Overview
The United India Family Medicare plan is a basic health insurance policy designed for individuals and families aged 18 to 65, offering sum insured options ranging from ₹3 lakhs to ₹25 lakhs. Optional covers include maternity and newborn baby benefits, daily cash allowance, and restoration of the sum insured. The policy can be purchased on an individual or family floater basis, making it flexible for diverse family needs.
Experts Review
Written by Ishita Jain
Editor
The United India Family Medicare plan offers a broad spectrum of health coverage suitable for families seeking moderate to high sum insured options (₹3-25 lakhs). Its key features include the restoration of sum insured (available for ₹3 lakhs and above), which replenishes the sum insured after exhaustion, but only once a year for different illnesses. Additionally, the plan also covers organ donor expenses for both the insured and the donor. The policy also includes maternity and newborn baby coverage up to 10% of the Sum insured.
However, the plan enforces a three-year waiting period for pre-existing diseases, which delays coverage for chronic conditions common in families. Disease-wise sub-limits apply to procedures such as cataract (10% of the sum insured), mental illnesses, and a room rent limit of up to a single private room, potentially limiting claim amounts for these treatments.
Premiums are generally competitive but tend to be 10-15% higher than comparable family floater plans from private insurers, reflecting the public-sector insurer’s operational model. United India Insurance has an average claim settlement ratio of around 94%, but its claim processing speed and customer service may lag behind those of its private peers.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No coverage if you are forced to hospitalize at home, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some. Need to opt add-on for maternity cover.
Doctor consultations are not covered, which is a key feature.
United India
Key Insights
Founded
1938
United India was established 87 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% claims settled in 30 Days
United India settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
United India has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
13 complaints per 10,000 claims registered
United India experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataract, Mental illness and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount upto 10% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹500-2000 for up to 10 days.
Maternity Benefits
New born covered up to 10% of SI
Hospital Cash
The insurer pays a lumpsum by adding a fixed sum (daily cash) every day until the day of discharge so you can deal with any potential loss in income during this time. The money will be reimbursed to you after you submit the required documents post-discharge, and while this looks like a neat benefit to have, we don’t recommend it since the benefit doesn’t compensate for the extra premium you pay.
Maternity
With this add-on, you get added coverage for maternity expenses i.e. childbirth and newborn expenses. However, the coverage is limited to 10% of the base Sum Insured.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that the patient is in a vegetative state.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy .
Non-infective arthritis
Piles
Fissures
Fistula-in-ano
Pilonidal sinus
Waiting Period
30 days Initial waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard overall. However, there is no specific illness waiting period which is a plus.
What's missing in the policy
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered. Need to opt add-on for maternity cover.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Family Medicare have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2 years waiting period before you can make claims related to pregnancy and childbirth.
Does Family Medicare have room rent restrictions?
Does Family Medicare offer a restoration benefit?
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