Health insurance policies generally contain certain with respect to coverage and claims, these are listed below briefly:
a. Minimum period of stay in Hospital In order to become eligible to make a claim under the policy, minimum stay in the Hospital is necessary for a certain number of hours. Usually the stipulated duration is 24 hours. This time limit may not apply for treatment of accidental injuries and for certain specified treatments.
b. Pre and post hospitalization expenses incurred during a certain number of days prior to hospitalization and post hospitalization expenses for a specified period from the date of discharge may be considered as part of the claim provided the expenses relate to the disease / sickness.
c. Cashless Facility Insurance companies have tie-up arrangements with a network of hospitals in the country. If the policyholder takes treatment in any of the network hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator (TPA) will arrange for direct payment to the Hospital. This is known as cashless facility.
d. Cumulative Bonus (CB) Health Insurance policies may offer “Cumulative Bonus” wherein for every claim free year (i.e. a year in which no claim is made); the Sum Insured is increased by a certain percentage at the time of renewal subject to a maximum percentage (generally 50%). This means that if in a particular year the insured makes no claims then he/she gets an advantage wherein the company offering the insurance increases the “Insured Amount” or amount agreed to be paid against a claim by a certain percentage. In case of a claim, Cumulative bonus will be reduced by 10% at the next renewal.
e. Additional Benefits and other standalone policies Insurance companies offer various other benefits as “Add-ons” or riders. There are also stand alone policies that are designed to give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc. These policies can either be taken separately or in addition to the hospitalization policy. A few companies have come out with products in the nature of Top Up policies to meet the actual expenses over and above the limit available in the basic health policy.
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