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Does a health insurance plan cover any other facilities/expenses besides hospitalization costs?

The health insurance plan, beside covering hospitalization costs, also provides the cashless facility through the third party administrator. Other covers include, pre and post hospitalization costs, accidents, pre-existing illnesses, and other ailments.

Apnainsurance.com Research Bureau

05 Dec 2007

Yes, it does. One of the primary facilities/services offered by insurers is providing the Cashless Facility at hospitals (those who have tied up with the insurer to form a network) throughout the country. The Cashless Facility means that the insured does not have to pay from his/her pocket for a large part of the expenses incurred at a network hospital - they are handled directly by what is known as the Third Party Administrator (TPA).

health insurance policies also provide cover for pre-hospitalization (up to 30 days) and post-hospitalization (up to 60 or 90 days from date of discharge) expenses, provided they are related to the ailment/accident for which the insured was hospitalized.

Hospitalization expenses of a person donating an organ during the course of an organ transplant are also payable subject to applicable limits specified in the insurance policy.

After three to four years of continuous renewals with the insurer, the insured is also in the happy position of being covered for pre-existing diseases, if any.

Certain insurers provide a benefit of Rs.10,000 if more than one member of the family (covered under one policy) is simultaneously hospitalized for a period of 5 consecutive days or more. A further benefit of Rs.10,000 is paid if the period of hospitalization is 10 consecutive days or more. This benefit is paid once in a year.

In the event of no claims, the insured is entitled to reimbursement of the cost of medical check-up once at the end of a block of every four or five claim-free years.


See also:

What are the different aspects that I should consider when buying a health insurance policy?

I work in Mumbai while my wife and children reside in Delhi; my parents live in Jaipur. Can I insure all of them? How will my parents avail the cashless facility?

Miscellaneous Health Insurance FAQs

health insurance FAQs about Coverage

health insurance FAQs about Claims

Health Insurance FAQs about Premiums


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