Your health plan covers more than hospitalization
02 Jun, 2014 02:02 PM
Here's a low down on a host of lesser-known benefits that are offered to customers of health insurance policies.

When 45-year-old Bangalore resident Rajeev Murthy's father underwent treatment for kidney failure, he knew he had his health insurance policy to fall back on. However, he was not aware of the additional lump-sum of 2 lakh for critical illnesses that he could claim from his insurer. Subsequently, on his insurance consultant's advice, he managed to claim this amount.

Sandeep Kandap, a 28-year-old software professional, faced a similar situation when his mother was diagnosed with pneumonia. Kandap made a claim only for the hospitalization bill, overlooking the post-hospitalization expenses the policy offered. Only after the agent stepped in did he claim the amount.

You could stand to lose if you do not scrutinize the policy documents thoroughly. "People tend to overlook benefits like ambulance charges, attendant allowance and pre- and post-hospitalization expenses. You should ascertain whether such expenses are payable," says Sudhir Sarnobat, CEO of health insurance consultancy firm Many insurers offer benefits over and above regular hospitalization and day care treatment procedures. Here are some under-utilized, no-strings-attached benefits that you need to keep track of.

Domiciliary expense

This refer to treatment taken at home under a doctor's advice and specific circumstances, where the insured can't go to the hospital. "This is rarely used, as the customer is not aware of the existence of such benefits," says Sandeep Patel, managing director and CEO, Cigna TTK Health Insurance. Insurers have specific conditions for claims under these heads. For instance, some policies lay down that the illness must necessitate treatment for at least three days for a claim to be raised. However, if you claim for domiciliary expenses, you will not get post-hospitalization expenses. Treatment of ailments, including asthma, bronchitis, common cold and fever is not eligible. There are also sub-limits for treatment at home. For example, Oriental Insurance's family floater policy pays the lower of 10% of the sum assured or 25,000 for domiciliary hospitalization. This sub-limit is 50,000 for its premium variant.

Donor expenses

Health plans not only cover the expenses incurred on the policyholder's treatment but, in case of an organ transplant, also pay for the hospital bills of the organ donor. "In case of organ transplants, the hospitalization and treatment expenses of the donor will also be covered by the health policy, " says Joydeep Roy, CEO, L&T Insurance.

Coverage of alternative treatments

IRDA guidelines on health insurance issued in 2013 asked companies to consider providing coverage to non-allopathic forms of treatment, such as ayurveda, unani, siddha and homeopathy. Some insurance companies have launched such plans. But there is a cap on the coverage offered. New India Assurance offers to reimburse 25% of such expenses, provided the treatment is taken at a government hospital.

Convalescence benefit

Besides paying the hospitalization bills and day care expenses, some insurance plans pay if the hospitalization has been lengthy, say, over 10-15 days. This benefit is over and above the sum insured and is paid as lump sum to the policyholder.

Complimentary health check-ups

Most insurers offer a free health checkup that is linked to the number of claimfree years. However, not many policyholders know about this benefit. The maximum benefit is capped at 1-2 % of the sum insured, depending on the insurance plan you have bought. "The benefit of health check- up offered by the insurers is largely unused. Such free health checks are normally a part of a well- being benefit offered each year irrespective of claims," says Patel.

Attendant allowance

If a person is hospitalized, at least one family member stays with him in hospital. His or her expenses is an additional financial burden on the family. Then there are other expenses, such as the charges for an extra bed or eating in the cafeteria. This is where the attendant allowance comes handy. It is paid on the basis of the number of days the insured person was in hospital. "It is reimbursed along with the claim documents. However, again due to lack of knowledge customers do not include this at the time of claim document submission and miss out on the benefit," explains Patel. However, insurance companies usually have a cap of 10-15 days on this payout. For instance, Oriental Insurance's health plan offers 500 per day, for a maximum of 10 days per illness. Tata-AIG General's policy pays 300-500 per day, with an overall cap of 9,000-15,000.
Source : The Times Of India

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