Understanding Health Insurance: Here’s What All You Need To Know

Well-being of a family is important for every individual and health of family members is of utmost priority for most of us. The fact of today’s life is that the medical emergencies can strike on anyone and anytime, irrespective of age, gender or individual’s lifestyle. While age-related ailments are inevitable, even the younger generation is not immune to the possible hospitalisation due to accidents or health issues fueled by lifestyle-related choices. Rising medical expenses are also of great concern for everyone today, and if not planned properly, prohibitive treatment costs can wreak havoc within a family.

Amid uncertainty, health insurance is an individual’s safety net in the event any family member needs to be hospitalised. Rising costs of hospitalisation may render individual health insurance cover inadequate to cover all the expenses.

Health Insurance plans covers following medical expenses/procedures:

1. In-Patient hospitalisation for less than 24 hours: While a basic health insurance policy requires the policyholder to stay in the hospital for a minimum of 24 hours to be eligible for an insurance claim, however today due to technological advancement in the medical field, most insurance companies are covering procedure/treatment not requiring in-patient hospitalisation for less than 24 hours under the purview of day care procedures.
2. Pre and Post-hospitalization expenses: Medical costs incurred 60 days prior to the hospitalisation and 90-days period following patient’s discharge – linked to the in-patient hospitalization are covered under the health insurance plans offered by insurers.
3. Domiciliary Treatment: Medical expenses that are incurred by the policyholder for availing medical treatments at his/her home at the advice of the attending medical practitioner in case he or she cannot be transferred to the hospital or because of non-availability of hospital bed, are subject to reimbursement under value-added health insurance plans. Reimbursement for the domiciliary treatment is payable provided that the condition for which the medical treatment is required continues for at least 3 days.
4. Coverage for Alternative Treatment: Health insurance plans does cover the medical expenses incurred for in-patient treatment under traditional or alternative forms of medicine such as Ayurveda, Yoga, Unani, Siddha Homeopathy, collectively known as AYUSH. Reimbursement for AYUSH treatment is payable for in-patient treatment taken in a government hospital or in any institute recognised by government and/or accredited by Quality Council of India/National Accreditation Board on health or any other suitable institutions provided that the policyholder is hospitalised for this treatment and the hospitalization is not for any evaluation or investigation. As a matter of prudence, if a claim is accepted under AYUSH, then any payment under allopathic treatment of the same policyholder and the same Illness or accident is not accepted.
5. Restoring of Sum Insured: Basic health insurance products have an annual limit of the sum insured, which means that a policyholder cannot claim more than the sum Insured from his/her health insurance policy during a policy year. However, with ever-rising medical costs, exhausting sum insured on health insurance policy in a single incidence of hospitalisation is quite possible today. Recognising changing dynamics of healthcare market and individuals’ needs of a secure and healthy future that guarantees coverage in case of medical exigencies, some insurers offer facility of automatic restoration of Sum Insured after the basic policy’s sum insured is exhausted during a policy year. Under this facility, if the basic sum insured is exhausted due to claims made during the policy year, then an additional sum insured (equal to 100% of the basic sum insured) inclusive of the no claim Bonus, if any, is automatically available for the particular policy year.
6. Maternity Benefit: Health Insurance policy has plans covering expenses towards pregnancy and maternity. In fact, any aspect that traces to pregnancy was not covered under traditional health insurance plans. However, the maternity benefit is available under the new age plans offered by insurers. As a matter of prudence, typically there is a waiting period of four years before the policyholder can avail of the benefit. It must be noted that Maternity Benefit in such plans is a part of sum insured and not over and above it. Also, the maternity benefit is for the first two deliveries, irrespective of previous babies being enrolled or not. While there is no coverage for normal healthy baby, such plans extend coverage to the new-born baby, who is ill and needs medical attention.

Disclaimer: All information in this article has been provided by HDFC Ergo and NDTV is not responsible for the accuracy and completeness of the same.