How to Combine Mediclaim and Family Health Insurance for Maximum Medical Coverage

As you work to protect your family's health, you'll encounter two common terms: Mediclaim and Family Health Insurance. While these terms are often used interchangeably, they refer to completely different but complementary methods of risk protection. A Mediclaim policy is primarily for reimbursement of your hospital bills and is an indemnity plan. Mediclaim covers the cost of hospitalisation. Family Health Insurance is usually a floater insurance policy that insures all family members under one policy with one sum insured. The real strength of these two products is to be able to design the best use of both as a way of creating a very strong multi-layered safety net.

The purpose of this guide is to help you combine an extensive Mediclaim plan with a Family Health Insurance plan to provide you with the best overall coverage for your family's medical needs, with no gaps and no shock financially.

Strategic Models for a Powerful Combination

There are two primary models for achieving the highest value for the lowest cost with Family Health Insurance and Mediclaim Plans.

1. High-Coverage Ladder (Family Floater & Top-Up Mediclaim Combined)

This model supports your family by providing them a minimum of a Family Floater Plan with reasonable sum insured (approx. ₹10-15 Lakhs) and purchasing additional family members a separate Top-Up Mediclaim Plan with a higher sum insured (approx. ₹50 Lakhs to ₹1.0 Crore) to help cover large healthcare expenses.

Utilizing this combination model would greatly minimize your risk of financial ruin from any single hospital bill related to large medical procedures (i.e., organ transplants or extreme cancer treatment) without incurring the high costs associated with Family Floater Plans with ₹1 Crore in limits.

2. The Risk Isolation Model (Floater + Individual Mediclaim for Seniors)

A key shortcoming of Family Floater Insurance plans is that if one insured (for example the youngest child) suffers a catastrophic accident/illness, this could potentially use up all of the funds in their shared pool, thereby leaving the remaining family members unable to file claims against the shared pool. The Risk Isolation model helps to resolve this issue by isolating the risk.

3: Comprehensive Care Model - Adding Floater and Critical Illness Mediclaim Rider

The Family Health Insurance plan will cover the costs of hospitalization, and you will attach the Critical Illness Mediclaim rider (a specific type of Mediclaim) to that policy, or you may purchase separate coverage.

The Essential Rules to Ensure Seamless Integration

1. Fully Disclose: Top-Up Mediclaim applications require a declaration of your base Family Health Policy, including the amount of deductible associated with that policy.

2. Claim Hierarchy: When using multiple policies in conjunction with one another, always start with your primary Family Health Policy. Only after you have exhausted your primary Family Health Policy should you submit a claim against your Top-Up Mediclaim provider. Proof of claim settlement from your primary Family Health Policy should accompany the claim submitted to your Top-Up Mediclaim provider.

3. Don’t Overlap and Find Synergy: Don’t purchase duplicate coverage from two separate policies for the same expense. The objective is to build a pyramid of coverage, not create a second layer of coverage for the same expense. In this case, a Top-Up adds height to your precise pyramid and a Critical Illness rider is a bonus.

4. Continuously Renew: Renew and keep your base Family Health Policy active at all times. If there is a lapse in your Family Health Policy, it will render your Top-Up Mediclaim invalid, as the conditions for the deductible will not be met.

Conclusion 

A variety of policies create a health fortress; you accomplish this by starting with your Family Policy as a base and adding supplemental coverage for extended protection based on your families needs. For example, utilizing a Top-Up; a Senior Plan for someone in the family that is older/beyond retirement age; or utilizing a Critical Illness benefit for a family member. All of the above options are forms of Mediclaim that cover you significantly above what the Family Policy alone covers. Thus, as a consequence, it covers your whole family for the "daily health" storms of life while at the same time protects against significant Financial "Tsunami" disasters by having some type of Mediclaim in place.

By constructing your Family Policy along with adding critically important supplemental protection for your family's needs, you are making a strong proactive, intelligent investment for the future and safeguarding the health and wealth of your family from the inevitable life uncertainties that are likely to arise. This type of investment will help give peace of mind to your entire family for many years to come.