What are the Benefits of Health Insurance?

This article mentions a complete list of benefits that a health insurance policy offers to help you decide your next purchase.

Comprehensive Medical Coverage

Health insurance plans are designed to offer a comprehensive medical insurance cover with which you no longer need to worry about managing steep treatment costs. It is the best possible solution to manage an unexpected hospitalisation or even a planned procedure without worrying about finances.

In-patient hospitalisation

In-patient hospitalisation refers to the treatment where the patient is admitted to the medical facility for at least 24 hours. All insurance policies are designed to cover in-patient hospitalisation in a policy.

Pre- and post-hospitalisation cover

Along with the treatment cost of hospitalisation, medical insurance benefits include pre as well as post-treatment expenses, which includes diagnosis charges and expenses for tests prescribed by a medical professional. On the other hand, post-hospitalisation cover provides financial assistance for the expenses that may be required after the actual treatment. Sometimes, the cost of medicines required can be high, and during these situations, a post-treatment cover helps. Generally, health insurance policies provide a 30-day cover for pre-treatment expenses, whereas a 60-day cover for post-treatment expenses.

Day-care expenses

Day-care procedures are surgeries that formerly required hospitalisation, but in today’s times, can be completed within a couple of hours. Improvement in medical technology, along with effective medicines and quality medical procedures, have made it possible. Alternatively, it is also known as short-term hospitalisation. Generally, the time required for a day-care procedure is anywhere above 2 hours, but less than 24 hours. The coverage for day-care expenses in health insurance insures minor treatments, which otherwise can be expensive.

Coverage for Critical illnesses

Illnesses that can be fatal and prolonged in nature such as heart ailments, renal failure, cancers of varying intensity are among the illnesses that are covered in a critical illness cover. Critical illness plans function differently when it comes to paying compensation. Here, the entire sum assured is paid in lumpsum by the insurance company on the diagnosis of the specified ailment. Such lumpsum pay-out provides financial support for treatment as well as other costs of medical support. A little-known benefit of a Critical illness insurance is the cover for organ donation.

Room rent & ICU charges

The comprehensive coverage of a health insurance policy includes cover for room rent and ICU charges. Room rent charges are expenses incurred during hospitalisation for accommodating the insured at the medical facility. Depending on the illness, a patient may be either admitted to a regular ward, or ICU, or even an ICCU. Generally, there is a limitation on the amount of room rent that is covered by the insurance plan. Beyond such an amount, any expenditure towards room rent shall be required to be paid by the policyholder.

*Standard T&C Apply

Cashless Treatment at Network Hospitals

Health insurance plans are purchased to avail financial protection for uncalled medical emergencies. Paying the medical bills at this time can be a bummer, and so can reimbursing them. So opt for a policy that offers a cashless claims facility. Via a cashless health insurance plan, the treatment cost is directly paid by the insurance company to the hospital, thereby not requiring a significant cash flow from your end.

Domiciliary Cover for Home Treatment

Health insurance benefits include domiciliary cover, where the policyholder can avail treatment at home. It may be required due to a lack of medical facilities, or the severity of the illness that limits the mobility of the patient. Elderly individuals can benefit from this advantage of health insurance. The primary benefit of this feature in health insurance is to enable ailing individuals to get treatment when there are problems either with hospitalisation or with the movement or mobility of the patient.*

Ambulance Charges for Transportation of the Patient

Health insurance plans also offer the additional benefit of ambulance expenses that are covered in the policy’s scope. Here, any charges for transporting the patient using an ambulance are covered in the health insurance plan. Since these charges are high, especially in metro regions, it is best to have the safety net of a health insurance policy covering such expenses.*

Coverage for Pre-Existing Diseases

The advantages of health insurance include coverage for pre-existing diseases. An individual at the time of purchase might have some already existing illnesses like chronic diseases like heart conditions, cancer, and asthma, and the like. It is especially the case for elderly buyers of health insurance plans. These illnesses, already existing at the time of purchase, are known as pre-existing illnesses. When you purchase a health insurance plan, its coverage includes pre-existing diseases as well as future treatments for specified ailments. So, you need not worry about paying from your pocket for these treatments. However, one thing to note is that the insurance company generally levies a waiting period before which such illnesses are included in your policy, and you must check it before buying.*

Cumulative Bonus at Renewal

Not every policy tenure has claims made by the policyholder. In these situations, the insurance passes on the benefit of making no claim by raising the sum assured of your policy at renewal. This increase in sum assured is known as cumulative bonus and ranges between 10% to 100% of the sum assured and is a lesser-known benefit of health insurance plans.*

Lifetime Renewability

Lifetime renewability benefit in medical insurance allows the policyholder to renew their health insurance plan without any restriction on age. This comes in handy when you are covered with a family floater plan and the eldest member hits the upper age limit. In ordinary situations, the coverage would end, but with the lifetime renewability benefit of health insurance, you can enjoy continued renewal for your entire life. Also, for senior citizens, lifetime renewability alleviates any financial pressure of a medical emergency with a continued renewal of their insurance cover.*

Convalescence Benefit

Some illnesses require a longer duration for recovery than the period of hospitalisation. It can be due to the critical nature of the treatment or severity of the illness. That’s when convalescence benefit comes in handy. In such situations, the insurer pays a lumpsum amount towards the recovery cost and the duration of such period may range between seven or ten days. It can even help to compensate for the loss of income during the period of recovery.*

Option to Seek Alternative Forms of Treatment (AYUSH)

Health insurance benefits include coverage for alternative treatments where procedures belonging to the disciplines of Ayurveda, Yoga, Unani, Siddha and Homeopathy are covered. These treatments aren't a part of mainstream medicine. Health insurance plans provide additional coverage to offer a choice of treatment to the policyholder.

Daily Hospital Cash Allowance

During the period of hospitalisation, you won’t be able to work, leading to a loss of income. In this scenario, a cash crunch may arise with mounting hospital bills. Using the daily hospital cash allowance, you can overcome such a situation. The insurance company provides a specified amount for every day of hospitalisation, compensating for the loss of income.*

Facility for Medical Check-Up

Since illnesses come unannounced, a health insurance plan benefits by providing a facility for medical check-up. Generally, this facility is available annually and by using one, you can evaluate your health and seek any treatment at an early stage. Depending on your health insurance plan, the cost of a medical check-up shall be borne by the insurance company. Alternatively, in some cases, these costs are also reimbursed by the insurer.*

Coverage for Bariatric Treatments

Not all insurance companies provide cover for bariatric treatments, only a select few (which includes Bajaj Allianz General Insurance Company). Bariatric surgery is a medical procedure for treating obesity when standard weight-loss measures such as dieting, routine and rigorous exercise have been attempted but have not resulted in the desired effects.*

Sum Insured Restoration Benefits

The restoration benefit is a feature in health insurance plans that restores any used amount of claim to its original sum assured. Generally observed with family health insurance plans, it helps tackle recurring medical expenses for the same beneficiary or different beneficiaries. With the soaring treatment costs, exhaustion of sum insured would mean you need to pay from your own pocket for its treatment. But with the reload feature by your side, the sum assured gets reinstated to the original amount.*

Restoration benefit is classified into two types, based on how the policy coverage is exhausted - complete exhaustion of the sum assured or partial exhaustion of the sum assured. In complete exhaustion, the entire sum assured must be exhausted; only then will the restoration benefit kick in. On the contrary, partial exhaustion requires only a part of the sum assured to be used up to restore it. It is essential to check which type of restoration benefit the insurance company offers when buying one.

Maternity Coverage & Newborn Cover

Health insurance benefits include coverage for pregnancy and childbirth costs. While motherhood is a new and magical experience, it may also come with medical complications. In such times, a health insurance plan can provide a financial shield, letting you focus on the treatment and not worry about the cost. In addition, maternity covers in health insurance policies also provide protection for new-borns as young as 90 days. One thing to remember - a detected pregnancy is considered as a pre-existing disease in maternity covers and hence, must be purchased beforehand.*

Add-On Riders

The benefits of a medical insurance cover also include the ability to customise your insurance cover using add-on riders. These riders are optional features that can be opted for to increase the scope of your health insurance policy. This way, one can customise their insurance policy to ensure additional coverage.*

Coverage of COVID-19

Other than compensating for treatments mentioned in the policy document, health insurance plans also extend to provide coverage for COVID-19. A circular by the Insurance Regulatory and Development Authority of India (IRDAI) in March 2020 declared all existing insurance plans to include coverage for COVID-19 and handle cases expeditiously[3]. Thus, if you are seeking coverage against the virus, a health insurance plan will provide the necessary benefits.*

Wellness Benefits

The concept of wellness benefits lies in the adage ‘prevention is better than cure.’ Wellness benefits are in addition to the financial support health insurance policies provide. They can be in the form of concession in renewal premium, membership benefits to specified organisations, vouchers for booster and supplements, free of cost diagnostic checks and health check-ups, redeemable pharmaceutical vouchers, and more. It is a win-win situation when opting for a plan with wellness benefits, as it helps to keep you ahead of ailments.*

Tax Benefits under Section 80D

Not just financial cover, health insurance plans also provide tax benefits. These tax benefits are available in the form of a deduction. Any premium paid is eligible for deduction under section 80D of the Income Tax Act. The value of the deduction differs based on the age group, with a maximum amount of ₹50,000. The table below summarises the deduction that can be availed –