Most individuals simply assume that their health insurance policy pays only for the hospitalisation expenses. However, contrary to this common belief, many health policies foot the bill for associated expenses, too.
There are several under-publicised benefits in health insurance that remain unused due to lack of awareness. Irrespective of whether your insurer or advisor has educated you about these benefits, it would be a great idea to read the policy document yourself.
Remember, the utility of your cover depends not only on its features, but also how well you are able to utilise them. Read on to understand such benefits.
Daily hospital cash allowance
All health policies take care of the cost of hospitalisation. However, what about the expenses incurred on, say, food or refreshments? Or, the money spent by your family while commuting between hospital and home? After all, even these add up to a substantial amount. Well, the solution lies within your policy in the form of Daily Hospital Cash Allowance. Check if your policy offers this pre-fixed, per-day cash hand-outs.
"This sum is handed over without the insured having to produce any bill to support the claim, no questions asked," says Sanjay Datta, head, underwriting & claims, ICICI Lombard.
Hospitalisation costs apart, some companies also take care of the insured's recovery expenses. Also termed as recuperating benefit, this feature promises a lump sum in case of a prolonged stay at the hospital. "The duration of prolonged stay usually varies between 7 and 10 days among policies.
This benefit is usually provided to ensure supplementary costs due to the stay in hospital, such as a loss of income for the number of days in hospital," says Antony Jacob, CEO, Apollo Munich. "Associated costs, such as compassionate visits by family members, are also covered to some extent."
In case of some policies, the post-hospitalisation stage could be treated as the recuperating period. You need to be aware of the eligible benefit amount and period, which are usually pre-defined.
The recent Insurance Regulatory and Development Authority (Irda) draft guidelines may nudge all companies into covering non-allopathic forms of treatment, like Ayurveda, Unani and Homeopathy, but some of them do so even today. For instance, New India Assurance undertakes to reimburse 25% of such expenses, provided the treatment is taken at a government hospital.
The proposed norms seek to let insurers to pay for these expenses even if the treatment has been availed at any institute that is either recognised by the government, accredited by Quality Council of India/National Accreditation Board on Health or any other suitable institution.
Treatment taken at home
The general impression of health insurance covers is that their scope is restricted to hospitalisation or day-care procedures. However, many policies widen their coverage ambit to include domiciliary treatment, too. That is, treatment undergone at home as per doctor's advice. Primarily, this would be because the patient is unable to visit a hospital. "Here, the insured may be asked to submit bills from the doctor's clinic.
The pay-out is percentage or value-based," says Datta. The amount and the number of days for which the benefit period is payable is capped in terms of percentage of the sum insured or absolute amount. For instance, your policy wordings could make it clear that the benefit is restricted to 10% of the sum insured or Rs 25,000, whichever is lower.
Expenses related to organ donors
Any transplantation surgery puts tremendous strain on the insured - financially and emotionally. What's more, besides the cost of the organ recipient's treatment, the donor's expenses are also included in the hospital bill. Now, there is a provision in your insurance policy to claim expenses related to the donor as well.
"As per Irda regulations, the coverage offered during organ donation in all health policies now include treatment undertaken by the organ donor to the insured person. The treatment costs cover the expenses in surgery and harvesting the organ," says Antony Jacob. "However, the coverage does not include screening charges."
For adults looking after an insured child at a hospital, some policies promise a fixed allowance. "If a child aged 12 years or less is hospitalised, a daily cash amount for one accompanying adult for each day after the third day of hospitalisation is included in health insurance policies," adds Jacob.
The specific parameters could vary as per the insurer and the product. For instance, Oriental General Insurance's health plan offers 500 for each day of hospitalisation, which will be paid for a maximum of 10 days per illness.
Lump sum for critical illnesses
Typically, all policies cover expensive procedures like dialysis and chemotherapy. However, certain products offer a higher sum insured limit for certain critical illness. For instance, L&T Insurance's health policy offers double the sum insured for treatment of these serious ailments.
Then, there are others that hand out a pre-defined amount once such illnesses are diagnosed - much like a critical illness cover, just that you need not buy a separate one for the purpose. Certain high-end plans also provide a lump sum as survival benefit 180-270 days after discharge.