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Health Insurance 888 views April 16, 2021
Health insurance covers your hospitalization expenses like – medication and laboratory test costs, ambulance fee, doctor fees, etc. So, if you have health insurance or are going to purchase one, you should know what medical expenses you can seek reimbursement for. Through reimbursement, you can get compensation for the medical expenses incurred during the hospitalization from the insurance company.
Table of Contents
Let’s check out here the list of medical expenses covered under reimbursement.
Room Rent Coverage
Your health insurance plan may have various sub-limits in respect of room rent. And those sub-limits may vary from one policy to another. For instance, you are hospitalized and your medical coverage has a room-rent sub-limit of INR 3,000 per day, and your room cost incurred is INR 5,000 per day. You will get INR 3,000 reimbursed from the insurer, while the remaining INR 2,000 is your liability.
Check out the table below and check out the plans that offer no sub-limit on room rent.
| Health Insurance Plan | Room Rent Sub-Limit |
|---|---|
| ICICI Lombard Complete Health Insurance | No room rent cap, covered up to the sum insured |
| HDFC ERGO Health Optima Restore | No sub-limit on room rent |
| Star Health Family Optima Insurance Plan | Up to In-Patient Hospitalization Cover |
| Niva Bupa ReAssure Health Plan | No room rent cap, covered up to the sum insured |
| Care Freedom | 1% of the sum insured for twin sharing room if the sum insured is up to INR 3 Lakh No room rent cap for twin sharing room if the sum insured is INR 5 Lakh or above No room rent cap for twin sharing room/private single room if the sum insured is INR 5 Lakh or above |
| Niva Bupa Health Companion | No room rent cap, covered up to the sum insured (if the sum insured is INR 5 Lakh or above) |
| ICICI Lombard Health Booster Plan | No room rent cap, covered up to inpatient hospitalization cover |
| SBI Arogya Plus Policy | Up to the sum insured |
| Niva Bupa GoActive Health Plan | No room rent cap, covered up to the sum insured (if the sum insured is INR 5 Lakh or above) |
Coverage for Pre and Post-Hospitalization Expenses
Under a health insurance policy, you can seek reimbursement for both pre and post-hospitalization expenses. Insurance companies offer coverage for a certain number of days both before and after the hospitalization, provided it is for the covered illness. Compare the pre-and post-hospitalization coverage of top health insurance plans below –
| Health Insurance Plan | Pre-hospitalization Coverage | Post-hospitalization Coverage |
|---|---|---|
| ICICI Lombard Complete Health Insurance | Up to 30 days | Up to 60 days |
| HDFC Ergo Optima Restore | Up to 60 days | Up to 180 days |
| Star Health Family Health Optima | Up to 60 days | Up to 90 days |
| Niva Bupa Reassure | Up to 60 days | Up to 180 days |
| ICICI Lombard Health Booster | Up to 60 days | Up to 90 days |
| HDFC Ergo Energy Plan | Up to 30 days | Up to 60 days |
| SBI Arogya Plus | Up to 60 days | Up to 90 days |
Ambulance Fee Reimbursement
If you have health insurance, you are free from the burden of transportation fees as it is borne by the insurer. The company will reimburse you the ambulance fee as per the limit mentioned in your policy document. Check out the below plans, and see which offers you the best reimbursement for the ambulance fee.
| Health Insurance Plan | Ambulance Fee |
|---|---|
| ICICI Lombard Complete Health Insurance | Up to INR 1,500 per hospitalization |
| HDFC Ergo Optima Restore | Up to INR 2,000 per hospitalization |
| Star Health Family Health Optima | Up to INR 750/- per hospitalization and an overall limit of INR 1,500/- per policy period. |
| Niva Bupa Reassure | Up to INR 2,000 per hospitalization |
| ICICI Lombard Health Booster | Up to INR 5,000 or actual, whichever is less |
| HDFC Ergo Energy Plan | Up to INR 2,000 per hospitalization |
| Star Health Criticare Plus | Up to INR 750 per hospitalization, a maximum of INR 1,500 per policy year |
Annual Medical Check-Up Coverage
A medical plan entitles the insured to receive free medical check-ups after every claim-free year. You can get this advantage even if you claim by opting for an add-on benefit. Under an annual health check-up coverage, the insurance company will compensate the amount incurred due to the medical test. The following are some of the popular health insurance plans that provide annual medical check-up coverage to you.
| Policy Name | Health Check-up |
|---|---|
| Niva Bupa Health Premia Insurance Plan | Medical check-up cover starts from day 1 and will be provided to you as follows -
|
| Bajaj Allianz Silver Health Plan for Senior Citizens | Free Health check-ups such as -
|
| Oriental Insurance Individual Mediclaim Policy | Annual medical check-up capped at 0.75% of the average sum insured |
| Aditya Birla Activ Care Senior Citizen Health Insurance | Annual health check-up coverage available once in a policy year that includes:
|
| Niva Bupa Health Companion | Annual health check-up coverage starts from the 2nd policy year, if the policy is in force without any break |
| Star Medi Classic Insurance Policy | Annual health check-up capped at 1% of the average basic sum insured, subject to a maximum of INR 5,000 |
Reimbursement Claim Process
You can seek reimbursement for medical expenses after getting discharged from the hospital. The following are the steps that you need to follow –
Step 1: Download the claim form from the insurer’s official website or visit its branch office
Step 2: Collect the documents from the hospital or chemist as required by the insurer, including
- Medical Certificate of the attending doctor
- Pathological reports – X-ray, blood tests, etc.
- Hospital discharge card
- Original bills and receipts
- Original pharmacy bills along with doctor’s prescription
- FIR or MLC Copy (in case of accident hospitalization)
- NEFT Details for direct claim settlement
- Duly filled KYC form
Step 3: Submit the above documents plus a duly filled and signed claim form and copy of your insurance card or policy.
Step 4: Once the documents reach the TPA or the insurer, wait for the payment processing, you would be notified about the claim approval or rejection via SMS or email.