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What All Ailments Are Not Covered in the Floater Coverage?

Author: Team Finpage
Floater health insurance covers the entire family under a single plan.
Tuesday, April 30, 2024

Floater health insurance covers the entire family under a single plan. This is like an umbrella cover where every member is protected under a common pool. It is a simpler and more affordable option than taking separate policies for each person. A comprehensive plan covers you and your family through the entire medical journey, from consultations and diagnostic tests to recovery and then follow-up care. This is a streamlined approach that ensures quality treatment for every family member.

It is economical because a collective fund leads to low premiums. Further, the premiums paid for the policy are eligible for tax deduction under both the old and new tax regimes in India. However, it is important to remember that some diseases are not covered by a family floater plan. Knowing it beforehand will help you avoid claim-related disputes and arrange for alternatives. Here’s a closer look at the ailments that are not covered under floater coverage.

Ailments Not Covered Under Floater Coverage

Generally, anywhere between 4 and 8 members of a family can be insured under this plan. This extends to the policyholder, spouse, children, parents, and parents-in-law. However, not all ailments are covered by this insurance. Here’s a look at what is excluded.

Pre-Existing Diseases 

Family floater plans generally do not cover pre-existing medical conditions. According to the IRDAI, any disease diagnosed up to 48 hours before the policy purchase falls under this category. This means if a family member already has a diagnosed health condition, then the costs tied to managing the same will not be included in the coverage. A few ailments that are on this list are:

  • Cancer

  • Diabetes

  • COPD

  • Anxiety

  • Kidney disorder

  • High blood pressure

  • Thyroid-related disorders

  • Hypertension

  • Heart diseases

  • Depression

Non-Medical Expenses

Cosmetic surgery, performed for aesthetic purposes, is not covered. However, if the cosmetic surgery qualifies as reconstructive surgery, it might be covered. It is important to inform the insurance provider if this is the case. Hair transplants are also not covered. However, they will be covered if deemed medically necessary. This means any surgery necessary to correct deformities due to congenital issues, medical treatments, or accidents.

Illnesses arising from intoxicating substances and nuclear incidents are also not covered. 

Other Things to Know About a Floater Plan

Here are a few factors to consider before choosing a floater plan:

  • The waiting period is typically between 2 and 5 years. Add-on benefits are also not covered during this time.

  • You can enjoy a cashless facility with a floater plan. This is when the bills are directly settled between the insurer and the network hospital.

  • Certain floater plans cover AYUSH treatment, which includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy. These are traditional healing methods. 

  • Add-ons like free health checkups, concierge services, and discounts in affiliated medical stores are available.

Family floater plans come with sub-limits. For instance, although it tends to have a cover of up to ₹6 lakhs, there could be a limit on daily room rent of ₹2,500. Further, it can be renewed until the oldest member of the policy reaches the maximum renewability age. Read the terms and conditions of the policy for an informed choice.

Team Finpage

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