There are several benefits that health insurance policies offer to customers. Unfortunately, most of us are not aware of these benefits.
For example, the father of one my friends from Mumbai had to undergo kidney failure treatment. My friend was aware of the fact that his health insurance policy will cover the treatment costs. He however did not know the lesser-known fact that an extra lump-sum amount of INR 2 lakhs could be claimed by him from the insurer as part of critical illness clause in the policy. After his insurance agent informed him of this benefit, he subsequently managed to get this additional amount.
There was another friend whose mother got hospitalized after she contracted pneumonia. This friend made a claim to the insurer for only the hospitalization expenses. He did not ask for the post-hospitalization costs that were also covered by the policy. In this instance as well, my friend claimed the additional amount after his insurance consultant advised him of the added benefit.
It is important for all of us to carefully and thoroughly read through the insurance policy documents; not doing so may result in you losing out on several benefits, if and when the need to make a claim arises. All of us usually overlook varied insurance benefits like attendant allowance, ambulance charges, and pre and post-hospital treatment expenses. It is important for us to check the documents and verify whether such expenses will be payable by the insurer before signing them.
Several insurers provide benefits which are over and above the normal treatment costs at day-care clinics or hospitals.
Some of the ‘no strings attached’ and under-used benefits of insurance policies are mentioned below:
- Domiciliary hospitalization
Domiciliary expense refers to home treatment availed by the insured under specific circumstances and on the advice of a doctor, wherein it is not possible for the customer to go to hospital. Most of us do not know that these benefits exist and hence it is rarely utilized. Specific conditions have also been put in place by the insurers with regards to these kinds of claims.
For example, as per some insurance policies it is important for an ailment to require treatment for a minimum of 3 days and only then such claims can be met. It may also be noted that domiciliary expense claims will void any and all post-hospitalization expenses claims. Treatment of health conditions like fever, bronchitis, asthma, and common cold does not qualify. Home treatment also comes with sub-limits. For instance, the family floater policy of Oriental Insurance allows for payment of 10 percent of the assured sum or INR 25,000, whichever is lower, for domiciliary expenses. The premium option of this policy has INR 50,000 as the sub-limit.
- Alternative treatments insurance coverage
The 2013 health insurance guidelines issued by the IRDA had asked insurance companies to take into account different kinds of non-allopathic treatments like homeopathy, ayurveda, siddha, and unani as for coverage. Some companies have come up with such policies. However, they come with caps on the coverage that is provided. The policy by New India Assurance provides 25 percent reimbursement of such non-allopathic treatment expenses if such treatment is carried out in a government hospital.
- Donor expenditures
Health insurance plans cover not just the costs incurred on treatment of the policy holder, but in cases such as an organ transplant, also covers the hospitalization expenses of the donor of the organ. This is one benefit that many of us are not aware of.
- Convalescence/recovery benefit
In addition to payment of day care costs and hospital bills, some insurance policies also offer payment in case of a lengthy hospitalization period, i.e., 10 to 15 days. This benefit is in addition to the insured sum and it is paid out as a lump sum to the insurance policy holder.
- Attendant allowance
In case a patient gets hospitalized, then one member from the family tends to stay with the patient during the hospitalization period. This person’s expenses are an added financial expense. It can include eating expenses in the hospital’s cafeteria, and fees for an extra bed, etc. This is when attendant allowance becomes very useful, especially financially. The allowance is paid by the insurer according to the number of days that the insured patient remained in the hospital for treatment.
Attendant allowance can be claimed at the time of getting reimbursement for hospital expenses. Most of us do not know about this allowance and hence do not include documents for it while making the hospitalization claim and thus lose out on this great insurance benefit. It may however be noted that most companies have a 10 to 15 days cap on payment of attendant allowance. For example, the health plan of Oriental Insurance offers a payout of INR 500 on a daily basis, per ailment, for not more than 10 days. The General policy of Tata-AIG offers a daily payout of INR 300 to 500 with the cap limit in the range of INR 9,000 to 15,000.
- Complimentary check-ups
There are many insurance companies that come with a free or complimentary health check up option. This benefit is linked to the total number of years that the policy holder has not made any insurance claims. Most customers do not have any knowledge of this policy benefit. The maximum limit of the benefit comes with a cap of 1 to 2 percent of the insured sum and is dependent on the plan purchased by the customer. This free health check up benefit offered by insurance companies typically remains largely underutilized or unused. It may be noted that the complimentary health checks are usually a part of the well-being insurance benefit provided every year regardless of claims.