Being careful about health is important for everyone, whether you’re young or old, although most young children cannot understand what is good for their health as well as their parents or other elders in the family. Even with elders looking out for them, no one can guarantee that the child will not develop any health problems. Knowing this, many parents wonder about health insurance for children - if it’s possible to get it and if yes, how to go about the process. In case of any kind of health problem, health insurance could at lead aid the parents financially while they deal with the mental stress of getting through the tough times. This article explains all you need to know about health insurance for children.

  1. Child health insurance and age
  2. Health insurance and facilities for the child
  3. Best health insurance for kids
  4. Health insurance for a newborn
  5. Minimum age for child health insurance
  6. Child health insurance mode of application and premium
  7. Documents needed for child health insurance
  8. Why health insurance is necessary for children
  9. Benefits of taking health insurance for children
  10. Things to remember while purchasing health insurance for children

Health insurance is a facility in which a person’s health is insured by a company and this insurance protects them from financial troubles when they face health problems. An individual can take this insurance for themself, a family floater plan for their entire family or separate cover for all the family members in one health insurance plan. Apart from this, you may have heard of senior citizen health insurance, which is specially designed for the elderly. Sometimes, health insurance plans are designed for specific diseases as well. If you are conscious of the health of your children, then it’s important to know that there is no age limit in health insurance for children, but the terms and conditions may differ from insurer to insurer. The standard age to avail of the child insurance plan is 18 years. Apart from this, there are many plans under which children are covered.

(Read more: Which is the best health insurance)

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If you are looking for the best health insurance for your child, then it is best that you find out about family health insurance plans under which children get all the benefits that elders get. Such plans usually cover 4 to 7 family members including children. Insurance companies also offer cashless claims, reimbursements and tax benefits through these policies.

If you feel that after adding children to the existing health insurance plan, the cover taken in the policy may fall short, then you can upgrade your policy. The cover or insurance cover is the maximum amount that you can claim from the insurance company. However, if you increase the cover, the premium you pay will also increase. There are two ways to claim health expenses for your child:

  • Cashless claim: In this, there is no need to pay in any way for treatment from a network hospital. However, some minor formalities still have to be done. For example, in case of a planned admission of the child, the TPA or insurance company is to be informed 48 hours before usually and if the admission is done suddenly, then they should be informed within 24 hours of the admission. After the treatment is completed, all the documents related to the hospital expenses have to be sent to the TPA or the insurance company. The company then checks these documents, talks to that hospital and settles the claim. Keep in mind, read your policy bond about the exact timing for when you have to inform your TPA/insurance company.
  • Reimbursement: This requires paying the full hospital bill. Then the discharge papers as well as all the treatment-related papers have to be submitted to the TPA/insurance company. If the documents are given to the TPA, they will send them to the insurance company, where they will be checked. If the papers are to be sent directly to the insurance company, the process may take less time. After checking the papers, the insurance company contacts the hospital and if everything is as per the terms and conditions of the policy, the total expenditure at the hospital or in some cases a percentage of it is returned to the insured. In the case of reimbursement, money is not transferred to you immediately and becomes available only after a few days. Also, not all health insurance companies have TPA arrangements. In such a situation, the agent of the insurance company or the customer care of the company has to be contacted directly.

(Read more: What is Top Up Health Insurance)

Most often, people take out insurance policies as soon as they find employment, but as their family grows in terms of having children, the parents start to consider taking a separate health insurance plan for them. They may even want to eliminate the existing health insurance plan and take a new policy in which children also get coverage. Here’s what is important for them to know - they can add the names of their children to the existing health insurance policy. Though many policyholders are not aware of this, this facility is easy and affordable too.

To add children to your individual health policy, you have to first convert your health policy into a family floater plan and then children can be included in it. A family floater plan is health insurance in which the entire family gets cover. Its speciality is that all the members are covered in a single policy. The sum insured (sum assured) can remain the same and the same premium is collected. Another feature is that if the sum insured of the family floater plan is Rs 20 lakhs, then one member of the family can also take the benefit of the entire amount and the whole family together can also take the benefit of the sum-insured. In such policies, the children get the same benefit that other family members get. It’s also easier and economical compared to taking out a new policy.

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A child from birth to one month is called a newborn. Separate health insurance cannot be taken for such children, as there are many risks involved in the early stages of life.

In fact, newborns have a weakened immune system when they are born and it takes some time for it to develop fully. As long as the immune system is weak, the body's ability to fight many diseases is limited or reduced, and this is why health risks in newborns can persist for a few months. A newborn can be insured in the following ways: 

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  • Through maternity insurance: Maternity insurance covers the health of the pregnant woman and her baby. However, most of the time it is taken as a rider, which means taking it as an add-on facility in your regular health insurance by paying an extra premium. It covers both normal delivery and operation expenses. Now since the health of the child is also covered in this, you can say that newborns can be added to the health insurance policy. However, under a maternity plan, coverage is available for the first 90 days from the birth of the child. After the completion of this period, the parents can add their child to the regular health policy by paying an additional premium.
  • Through group health insurance: The difference between group health insurance and regular health insurance is that regular health insurance usually has a waiting period for the treatment of diseases, which means that you will be eligible for the insurance money only after a certain period of time has passed. This is not the case with group health insurance; additionally, it does not require a medical examination and the premium is also low. Since a large number of people are insured simultaneously, the insurer benefits in a big way. Group health insurance usually covers sudden hospitalization, COVID-19, critical illnesses, maternity, etc. and, as mentioned above, both the mother and the newborn are covered under maternity insurance.
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Since health risks are associated with newborns for some time, health insurance companies fix the minimum age for a child (usually, 90 days) after which period they are covered under the policy. If you want to take a separate health insurance plan for your child then you can go for the myUpchar Bima Plus policy. It is mandatory for a person to be at least 10 years old to take this policy. However, most insurance companies provide separate health insurance to an individual only when he/she is at least 18 years of age or if the family health plan includes a person above 18 years of age.

Adding a child to your existing health policy requires a separate application, which can be done at the time of renewal every year. If the health insurance company has agreed to cover the child from day one, then the company should notify the same within a week of the birth of the child.

When you link the newborn to the existing health policy, you have to keep in mind that there will be some changes in the existing premium. Simply put, the premium will increase slightly.

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In the case of a newborn, the documents related to the birth of the child will have to be provided for the cover. This usually includes the original birth certificate, the birth papers from the hospital and the discharge report from the hospital.

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Young children are at a higher risk of diseases than adults. The main reason for this is their lifestyle, which includes not eating on time, eating out often, not being aware of clean food, hygiene habits, etc. So, it may be a good idea to add your children to your health insurance policy to protect them in case of any health problems.

(Read more: What does health insurance cover)

Health insurance for children can generally be beneficial in the following ways:

1. Low Premium: Whether you take health insurance for children as a rider or separately, both have low premiums.

2. Large scale coverage: Generally, there is no restriction in coverage facilities for children and they are given a large level of coverage.

3. Additional facilities: Children can get additional services such as expert consultation, nutrition and diet information, etc.

4. No claim bonus: Some health insurance plans for children offer a no claim bonus. This means that if you do not file a claim, the health insurance company can give you a discount on the premium or increase your sum insured.

(Read more: What does health insurance not cover)

While buying health insurance for children, you should keep in mind the following factors:

  • Keep age in mind: When it comes to buying a health insurance plan for children, it is always advisable to take health insurance at the earliest age.
  • Individual plans: It is advisable to take an individual health insurance plan for the children when they mature. However, because it offers more coverage, the premium amount will also be higher. In the early years of life or around the age of 20, children are often focused on their career and they do not pay attention to buying health insurance or do not have the proper information related to it. So, as a parent, you can take the initiative and help them buy the right insurance plan.
  • Family health insurance: If your children are below the age of 21 or 25 years (as per the policy of the company), you can include them in your family health insurance plan. The advantage of this is that you will not have to take a policy for each member of the family or pay separate premiums for everyone.
  • Critical illness plan: If you are worried about your child falling prey to some serious illness, you can consider critical illness insurance. In case the illness becomes apparent, a fixed payment is made by the insurance company.
  • Employee group insurance: If you are a salaried individual, you may have group insurance from your employer. Generally, many employers offer the option of covering the entire family, including children, in their policy. However, if you plan to leave the company in the future, then you will not be able to avail of this policy. Hence, it is not advisable to rely solely on such schemes.

At present, there are many health insurance companies, selling around 200 types of policies. There may be a variation in the rules of every company or policy, so while making your decision, read and understand the information related to the premium, caution, terms and conditions, what will be covered and what will not be available thoroughly.

(Read more: Income tax benefits of health insurance)

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