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Indemnity vs. Benefit Health Insurance

An indemnity health insurance policy takes care of your hospital expenses either through a cashless facility or reimbursement, whereas the defined benefit plan pays you a particular sum despite your actual expenses. In case you are wondering what an ideal choice to make is we suggest that you opt for a fixed-benefit plan along with an indemnity-based cover to comprehensively address your health needs.

Individual Sum Insured OR Family Sum Insured?

Individual Health Insurance

The individual health insurance policy is designed to provide you greater flexibility with the sum assured and is applicable to every member of your family covered under the plan. For e.g. if you choose a sum assured of Rs.5 lakhs for your family of four, as per the scope of this policy , each member of your family is allowed claims up to Rs.5 lakhs.

Each member of the family can choose different sum insured based on their needs. However, the premium for this plan is determined by the age. This plan could work out to be the best in the eventualities of personal illness with the options to pick cashless hospitalization and other add-on covers.

Family Floater Insurance

Family Floater plans are best suited for a family that is young & small as it focuses on bringing your entire family under one single cover. As compared to individual plans, family floater Mediclaim plans help in saving a lot of money with its umbrella cover.

The chosen sum assured is applicable to all family members covered under the plan, collectively. For e.g. if you choose a sum assured of Rs. 5 Lakhs for your family of four , then all the four members are together covered for Rs.5 lakhs. If one member makes a claim, it reduces the cover of the other members to the extent of the claim made. However, for this same reason, Family floater health insurance typically provides you options with higher sum insured than individual health plans.

HOW MUCH SUM INSURED IS GOOD?

The Sum insured, which is the total insured value for your health insurance is calculated based on the following factors:

  • Age
  • Lifestyle
  • Pre-Existing Health condition

For instance, if you are between the age group of 25-30 and you buy a health insurance policy with a sum insured of Rs. 5 lakhs, it is perhaps too high for you considering your age and health condition. Similarly, if you are 50 plus and you have a sum insured for only 1 lakh, this will be too low since you are more susceptible to unforeseen health risks.

Note that in case of the insured person's hospitalization any bill that is lower than the sum insured will be entirely paid by the insurance company.

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