It is good to be aware of ‘Deductibles’ in your health insurance claim

As per standard industry practice, there are non-payable items in hospital bills under health insurance claims

You should be aware of what is payable and not payable on your hospitalisation claim by your health insurer. All insurers will require an itemised bill for the purpose of processing the claims, whether it is a cashless or a reimbursement claim.

Certain of the items in the bill, charged by the hospital, are not payable by the Insurance Company, as an Industry standard. These non-payable charges in the hospital bill are called ‘Deductibles’.

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Room Rent Limit – Why and how it is important

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance.

The limit imposed on the coverage of boarding expenses or room rent, along with nursing fees of the hospital is called room rent limit in health insurance. The limit is expressed as an absolute amount or as a percentage of Sum Insured or by the category of room. For instance,

  • If the allowed room rent limit in your health plan is ₹5,000, your plan would cover your boarding expenses up to ₹5,000.
  • If the limit is expressed as 2% of the Sum Insured and the chosen Sum Insured is ₹5 Lakhs, your plan would cover your boarding expenses up to ₹10,000.
  • If the limit is expressed by the category of room as Single Private room, then your highest eligible category is Single Private Room.
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Exclusions and Waiting Period in Health Insurance

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy.

It is imperative for any insurance buyer to know the details of coverage extended by various insurers before buying.

Two of the most important terms of health insurance are Exclusions and Waiting periods.

While buying health insurance policy for the first time, all the insurers exclude coverage of certain diseases for a specified period of time from the date of inception of the policy. Those are called exclusions and the period of exclusion of coverage is called waiting period.

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Daycare Procedures

Treatments that require less than 24 hours of hospitalisation

Due to advancements in technology, outpatient procedures such as cataract operations, etc., do not require 24 hours of hospitalisation. These come under the list of daycare procedures covered by an insurance company. The list of daycare procedures covered varies from one insurer to another. The full list of such procedures will be specified in the policy.

Ambulance Charges

Benefits paid towards usage of ambulances

As per a limit specified in the policy, the insurer pays for the Ambulance Charges related to each and every emergency hospitalisation. Usually, the limit is Rs. 1000 to Rs. 1500 per emergency hospitalisation.

Automatic Restoration

Sum Insured exhausted? No issues! This add on automatically restores it..

When your health insurance Sum Insured gets exhausted due to hospitalisation treatments midway during the policy period of one year, the automatic restoration benefit restores an equivalent amount of the Sum Insured for the remainder of the policy period.

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Convalescence Expenses

Benefits that are paid towards the insured’s recovery expenses

Convalescence benefit is also known as recuperating/recovery benefit. Under this benefit, the health insurance company covers the incurred recovery expenses for the insured. This acts as a cushion for the insured, paying any costs that may arise during and after hospitalisation. See Post Hospitalisation.

Critical Illness

A critical illness insurance policy covers the insured against life-threatening critical illnesses such as cancer, heart attack, renal failure etc. Upon surviving a minimum number of days, the insured can avail the benefits as mentioned in the Policy