Family Medicare in one table
| Insurer | United India Insurance Company Limited |
|---|---|
| Sum insured | ₹3, 4, 5, 6, 7, 8, 9, 10, 15, 20 or 25 lakh, on either an individual or a family floater basis |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Family Medicare covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from United India's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | No co-payment, at any age or sum insured | No Co-payment |
| Room Rent Limit | Below ₹5 lakh, 1% of sum insured a day. On ₹5 lakh and above, 1% of sum insured or a single-occupancy standard AC room, whichever is higher – so on most covers the room category, not a percentage, sets the limit | No room rent capping |
| ICU limit | Below ₹5 lakh, 2% of sum insured a day. On ₹5 lakh and above, actuals | No ICU capping |
| Disease sub-limit | Cataract capped at 10% of sum insured or ₹50,000 an eye. Mental illness at 25% of sum insured up to ₹3 lakh a policy period | No sub-limit |
| No Claim Bonus | You pick one. Cumulative bonus adds 20% of the sum insured for each of the first five claim-free years and 10% thereafter, to a maximum of 200%. The alternative is a premium discount of 5% a year for five years then 2.5%, to a maximum of 50% | 50% each year (Minimum upto 100%) |
| Restoration Benefit | 100% of the sum insured restored automatically and instantly, once a policy period, for an unrelated illness only, on any sum insured from ₹3 lakh | 100% restoration once in a year |
| Pre-Hospitalization | 30 days, and pre and post together are capped at 10% of the sum insured | At least 60 days |
| Post-Hospitalization | 60 days, and pre and post together are capped at 10% of the sum insured | At least 120 days |
| Consumables | The non-payable items listed in the policy are not covered, and there is no add-on that buys them back | Consumables covered |
| Day-Care Procedures | All day care treatments covered, with no capped list | Covered without a capped list |
| Organ donor | Donor's in-patient expenses covered when you are the recipient. If you are the donor, a lump sum of 10% of the sum insured after the policy has run 12 months | Covered |
| Home care treatment | 10% of the sum insured or ₹30,000, whichever is lower, for up to 14 days per incident | Included |
| Road ambulance | 0.5% of sum insured up to ₹2,500 per event, and 1% of sum insured up to ₹5,000 a policy period | Included |
| Health check-up | Every three claim-free years – 1% of the average sum insured of the preceding three years, up to ₹5,000 a person on an individual policy or ₹10,000 on a floater. It does not reduce the sum insured | Included |
| Entry age | 18 to 60 for adults, children from 91 days. Above 60 you can renew but not join | No maximum entry age |
Family Medicare add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Family Medicare discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Family discount | Up to 5% | On an individual sum insured policy where more than one member of the family is covered. It does not apply to the optional cover premium. |
| Floater discount | Up to 15% to 30% | On a floater policy, by family composition. Two adults, or one adult with children and parents, attract 30%; a single adult with parents or children attracts 15%, or 20% where an adult is aged 40 to 50. |
| No Claim Discount | Up to 50% | Taken instead of the cumulative bonus: 5% off the renewal premium for each of the first five claim-free years, then 2.5% a year, to a ceiling of 50%. |
From the plan prospectus. The floater discount is the largest lever here and depends on your family composition, so it is worth quoting more than one arrangement of the same family.
Family Medicare waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Named specific illnesses (Table A) | 24 months |
| Joint replacement, named mental illnesses, neurodegenerative disorders (Table B) | 36 months |
| Maternity, if the optional cover is taken | 24 months |
| Pre-Existing Disease | 36 months |
The named illnesses that wait 24 months for Table A, 36 months for Table B
Two named lists run in parallel. Table A, below, waits 24 months. Table B – joint replacement for a degenerative condition, age-related osteoarthritis and osteoporosis, macular degeneration, the named mental illnesses and all neurodegenerative disorders – waits 36 months. Where a listed condition is also pre-existing, the longer of the two waits applies, and an accident is covered from day one. The list is indicative – the policy wording carries the full set.
Family Medicare exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Family Medicare falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Family Medicare questions, answered
Is there a room rent limit on Family Medicare?
It depends on your sum insured, and the distinction matters. Below ₹5 lakh, the limit is 1% of the sum insured a day and ICU is 2%. From ₹5 lakh upward, the limit is 1% of the sum insured or the charge for a single-occupancy standard AC room, whichever is higher, and ICU is paid at actuals. In most hospitals the AC room figure is the higher of the two, so the percentage cap stops binding. Take a room above your entitlement and a proportionate deduction still applies to the associated medical expenses.
How does restoration work on this plan?
If the sum insured is used up partly or wholly by claims during the year, 100% of it is restored automatically and instantly. On an individual sum insured basis each insured person gets one restoration a year; on a floater the family gets one between them. Two limits: the restored amount can only be used for an illness unrelated to the one already claimed for that person, and anything left over does not carry into the next year. It is available on every sum insured from ₹3 lakh.
Should I take the cumulative bonus or the no-claim discount?
United India makes you choose one at each renewal. The cumulative bonus adds 20% of the sum insured for each of the first five claim-free years and 10% for each year after that, to a maximum of 200% – so ₹10 lakh can reach ₹30 lakh of cover. The no-claim discount instead cuts the premium by 5% a year for five years then 2.5% a year, to a ceiling of 50%. If your worry is a large hospital bill rather than the annual premium, the bonus is worth far more. A claim in any year pulls whichever you chose back by one slab.
Is maternity covered?
Only if you buy the Maternity Expenses and New Born Baby Cover, and only on a sum insured above ₹3 lakh. The policy with that cover must have run 24 months, it pays for at most two deliveries or terminations in a lifetime, and the amount is 10% of the sum insured capped at ₹40,000 for a normal delivery or ₹60,000 for a caesarean. Anyone who already has two living children cannot take it. Taking the cover also brings the newborn in from day one and switches off the internal congenital anomaly wait for that child.
What are the waiting periods?
Any illness other than an accident waits 30 days. A named list including cataract, hernia, piles, stone disease and benign tumours waits 24 months. A second list – joint replacement for a degenerative condition, age-related osteoarthritis and osteoporosis, macular degeneration, the named mental illnesses and all neurodegenerative disorders – waits 36 months. Declared pre-existing disease waits 36 months, the maximum IRDAI permits, and where a listed condition is also pre-existing you serve the longer of the two.
Can I still buy this plan after 60?
No. Entry closes at 60 for adults on Family Medicare, and above that United India allows renewal of an existing policy but not a fresh one. There is no maximum renewal age once you are in, so buying before the birthday secures lifetime cover. If you are already past 60, this is not the plan to ask for – United India sells separately filed products for older entrants, and you should compare those on their own terms rather than assume they mirror this one.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other United India plans we have read
United India files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.