- Date : 03/12/2019
- Read: 7 mins
Features of health insurance plans that not everyone knows about. Understand these and make the most of them today.
Let’s assume you are trying to convince your friends to buy a health plan, out of concern for them and their families. You decide to list the benefits so they realise what they are missing out on. How many can you list? Three maybe, or four? And what are those benefits? Hospitalisation expenses, cashless admission in ‘listed’ hospitals, tax breaks, a single cover for all family members...
And now you’re scratching your head trying to recall more features – because surely there ought to be more? You want to present one or two brilliant features that can knock your friend’s socks off and make them jump online to buy a health insurance policy. Or collar an agent into selling them one.
You are not alone in your confusion. Most policyholders are not aware of all the features of their health plans. Nor do they fully utilise the benefits. Okay, so it’s not easy to read and remember the fine print in a 60-page policy document. And there is only so much an agent can explain to you, given how busy people are today. Fair enough!
So let’s check out some of the lesser known features many health plans offer:
1. Not just allopathic treatment: As per the Insurance Regulatory Development Authority of India (IRDAI) 2013 guidelines, health plans can cover alternative treatments such as Ayurveda, Unani, Siddha, and Homoeopathy (AYUSH). Since then, many health insurers have been providing for alternative treatments from a government hospital or an institute recognised by the Quality Council of India and National Accreditation Board for Hospitals and Healthcare. Over the last five years, insurers have launched benefits under different terms and conditions. While some bring this under the ambit of their primary coverage plan, others keep it under sub-limit treatment. So, if you are a proponent of alternative medicine, check if your health plan covers it.
2. Free health checkups: Your health plan offers free medical checkups, as long as it is within the predetermined limit stated in the plan. The plan is available to policyholders who have had four or five consecutive claim-free years. What’s even better is that the health checkup is cashless when availed of at an empanelled hospital or centre. So make sure you use your free health checkup.
3. Domiciliary/Day Care treatment: Treatment at home for disease or injury, under medical supervision, is compensated for by health insurance companies. Though hospitalisation would be the normal recourse, the patient’s feeble condition or unavailability of a hospital room/bed can often make this difficult. There is a limit on the amount and number of days for which the benefit is available, so familiarise yourself with the terms and conditions. Some insurers cover as many as 500 days of domiciliary treatment.
4. No-claims bonus: If you don’t file a claim during the policy’s year-long tenure, you’re eligible for a bonus. The bonus could be a higher sum insured (up to 50 percent) or a discount in premium during the annual renewal. Insurers may also offer a cumulative bonus instead for every no-claim year. Check for this benefit during a year in which you don’t file any claims.
5. Convalescence/Recovery benefit: Your health insurer could pay you a lump sum to cover additional costs – such as loss in income or compassionate visits by family members – resulting from prolonged hospitalisation, as defined in the policy document. It could range from 7 to 12 days. Look up the terms and conditions to make use of this feature.
6. Daily cash benefit/Daily hospital cash allowance: During hospitalisation, your insurer could offer additional coverage for expenses other than the mainstream treatment. These could be towards food and hospital visits. In case of ICU and accidental hospitalisation, the allowance could be double. Remember to use it if it’s available.
7. Lifelong renewability: As long as you have been making regular and timely payment of premium upon renewal, your policy is lifelong.
8. Sum assured restoration/Recharge: If you’ve exhausted the entire sum assured within the policy’s annual term, the health insurer could recharge it for you, subject to terms and conditions. The facility to restore is available when the sum assured is used up completely from earlier claims. The coverage is usually for future claims unrelated to those already made. Some insurers may offer unlimited refills during a policy year.
9. OPD treatment: Your health plan could reimburse outpatient expenses such as doctor’s consultation fees, pathological tests, and cost of medicines. You don’t need to be hospitalised to make this claim.
10. Organ transplant: Health insurance plans include surgery costs for an organ transplant, either in full or in part or as an add-on benefit. Notably, the scope of coverage is limited to harvesting the organ and excludes donor’s hospitalisation costs, post-surgical complications, and cost of screening.
11. Attendant allowance: Health insurance plans for children offer an allowance to an accompanying adult. In most cases, the number of days is prefixed, and the amount predefined.
12. Dental treatment and bariatric surgery: Health plans have started to include dental treatment once in every few years, with sub-limits. No more considered a cosmetic procedure, bariatric surgery for obese patients fighting weight-related medical conditions is also covered for its life-saving benefit.
13. Flexibility: You can find health plans that will cover you regardless of your age. On retirement, you could opt for a floater that covers you and your spouse during your twilight years. Similarly, some health insurers offer policies customised for people not covered due to a pre-existing illness or as a result of pre-policy medical tests.
14. Reimbursement claims: If you’ve sought treatment in a non-networked hospital, you could still file a reimbursement claim. If a cashless claim is rejected due to incomplete paperwork, you can try again later after the paperwork is complete.
15. Maternity expenses: There are health insurance policies specifically designed to cover maternity expenses incurred in hospitalisation for the delivery, prenatal expenses (checkups, tests and medication, even emergency ambulance services) and post-natal expenses (follow-up visits, medication, related confirmatory tests, etc). These policies go as far as covering the newborn’s medical expenses from birth to 90 days. The waiting period for these policies is nine months.
16. Pre- and post-hospitalisation expenses: Pre-hospitalisation expenses are the medical expenses you pay for an ailment that you were admitted for later. Most health insurance plans will cover these medical expenses for anywhere between 30 and 90 days prior to hospitalisation. For example, medical tests (blood test, urine test and X-ray) asked by the doctor for diagnosis and subsequent treatment of the medical condition is a pre-hospitalisation expense. Post-hospitalisation expenses refer to the medical expenses in the follow-up treatment of the condition for which you were hospitalised. Most health insurance plans will cover these medical expenses for anywhere between 45 and 90 days after discharge from the hospital. Diagnostic charges, consulting fees and medicine costs are examples of post-hospitalisation expenses covered. If your health insurance policy offers out-patient department (OPD) or day-care procedures, physiotherapy expenses will be reimbursed. Acupuncture and naturopathy aren't covered. To claim both, pre and post hospitalisation expenses submit your original bill receipts and relevant copies of doctor’s certificate and discharge summary.
17. Ambulance expenses: Some policies may reimburse the ambulance fee under a family floater plan or expense cover. Additionally, an air ambulance cover for up to a limited value can be provided as an add-on.
Ignorance isn’t bliss. Awareness is advantageous. So familiarise yourself with these features in the context of your existing health plan or while selecting anew from a host of policies. Avail these benefits to maximise protection and get your money’s worth.
Disclaimer: The policy benefits might vary depending on the health insurance plan bought by the user. All these benefits might or may not be available in their plan. Users are advised to check their policy document to ensure they are fully aware of all features and benefits of their health insurance plan.