The escalation of diseases, their treatment and expenses has led way to the real need of health insurance. It is essential to have a health insurance for yourself and your family but before you purchase one, you should know each and every detail of the policy ranging from benefits to exclusions. It is a must to know the health insurance terminology to make the most out of your plan.
It is the case wherein the patient has been admitted in the hospital for more than 24 hours. Typically it provides a cover for room rent, boarding expenses, ICU, doctor’s fees, medicines, diagnostic procedures etc.
Pre hospitalization covers the expenses under diagnostics, medicines and consultation in reference to the treatment received before hospitalization. All these medical expenses incurred due to illness are reimbursed when the claims are accepted by the insurer. This cover is valid for 30 days prior to hospitalization.
Once the insured is discharged, the post hospitalization expenses in relation to the treatment are covered under this section. This cover is valid for 60 days post hospitalization. It includes cost of medicines and consultancy etc.
At times, the insured needs to get the medical treatment at home. Such a treatment is allowed only under the following two reasons –
Could not be transferred to a hospital, or
Hospital bed was unavailable
All sorts of medical expenses incurred during such a treatment are covered under domiciliary hospitalization. The pre-requisite for this cover is that the patient needs to get doctor’s recommendation and his illness should continue for at least 3 days.
Diseases not covered under domiciliary hospitalization:
Brain related disorders (Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders etc.), diseases related to respiratory disorders (Asthma, Bronchitis, Cough and Cold, Influenza etc.), bone related disorders (Arthritis, Gout and Rheumatism) and kidney disorders (Chronic Nephritis, Diarrhoea, Dysenteries, Diabetes Mellitus etc.).
Day Care treatment
Because of technological advancement, there are many diseases, the treatments of which do not require the patient to get admitted for 24 hours. Such cases are a part of in-patient treatment but because of shorter time these are categorized as day care treatment. The list of day care procedures covered may vary from one insurer to the other. Few popular procedures under this section are – cataract eye surgery; operations on the nose & the nasal sinuses; operations on the tonsils & adenoids; cancer chemotherapy; lithotripsy (kidney stone removal) etc.
Organ Donor Expenses
Donating organ is a noble cause and thus insurance companies provide a cover for the medical expenses on the treatment and recovery of the individual who volunteers to donate the organ. The pre and post hospitalization expenses of the donor are not considered under this feature, but yes all the medical expenses of the insured are taken care by the insurer. They might not include the complications which are likely to arise during the transplant process.
When you buy health insurance, there is a waiting period of around 1 to 3 months, depending on the insurer. During this activation period, the insured is not provided a cover for any illness apart from accidents.
Health Insurance Portability
With health insurance portability, one can change his/her insurance company without fear of surrendering the benefits of waiting period. You can shift your company during renewal process or when buying a new insurance. It has become an integral part of health insurance from October 2011.