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Many policyholders wrongly assume that their health plan covers only hospitalisation expenses. Find out about a few lesser-known benefits that are offered to customers of health insurance policies. SANDEEP KANDAP 28 years, Mumbai When his mother underwent treatment for pneumonia, he claimed only the hospitalisation expenses. Only after he was told by his agent did he claim the expenses incurred on follow-up treatment and medicines.

When 45-year-old Bangalore resident Rajeev Murthy's father underwent treatment for kidney failure, he knew he had his health insurance policy to fall back on. However, he was not aware of the additional lump-sum amount of `2 lakh for critical illnesses that he could claim from his insurer. Subsequently, on his insurance consultant's advice, he decided to enquire with his insurer and managed to claim this amount after several rounds of negotiations.

A similar situation when his mother underwent treatment for pneumonia at a Mumbai hospital. Kandap initially made a claim only for the hospitalisation bill, overlooking the post-hospitalisation expenses that the policy offered. Only after the agent stepped in did he claim the amount spent on follow-up treatment and the medicines prescribed by the doctors.

These examples demonstrate what policyholders could stand to lose if they do not scrutinise their policy documents thoroughly. People tend to overlook benefits like ambulance charges, attendant allowance and preand post-hospitalisation expenses. You should read your policy documents carefully and ascertain whether such expenses are payable.

 

Many insurers offer benefits over and above regular hospitalisation and day care treatment procedures. Here are some underutilised, no-strings-attached benefits that you need to keep track of to make the most out of the premiums you pay.
Domiciliary expenses Domiciliary expenses refer to treatment taken at home under a doctor's advice and specific circumstances where the insured is unable to travel to hospitals. This is rarely used, as the customer is not aware of the existence of such benefits under which home treatment expenses are covered. Insurance companies have specific conditions for claims under these heads. For instance, some policies lay down that the illness must necessitate treatment for at least three days for a claim to be raised. Also, if you make claims for domiciliary expenses, the company will not pay for post-hospitalisation expenses. Treatment of ailments like asthma, bronchitis, common cold and fever is not eligible for this claim.

There are also sub-limits for treatment taken at home. For example, Oriental Insurance's family floater policy pays the lower of 10% of the sum assured or `25,000 for domiciliary hospitalisation. This sub-limit is `50,000 for its premium variant. SBI General's product provides a benefit of of up to 20% of the sum insured, with the maximum amount payable being capped at `20,000.
Donor expenses Health plans not only cover the expenses incurred on the policyholder's treatment but, in case of an organ transplant, also pay for the hospital bills of the organ donor. In case of organ transplants, the hospitalisation and treatment expenses of the donor will also be covered by the health policy,. Typically, there are no sub-limits, but some pre and post hospitalisation, donor screening costs and treatment expenses incurred by the donor after the harvesting are not covered.

Coverage of alternative treatments The Insurance Regulatory and Development Authority guidelines on health insurance issued last year have asked companies to consider providing coverage to non-allopathic forms of treatment, such as ayurveda, unani, siddha and homeopathy. Some insurance companies have also launched plans that cover the expenses on such treatments. But there is a cap on the coverage offered. For instance, the PSU insurer New India Assurance offers to reimburse 25% of such expenses, provided the treatment is taken at a government hospital. Likewise, Tata-AIG General has placed a cap of `20,000-25,000 for this benefit.

Convalescence benefit Besides paying the hospitalisation bills and day care expenses, some insurance plans also pay if the hospitalisation has been lengthy, say for more than 10-15 days. This benefit is over and above the sum insured and is paid lump sum to the policyholder.

Complimentary health check-ups Most insurers offer a free health check-up that is linked to the number of claim-free years, ranging from two to four years. However, insurers say not many policyholders know about this benefit and even fewer actually claim it. The maximum benefit is capped at 1-2% of the sum insured, depending on the insurance plan you have bought. The benefit of health checkup offered by the insurers is largely unused. Such free health checks are normally a part of a wellbeing benefit offered each year irrespective of claims. However, the industry average of utilisation of this benefit is less than 1-2%.

Attendant allowance If a person is hospitalised, at least one family member stays with him in hospital. His expenses and travelling to the hospital is an additional financial burden on the family. Then there are other expenses, such as the charges for an extra bed or eating in the cafeteria.

This is where the attendant allowance comes handy. It is paid on the basis of the number of days the insured person was in hospital. It is reimbursed along with the claim documents. However, again due to lack of knowledge customers do not include this at the time of claim document submission and miss out on the benefit. However, insurance companies usually have a cap of 10-15 days on this pay out. For instance, Oriental Insurance's health plan offers `500 for each day of hospitalisation, for a maximum of 10 days per illness. Tata-AIG General's policy pays `300-500 per day, with an overall cap of `9,000-15,000, depending on the plan chosen.

 

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