which can take untimely death like cancer, serious heart stroke, paralysis, heart valve replacement, kidney failure, multiple sclerosis etc. Usually, 10-15 diseases are covered but in case of a comprehensive package can be elevated to a limit of 38 diseases.
• Restoration Benefit - This becomes useful when you exhaust your sum insured value amount with bonuses in claims and need more financial help to cure other diseases. Restoration benefit is like a plan which you may keep in a condition of an extremely difficult medical situation when you become have claimed all your health insurances.
• Personal Accident Cover - This financially covers you from the accidents which may result in death, partial disablement, or heavy injuries to the body of the policyholder.

Exclusion of the Plan

1. Any illness caused due to consumption of alcohol, cigarette, cannabis or any other harmful material.
2. Sexually transmitted diseases like HIV/AIDS and some genetic disorders.
3. Cosmetic treatment, dental surgeries, joint replacements, abortion, cataract, hernia, piles, etc
4. Therapies such as naturopathy, magnetic therapy, acupressure, reflexology etc
5. Self-inflicted injuries like suicides, eating poison etc
6. Pre-existing medical diseases may not be covered. Some companies include pre-existing conditions but only with the waiting period of 4 years.
7. Injuries resulting from war, nuclear/chemical weapon, radioactivity etc.
8. Accidents/ailments happening in starting 30 days cool off period of the policy is not covered.

Example: 1

There is a family of four members where Shyam and Sukriti are husband and wife with a daughter of 15 years and a son of 13 years. The age of the couple is 44 years(Shyam) and 42 years (Sukriti). Sukriti advised Shyam to invest in health insurance as they are becoming aged and also have the responsibility of two children on their shoulders. Taking health insurance will save them from getting financially paralyzed due to uninvited medical issues.

Eventually, they bought the Health Suraksha Gold Plan from HDFC ERGO with a sum insured of Rs 10 lakh for one year. The premium payable according to their age and number of members included in the policy is Rs 27,688 per year. Also, the salaried income which Shyam was taking off ranged between 7-10 lakhs. After one year of the policy, Shyam was diagnosed with a brain tumor (critical illness) for which he took critical illness benefit as add-on cover. This step saved his family from facing future financial crisis.

He also received a discount on the sum insured by adding his wife and two children in the policy.

Example: 2

Aman and Aditi are newly wedded couples and both showed an interest in taking health insurance to get protection from medical uncertainties. Aman is of 27 years and Aditi is 26 years of age. Aman works in TCS as a software developer holding a salary between 10-15 lakhs and lives in Delhi. The sum insured taken was 10 lakhs for one year with an annual premium payment of Rs 17,997. In the policy, they are getting cashless treatment at 351 network hospitals located in their city. As they are planning to conceive in the next 3 years, this plan will give them financial help at the time of delivery of an infant.

Summary of the Plan

Overall the Health Suraksha Gold Insurance for Family covers all the essential benefits and features that have the capacity to satisfy all the medical needs of the policyholder and the family members. It is a highly flexible plan that gives you variant choices in adjustment to the comfort of the family members.

HDFC has established a good reputation in settling the claim of its customer. The company also provides you with health care at the time of purchase. Health care becomes a necessity when you use service of cashless treatment at network hospitals.

FAQs

1. How many members can be covered in the family floater plan?

Under the family floater plan, the maximum number of members that can be included is 4 where you have the choice to involve your child and spouse. You can choose any of the option provided below-

• 2 adults
• 2 adults and 1 child
• 2 adults 2 children
• 1 adult 1 children
• 1 adult 2 children

2. How to get health insurance for a family of four including two adults and two children?

First, compare which plan is giving you more benefits in the face of coverage.

3. What is a family floater and what are its advantages?

Family floater is exclusively for the individuals who want to safeguard their family member in case of any medical emergencies. There are plenty of benefits available under the family floater plans listed as follows:

1. You only have to pay one single amount of premium for all your family members.
2. If one of the family members gets struck with an accident or illness and need hospitalization, then the total sum insured can be utilized towards the treatment of the member.
3. You get discount on the payment of premium if you add more members to the policy but not exceeding the maximum limit.

4. What are special discounts available under this policy?

The policyholder will get a 10% discount on the sum insured if he/she includes 2 or more family members into the plan. Another kind of discount available is on the purchase of a two-year policy term. The discount limit is 10%.

For instance, suppose Ritu buy a two-year policy for a family of four members with Rs 5 lakh of sum insured. The premium for one year is 17673 while whereas the premium offered by the company for two-year policy tenure was Rs 31,812 (actual premium was Rs 35,346). Ritu was gaining a discount of Rs 3,534 on buying a two-year policy.

5. Do I need to go under medical examination to buy the policy?

If you are under 55 years of age then there is no need to undergo for medical examination. Whereas if the primary policyholder involves any member above the age of 55, then the medical examination is necessary.

6. How premium changes with the change in the age of the policyholders?

There are multiple factors responsible for the change in the premium rate-

1. With growing age, the chances of medical problems elevate which is why companies increase the premium amount.
2. We live in a vibrant economy where prices keep on fluctuating for everything which consists medical expenses too. The cost of expenses like doctor fee, pharmaceuticals cost, treatment, check-ups, consultation etc also become expensive. This results in a premium value.
3. Other factors responsible for is related to policyholder’s pre-existing ailments, family medical history, addictions (smoking, alcohol), profession, gender etc.

7. What are the benefits of renewing the policy?

1. By renewing your policy timely, you can avail the benefits of coverage provided without any procrastination. If you got late then you have to wait for 30 days to get off the coverage.
2. Another benefit that is added to your insurance on renewal is 5% of No Claim Bonus (NCB) if you haven’t registered any claim on each renewal.
3. Some coverages like maternity and critical illness have a waiting time of 4 years. If you haven’t applied for up-to-date renewal, then the waiting period begins again with the scratch.

8. How to renew your health insurance policy online?

The online procedure for policy renewal is secure, less time consuming, and smooth.

1. Visit the company website and click on the option of “Instant Renewal”.
2. Then, fill the requisite details of your policy.
3. You will get information about the premium to be paid.
4. Click the payment option that will ensure your renewal.

*You get 30 days to renew your expired policy starting from the date of expiry.

9. What is the procedure to add a new member to the existing family floater plan?

To add a member, you just need to fill a health declaration and an endorsement form. This health declaration will include the new member’s personal information and health history so far.