Health Insurance 103 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.

Health Insurance

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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 PlanRoom Rent Sub-Limit
ICICI Lombard Complete Health InsuranceNo room rent cap, covered up to the sum insured
HDFC ERGO Health Optima RestoreNo sub-limit on room rent
Star Health Family Optima Insurance PlanUp to In-Patient Hospitalization Cover
Max Bupa ReAssure Health PlanNo room rent cap, covered up to the sum insured
Care Freedom1% 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
Max Bupa Health CompanionNo room rent cap, covered up to the sum insured (if the sum insured is INR 5 Lakh or above)
ICICI Lombard Health Booster PlanNo room rent cap, covered up to inpatient hospitalization cover
SBI Arogya Plus PolicyUp to the sum insured
Max Bupa GoActive Health PlanNo 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 PlanPre-hospitalization CoveragePost-hospitalization Coverage
ICICI Lombard Complete Health InsuranceUp to 30 daysUp to 60 days
HDFC Ergo Optima RestoreUp to 60 daysUp to 180 days
Star Health Family Health OptimaUp to 60 daysUp to 90 days
Max Bupa ReassureUp to 60 daysUp to 180 days
ICICI Lombard Health BoosterUp to 60 daysUp to 90 days
HDFC Ergo Energy PlanUp to 30 daysUp to 60 days
SBI Arogya PlusUp to 60 daysUp 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 PlanAmbulance Fee
ICICI Lombard Complete Health InsuranceUp to INR 1,500 per hospitalization
HDFC Ergo Optima RestoreUp to INR 2,000 per hospitalization
Star Health Family Health OptimaUp to INR 750/- per hospitalization and an overall limit of INR 1,500/- per policy period.
Max Bupa ReassureUp to INR 2,000 per hospitalization
ICICI Lombard Health BoosterUp to INR 5,000 or actual, whichever is less
HDFC Ergo Energy PlanUp to INR 2,000 per hospitalization
Star Health Criticare PlusUp 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 NameHealth Check-up
Max Bupa Health PremiaMedical check-up cover starts from day 1 and will be provided to you as follows -

  1. Silver option - Once in two policy years

  2. Gold option - Annual medical check-ups covered up to INR 2,500 perinsured

  3. Platinum option - Annual medical check-ups covered up to INR 5,000 per insured

Bajaj Allianz Silver Health Plan for Senior CitizensFree Health check-ups such as -

  1. Laboratory tests for fasting blood

  2. Complete blood count

  3. Serum test

  4. Cholesterol check

  5. Urine routine

  6. Chest X-ray

  7. ECG

Oriental Insurance Individual Mediclaim PolicyAnnual medical check-up capped at 0.75% of the average sum insured
Aditya Birla Activ Care Senior Citizen Health InsuranceAnnual health check-up coverage available once in a policy year that includes:

  1. Mammography

  2. PAP smear

  3. Thyroid function test

  4. TMT (2 D Echo if the customer is not able to walk on the treadmill)

  5. Chest X-ray

  6. Sonography Abdomen

  7. ENT check-up

  8. OPG (Dental x-ray)

  9. Vitamin D

  10. Vitamin B12

  11. Calcium

Max Bupa Health CompanionAnnual health check-up coverage starts from the 2nd policy year, if the policy is in force without any break
Star Medi Classic Insurance PolicyAnnual 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

  1. Medical Certificate of the attending doctor
  2. Pathological reports – X-ray, blood tests, etc.
  3. Hospital discharge card
  4. Original bills and receipts
  5. Original pharmacy bills along with doctor’s prescription
  6. FIR or MLC Copy (in case of accident hospitalization)
  7. NEFT Details for direct claim settlement
  8. 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.

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