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Known / Unknown Benefits Of Your Health Insurance!

Neha Gadoo Neha Gadoo 02 February 2017
4.0 (5 votes)

Unaware of what your health insurance plan can provide you with? Never mind most of us fall into the same league. Most of us believe the said about health insurance policies. i.e they cover hospitalization charges, but there is much more to a health insurance than hospitalization charges.

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photo credit: Mylla via photopincc

Unaware of what your health insurance plan can provide you with? Never mind, most of us fall into the same league. Most of us believe the said about health insurance policies. i.e they cover hospitalization charges, but there is much more to a health insurance than hospitalization charges.

A traditional health insurance policy provides you with

  • Peace of mind: With health care coverage, your plan pays some of your medical costs and makes you more at ease.
  • The FFF- family's financial future: Having health coverage lessens the likelihood that you'll have to dip into savings to pay for unexpected medical costs.
  • Pre and post hospitalization expenses.
    • Room, Boarding expenses
    • Nursing expenses
    • Fees of surgeon, anesthetist, physician,consultants, specialists
    • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and similar expenses.
  • Sum Insured: The Sum Insured offered may be on an individual basis or on floater basis for the family as a whole.
  • Cumulative Bonus ( CB) :Health Insurance policies may offer Cumulative Bonus wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage (generally 50%)
  • Cost of Health Check-up: Health policies may also contain a provision for reimbursement of cost of health check up. Read your policy carefully to understand what is allowed.
  • Minimum period of stay in Hospital: Usually this is 24 hours of hospitalization to be able to make a claim.
  • Cashless Facility: Insurance companies have tie-up arrangements with a network of hospitals in the country.

Earlier buying health insurance was like buying Nokia phone very few options to choose from. The policies that were available had standard features with a nominal difference in their premiums.

In the past, health insurance buyers had the options of choosing only from PSU companies, of late, with the entry of exclusive health insurance companies in India, you can see the much needed innovation in terms of customer friendly benefits such as lifelong renewal, restoration of cover, portability offered by these key players.

To simplify things, here are some of the good, unique, known and not-so-known health insurance benefits offered by the insurance companies in the recent time:

Lifelong renewal

A traditional mediclaim policy has a fixed age limit but some of the policies have eliminated the exit age clause i.e. the customer can enjoy the benefit of renewing the policy and enjoying the health insurance coverage all through his life. This is an important benefit as most individuals need a health insurance policy in the latter years of their life.

Coverage for larger families in one health insurance policy

Typically, a traditional policy would cover only one insured member for the coverage or sum insured but in the recent times family floater health insurance is designed to cover the family's medical expenses under one umbrella. The sum assured is available to all members.

Eg.Oriental insurance family floater covers your immediate family members (spouse, dependent children, parents or parents in laws up to the age of 60 years) while Max Bupa Family First covers up to 13 relationships under one umbrella.

Cover restoration

Some health insurance product undertakes to restore the basic sum insured in case the policy holder utilizes the entire cover in a particular year. For instance under Apollo Munich's product, the restoration facility can be used to bear the expenses for any ailment/condition that is dissimilar to the one for which the claim has been made. The Religare Care offers an improved restored option where the insured individual does not have to wait for the sum insured to be exhausted.

Second Opinion

Standard health insurance policies would cover only one doctor's consultation fee but in the recent times specialized health insurance companies know the importance of getting second opinion from a specialized doctor and hence offer the benefit of second opinion from a medical practitioner for selected major illnesses. Eg. Religare offer the Second opinion coverage.

Vaccination cover

Previously mediclaim polices did not cover maternity expenses, but of late health insurance plans cover maternity expenses and also provide the vaccination expenses for the children. Please note, that this benefit is covered post waiting period for maternity ranging from 2 years to 4 years. Eg. Plans offered by Max Bupa, Star Health, Apollo, etc have this feature.

Health Insurance covering OPD expenses

24 hour hospitalization for reimbursement was the traditional way , new health insurance providers cover outpatient department (OPD) expenses, like routine doctor consultations, medical checks, dentist consultation and treatment bills. The inclusion of OPD benefits means that the insured individual need not be hospitalized to seek insurance benefits. E.g. ICICI Complete health and Star Health Comprehensive offer health insurance with OPD benefits.

Take advantage of health and wellness tools

Beside from providing financial protection, many health insurance plans offer benefits, resources and incentives to help you and your family get and stay healthy.

These may include coverage for annual check-ups and screenings, and discounts on exercise programs and alternative care treatments. Review your plan materials and take advantage of the programs offered.

Varied premium structures

Earlier the premium structures of the health insurance policies remained same all over India, but in the recent times some companies like Bharti AXA, Max Bupa, New India Assurance, Star Health, etc. have introduced the concept of Zone based premiums for Metros and Smaller Towns.

The pricing structure for the health insurance policies for smaller towns is lower than the pricing in metro cities mainly because the medical expenditure and cost of treatment is higher metro cities.

Daily hospital cash allowance

Really! did any of you know that all the food, commuting, family expenses, all are paid by the insurer! After all even these add up to substantial amount. Yes, the solution to this is your policy. Check for daily hospital cash allowance, in form of pre-fixed, per day cash handouts,this is usually provided without the requirement of submitting any bills or documents.

Convalescence Benefits

Is your recovery not costly? Oh yes hospitalization charges apart some companies also take care of the recovery charges. 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.

In case of some policies, the post-hospitalization stage could be treated as the recuperating period. You need to be aware of the predefined benefit amount and period.

Treatment taken at home

The usual impression of health insurance covers is that their scope is restricted to hospitalization or day-care procedures. However, many policies widen their coverage to include home treatments too. 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."

Attendant allowance

Your kid is hospitalized? No worries, 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 hospitalized, a daily cash amount for one accompanying adult for each day after the third day of hospitalization is included in health insurance policies,"

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.There are also others that give 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.

Now that we have enlightened you with all the publicized and unpublicized benefits, you are good to enjoy them all.

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Neha Gadoo
Written by Neha Gadoo
Daring and Bold, Neha loves philosophy, trekking and walking bare feet in the rain. Loves talking and can stare out of a car window for hours continuously.