Other expenses and charges in health insurance policy!

What are other charges and factors for a health insurance policy?

Organ Donor Expenses
In case of organ failure (especially kidney failure), transplantation of the organ become necessary. In such cases, a person of the family donates the organ to save the life. In such case two persons are hospitalised and expenses incurred may be nearly doubled. Health Insurance covers cost of hospitalization for person receiving the organ while expenses incurred by person donating the organ ware not covered even if he/she has health policy. There are few companies like Max Bupa which covers the cost incurred for person donating the organ subject to overall limit.

Domiciliary Treatment
This is not so important criterion while selecting an health insurance plan since as per the terms conditions, reimbursement for domiciliary treatment is rare. Domiciliary treatment covers expense incurred for medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a Hospital/Nursing Home but actually is taken while confined at home in India due to the following reasons:

  1. The condition of the patient is such that the patient /she cannot be moved to the Hospital/Nursing Home or
  2. Due to lack of accommodation at the Hospital/Nursing Home, the patient cannot be removed.

The condition should continue for 3 days. Certain illness like Asthma, Bronchitis etc. are excluded.

Pre & Post hospitalization Expense
This is important but not critical factor in selecting a product or company. Most companies allows 30 days pre-hospitalization and 60 days post hospitalization expense. So expenses incurred for medicine or for consultation in case of post hospitalization are covered. Some Companies specify upper limit for post-hospitalization expense. These are covered only when the hospitalization claim is accepted by the Insurance Company.

Emergency Ambulance Charges
This is again a desirable feature since in case of emergency or post surgery, ambulance services might be needed by the patient. Nearly all the Insurance companies provide for the Ambulance charges, different company have different limit starting from Rs 750 to Rs 2000/- per hospitalization. Companies also specify maximum limit towards ambulance charges in a year.

Day Care Treatment
With medical advancement of technology, hospitalization for treatment of certain diseases is not mandatory. Insurance Companies realises this fact. Further due to no hospitalization, lodging & boarding expenses are saved. Expenses incurred on treatments of diseases like the following are also covered (even though the hospitalization is for less than 24 hours) –
chemotherapy, radiotherapy, eye surgery, dialysis, lithotripsy, tonsillectomy, d&c, cardiac catheterization, cataract, coronary angiography, coronary angioplasty, hernia repair surgery and hydrocele surgery etc. Various Companies have specified list of surgeries whose treatment are covered. The number of day care surgeries ranges from 9 (ICICI Lombard) to 146 (Apollo Munich) to all (Max Bupa). This is an important fact to consider since with further advancement, this list will grow.

Daily Cash Benefit
Normally in case of child hospitalization, one adult attendant is needed. In such cases, the expenses increase. Only Apollo Munich pays fixed daily amount for the accompanying adult with child below 12 years for hospitalization of more than 72 hours.

New Born Baby Coverage
The minimum age for Health Insurance coverage is 3 months. Therefore the new born babies are not covered under Health Insurance policy. However in case the maternity expenses are paid by the Insurance Company (like Max Bupa, Apollo etc.), the expenses incurred on the New Born Bare baby are allowed, subject to limit. Vaccination charges are normally not covered by Insurance companies. Presently only Max Bupa allows reimbursement of Vaccination expenses in their Platinum plan.

Cumulative Bonus or No Claim Bonus
In case of Claim free year, many companies reward the customer by either enhancing SI by 5% to 10% for e very Claim Free year, subject to maximum Cumulative Bonus of 50% or by offering 5% to 10% discount on Renewal Premium.
What happens if a person makes a claim – In such case the Cumulative Bonus is reduced by 20% thus it does not become zero, if a person has accumulated 50% Cumulative Bonus, making one claim.

Health Check-up
Most insurance companies reward their customer in case of no claim by offering free Health Check up. Free Health Check is offered for every/two claim free years for one or more family member. Some companies reimburses the expense incurred (subject to limit) on Health check-up while some gets the health check up from their Network Hospital. Max Bupa offers health check up for all the members of the family regardless of claim

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