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Child Health Insurance

Children today are at an increasing risk of getting a lifestyle disease. Hence, investing in their health is the first step towards ensuring children’s future. From the time a child is born, his or her needs and well-being become the top priority for parents. They try their best to give the child a healthy and financially secure life. Along with maintaining a healthy lifestyle, investing in children’s health insurance is equally important. However, choosing a health insurance plan for children is not an easy task, considering the wide range of options available in the market today.

If you are a confused parent and want to make an informed decision, keep reading to find out everything about child health insurance.

What is a children's health insurance?

Children’s health insurance is a health insurance plan specially designed to meet the medical needs of children. Such plans cover medical expenses of a child related to hospitalisation, vaccination, check-ups and medical emergencies. A child health insurance plan provides coverage till the child turns 25. Health insurance for your child is a necessity considering the rise in infectious diseases and changing lifestyles.

Can a child have a separate health insurance plan?

Yes, a child can have a separate health insurance plan. However, the decision to buy a separate health insurance for children depends on the personal choice and healthcare needs of the child. If a child has some special medical needs and requires regular and frequent medical attention, it is best to invest in a separate health insurance plan for children instead of exhausting the family coverage. It is important to understand the scope of coverage of a child health insurance plan and ensure that it covers all the healthcare requirements of your child before you invest in a separate child health insurance plan.

How does a children's health insurance (CHI) plan work?

A child health insurance plan works in a similar way as a standard health insurance plan. Whether the child is covered in a family floater plan or an individual health insurance plan, his medical needs are covered depending on the terms and conditions of the plan. An individual health insurance plan provides many additional benefits such as critical illness coverage, free annual medical check-ups, lab diagnosis, ambulance costs and much more. Note that, these benefits may vary depending on the insurance company. Here are some important points regarding the working of a CHI plan.

1. A claim under a CHI plan can be filed on a cashless as well as reimbursement basis.
2. Cashless facilities can be availed only at the network hospitals, where you have to inform the insurer 72-48 hours before planned hospitalisation and within 24 hours of emergency hospitalisation.
3. A reimbursement claim is filled when the treatment is taken in a non-network hospital. Once the child is discharged, the claim is filled with all relevant documents within 7 days of discharge.

Types of children health insurance plans

There are two types of health insurance plans available for children.

Individual health insurance plans provide health coverage on an individual basis. It is a stand-alone health insurance plan where the entire sum insured is available for an individual. So if you are looking for a separate child health insurance plan, an individual health insurance plan is the option for you. These plans offer a number of benefits such as coverage for ancillary expenses in addition to hospitalisation and treatment expenses.

Family floater health insurance plans provide coverage for the entire family under a single plan. In this plan, the sum insured is shared by all the family members. Such a plan covers self, spouse, children and dependent parents. These plans are flexible in nature as they allow the addition of new family members such as a newborn baby. The baby is covered for 90 days under the plan. These plans are affordable compared to individual health insurance plans.

In addition to these two types, children of salaried individuals are covered under the group health insurance plans provided to the employees of a firm. However, the coverage over by the employer’s health insurance plan may not be adequate to fulfil all the healthcare needs of the child or the family.

Inclusions of children health insurance plans

It is important to understand what is covered in a child health insurance plan to avoid claim rejection. Here are some of the common inclusions of children health insurance plans.

1. Hospitalisation expenses – Child health insurance plans provide extensive coverage for in-patient hospitalisation for more than 24 hours including room rent, ICU charges, nursing expenses, doctor’s fees and other related expenses.

2. Pre and Post-hospitalisation expenses – CHI plans also cover any medical expenses incurred by the child before and after hospitalisation for a period specified in the policy.

3. Newborn baby cover – It provides coverage for neonatal care. This cover is mostly available in family floater plans or with maternity benefits.

4. Vaccination – All the vaccinations required for the baby in the first year are covered. This is also included with the maternity benefit.

5. Daycare treatments – Treatments that require less than 24 hours of hospitalisation are also covered in child health insurance plans.

6. Domiciliary treatments – Treatments taken at home by the child, on the doctor’s advice, are also covered under health insurance plans for children.

Exclusions of children's health insurance plans in India

There are certain treatments that are not covered under a child health insurance plan. Some common exclusions include

1. Expenses incurred for the treatment of injuries caused by participation in adventure sports.
2. Any pre-existing disease during the waiting periods.
3. Expenses incurred in the treatment of congenital disabilities.
4. Expenses incurred in the treatment of any behavioural or personality disorders in the child.
5. Expenses incurred in the treatment for substance abuse.

Why should you buy health insurance for children?

The primary reason why you should buy health insurance for children is to give your child the best medical care during an emergency. There are many other reasons why you should consider buying a CHI.

1. Medical inflation – Due to rising medical inflation, quality medical services are becoming expensive and inaccessible for most people. Buying health insurance for your child will ensure that your child has access to medical care whenever he requires irrespective of the cost of the treatment.

2. Injury prone – Children are playful and mischievous. They often don’t understand how to take care of themselves and are prone to injuries or accidents. Hence it becomes necessary to buy health insurance which acts as a financial cushion against unanticipated medical expenses.

3. Low immunity – Children have low immunity compared to adults. They catch infections easily. Frequent infections or sickness due to a contracted disease may affect your finances. A health insurance plan provides coverage for unexpected medical expenses.

Eligibility for children's health insurance

The eligibility criteria for child health insurance plans depend upon the insurer you select. It varies across insurance companies. Some common criteria for availing of a child health insurance plan include,

1. A newborn baby is covered from day 1 to 90 days if one of the parents has a family floater plan.
2. You can add babies over 90 days to your existing plan if an additional premium is paid. Note that add-on covers for personal accidents and critical illness are available only when the child reaches the age of 18.
3. A baby is covered from day 1 if one of the parents has a health insurance policy on an individual basis.
4. A child up to the age of 20 to 25 years can be covered under his parent’s family health insurance plan.
5. Documents required for a child health insurance plan include the birth certificate of the child, his medical reports, and maternity records.

Benefits of buying children health insurance plans

Children health insurance plans come with a range of benefits as given below;

1. Comprehensive coverage – Child health insurance plans offer comprehensive coverage for hospitalisation expenses incurred by the insured child, vaccination costs, daycare procedures and much more.

2. Low premiums – The premiums for child health insurance plans are generally lower because children are young and pose a lower risk. Buying a child health insurance plan at an earlier age can help you secure a premium for your child.

3. Additional benefits – A child health insurance plan provides many additional benefits such as consultation for nutrition and diet for the child, access to special medical care for special healthcare needs, etc.

4. Financial support – A child health insurance plan acts as financial support during a medical emergency and lets you access quality medical care without worrying about the high medical costs.

5. Available online – Child health insurance plans are easily available online. With a rise in fintech companies and digital platforms, insurance can also be purchased online like everything else. It is easier to compare many plans and their features online to help you make an informed decision.

6. No claim bonus – If there are no claims filed in a policy year, you get a no-claim bonus. This bonus can be used as a discount when you renew the policy.

List of Children Health Insurance Plans in India

Before you finalise a children’s health insurance plan, it is recommended that you explore and compare the features of various plans. Verify their inclusions and exclusions to make an informed decision. Here is a list of some of the best children’s health insurance plans in India as mentioned in the table given below:

Plan Name	Entry Age	Sum insured (₹)	Inclusions	Coverage Type
Care Supreme	Child – 90 days to 24 years Adult – 18 years to 99 years	7L, 10L and 15L	In-patient care Daycare treatments Modern treatments Pre & post-hospitalisation expenses AYUSH treatment Domiciliary hospitalisation Organ donor cover	Individual Plan Covers upto 6 members Family floater plan Covers on a 2A2C basis.
Aditya Birla Activ Fit	Individual Plan Child – 5 years to 25 years Adult – 18 years to 45 years Family floater plan Child – 91 days to 25 years Adult – 18 years to 45 years	5L to 1Cr	In-patient care Daycare treatments Modern treatments Pre & post-hospitalisation expenses AYUSH treatment Domiciliary hospitalisation Organ donor cover Maternity cover Domestic emergency assistance service Unlimited sum insurance refill	Individual Plan Covers upto 14 members Family floater plan Covers on a 2A2C basis.
HDFC ERGO Optima Secure	Individual Plan Child – 5 years to 25 years Adult – 18 years to 65 years Family floater plan Child – 91 days to 25 years Adult – 18 years to 65 years	5L to 2Cr	In-patient care Daycare treatments Modern treatments Pre & post-hospitalisation expenses AYUSH treatment Domiciliary hospitalisation Organ donor cover	Individual Plan Covers upto 19 members Family floater plan Covers on a 4A6C basis.
Manipal Cigna Pro Health Prime Advantage Plan	Child – 91 days to 25 years Adult – 18 years to No limit	5L to 1Cr	In-patient care Daycare treatments Modern treatments Pre & post-hospitalisation expenses AYUSH treatment Domiciliary hospitalisation Organ donor cover Unlimited SI restoration Bariatric surgery Cashless OPD coverage Annual health check-ups Unlimited tele consultation Optional Maternity, newborn and first-year vaccination cover	Individual Plan Covers upto 17 members Family floater plan Covers on a 2A3C basis.
SBI General Arogya Supreme	Child – 91 days to 25 years Adult – 18 years to 65 years	3L to 25L	In-patient care Daycare treatments Modern treatments Pre & post-hospitalisation expenses AYUSH treatment Domiciliary hospitalisation Organ donor cover Bariatric surgery Genetic disorders Internal congenital anomaly Domestic emergency assistance service Sum insured refill	Individual Plan Covers each member separately Individual Family Plan Covers upto 6 members on an individual basis under a single policy. Family floater plan Covers on a 4A2C basis.

Tips for choosing the right children's health insurance policy

To find the most suitable health insurance plan for your children, follow the given tips to purchase the right plan.

1. Invest early
The age of the child is a crucial factor when selecting a health insurance plan. Buying coverage for a newborn makes it easier to cover any infections and health issues common in babies. It is recommended to cover the child in your existing family health insurance if the child does not require any special medical care.

2. Consider the scope of coverage and sum insured
Review the coverage offered by a health insurance plan. Check all the diseases and medical procedures covered under the plan to ensure that the coverage matches your child’s healthcare needs. Also, opt for an adequate sum insured so that your out-of-pocket medical expenses are minimal.

3. Use a premium calculator
Use a premium calculator to compare the premiums of different plans and for different coverages in order to find optimum coverage at the best premium. It is always recommended to include the child in your family floater health insurance plan if you want to save on premiums.

4. Look for additional benefits
In addition to basic coverage for hospitalisation expenses, check for additional benefits offered by a plan such as coverage for ancillary expenses, OPD coverage, maternity benefits, newborn baby cover, and coverage for vaccinations. These additional benefits can further ease a parent’s financial burden on payment of additional premiums.

5. Disclose your child’s medical history
Share all the details regarding your child’s medical history with your insurer to avoid claim rejection in future. It will also help you get customised coverage according to your child’s medical needs.

Common mistakes to avoid while buying a children's health insurance plan

Buying a children’s health insurance policy in haste without doing thorough research and without understanding your healthcare needs can cost you heavily in future. Here are some common mistakes that you can avoid when buying a children’s health insurance policy.

1. Inadequate coverage
To save premiums, people often make the mistake of buying a policy with a low sum insured, not considering future medical costs and their own healthcare needs. Remember when you buy a family floater policy, you should consider the age of every family member and their healthcare requirement before finalising a sum insured value. The sum insured should be enough to cover multiple medical expenses.

2. Not paying attention to waiting periods and exclusions
It is important to check the waiting periods for pre-existing diseases and major exclusions in the policy to avoid claim rejection in future. Compare various plans to find a plan with low waiting periods. Also, take note of the exclusions and ensure that the policy does not exclude common ailments or any condition that you might need coverage for.

3. Ignoring deductibles
Every health insurance has a deductible which is the percentage of the claim amount that the insured has to bear. You should not ignore this percentage if you do not want to pay hefty amounts as deductibles in the claim. This percentage depends on the insurer, so go for a plan with a minimum deductible percentage.

4. Hiding a child’s medical history
You get coverage according to the information you provide to your insurer. Hiding the present or past medical conditions of a child when buying a child’s health insurance is a mistake you should avoid. Any claim due to a misrepresented medical condition is most likely to get denied. Being honest will help you get the right coverage and will get your claim accepted.

5. Ignoring the terms and conditions of the policy
It is important to understand all the terms and conditions of a policy before buying. Understanding the policy’s coverage, exclusions, waiting periods, and claim process is crucial to getting the maximum benefit of your health insurance. Ignoring these important details can cost you your money and leave you without coverage.

To Sum Up!

In today’s times, securing your children against rising medical costs and unexpected outbreaks of dreadful diseases is absolutely necessary. To ensure your child always gets the best medical services and to protect your savings from medical expenses, invest in a child health insurance plan now.

Frequently Asked Questions

Children are prone to injuries and infections when they are young. If they don’t get proper medical care on time, a small injury or a minor infection can cause lifelong damage. So a child health insurance plan will ensure that you never have to compromise on your child’s healthcare due to lack of funds.

Yes, you can buy a separate health insurance for your child with a higher coverage if your child needs special and frequent medical care. However, adding your child to your existing family floater plan would be more cost-effective.

The eligibility for child health insurance plans depends on the insurer you choose. However, generally, children are covered from the age of 91 days to 25 years.

Yes, you can get critical illness cover under a child health insurance policy. Some policies offer it as an additional benefit or some offer it as an inbuilt cover. Note that a critical illness cover is available for the child only after he turns 18.

Check with the insurer about what are the discounts available. If you are renewing an existing policy, you can get a no-claim bonus discount on your renewal premium if you haven’t made any claims in the last policy year.

When the child reaches the exit age or turns 25 years, the existing policy can be converted into an individual health insurance policy for adults and the child manages his health insurance on his own.

Yes, you can buy a child health insurance plan by visiting the insurer’s website.

The waiting period in a child health insurance plan depends on the insurer you select.

Child health insurance provides basic health care coverage like hospitalisation expenses, pre and post-hospitalisation, day care procedures etc. along with some additional benefits. Check with your insurer what is covered in your child's health insurance plans.