The Hidden Benefits of Personal Health Insurance


The Hidden Benefits of Personal Health Insurance

Customers should explore many hidden benefits in personal health insurance plans to avail of benefits during the policy period. These benefits would be hidden in plain sight for the customers, and most would not pay heed to these benefits in the first instance. Insurance intermediaries would also not explain these benefits to the customer while selling personal health insurance policies, and as a result, customers miss out on these benefits. Personal health insurance has many benefits that, if correctly exploited, can reap good customer returns.

Here are Some Lesser-Known Advantages That Insured Customers Can Enjoy With Their Health Insurance Plans:

Convalescence Benefits:

Convalescence benefits are those that are paid to the insured customer during the time of recovery following an accident, illness or disease. Convalescence benefit is usually given as a lump sum if the hospitalization has exceeded for a certain number of days. The convalescence benefits are payable only once during the policy period. However, due to a lack of awareness, many customers would not opt for these benefits when hospitalized. When a person is hospitalized, he/she would not be working and would lose a certain amount of their income, which would be compensated with the convalescence benefit to a certain extent. In addition to the loss of income, insured members would have few visitors who would stay with the hospitalized insured member, which would incur certain expenses. These expenses can also be covered under the convalescence benefits of the personal health insurance plan.

Domiciliary Hospitalization:

Domiciliary hospitalization is getting treated from your home. In case of any disease, illness or accident, you could get treated from your home, and the insurance company would reimburse the cost for such treatments. Domiciliary hospitalization would incur certain expenses, such as the cost of medicals, doctors, nursing fees etc., which the personal health insurance plan would pay. It is important to note that the treating doctor would decide on domiciliary hospitalization and not as per the wish of the insured customer. There are two scenarios in which the treating doctor may prescribe domiciliary treatment for the insured member:

  • Suppose the treating doctor feels that shifting the injured patient to the hospital would threaten his/her life. If the patient is shifted to the hospital, his/her condition might worsen and lead to complications.
  • In case of a pandemic, when there are not enough beds in the hospital, the treating doctor can recommend domiciliary hospitalization. In the case of COVID-19, many hospitals were full, and people got treated from their homes and claims were paid under the domiciliary hospitalization section.

Yearly Medical Checkup:

The other hidden benefit of personal health insurance is the yearly medical checkup available in case no claim is made during the previous policy period. This feature is known to a few customers, and customers would also not make use of this feature in particular. A yearly medical checkup is available only if there is no claim during that particular year. The diagnostics done under the medical checkup would vary from one health insurance plan to another. Yearly medical checkups can be utilized by the insured customer from any of the network hospitals or diagnostic centers of the insurance company, and the reports would be shared with the insured customer and the insurance company. A yearly medical checkup allows customers to understand their health condition and take certain precautions to improve it. These reports would allow the insurance company to estimate the occurrence of claims in the near future and maintain their reserves accordingly. Various medical tests are covered under the medical checkups, such as blood tests, urine tests etc.

Reinstatement of Sum Insured:

The other less known benefit of personal health insurance is that the sum insured would be reinstated in case of exhaustion of the base sum insured. The base sum insured, if exhausted, would be replaced up to the previous limit once during the policy period. There is a facility to utilize the replaced or reinstated sum insured for claims arising in the future. It is important to note that the reinstated sum insured could be utilized only for a new illness and not the existing claim or existing illness. In the case of a family floater policy, the reinstated sum insured can be utilized by any new member who has not claimed previously but the member who claimed previously cannot again claim for the same illness. For example, if you have been diagnosed with kidney failure and have exhausted the sum insured in your treatment, your insurance company would reinstate your sum insured to the base level. In the same policy period, if you are again diagnosed with kidney failure, you cannot utilize the reinstated sum insured. Still, if your family members are hospitalized with kidney or any other illness, they can utilize the reinstated sum insured.

Insurance companies are also offering add-ons under which the customers can avail of unlimited reinstatement options, i.e., the sum insured would be reinstated an unlimited number of times.

Free Consultations:

The other less-known benefit of personal health insurance plans is that they offer free consultations for their customers. Insured customers can avail of free tele consultations with the empaneled doctors of the insurance company regarding their illness or disease or any treatments. Certain personal health insurance plans offer unlimited teleconsultations to their customers. There is also an option to get a second opinion from any impaneled doctor, and the insurance company will bear the charges. A second opinion can be availed if you are unsatisfied with the existing treatment and want to explore its alternatives. Free teleconsultations would save the time and energy of the customers. You can avail consultations for any specific illness from your home. Online teleconsultations have gained momentum during the COVID period and are still popular among people.

Daily Hospital Cash Benefit:

Daily hospital cash benefit is another hidden benefit in your health insurance plan. Daily hospital cash benefit is paid to the insured customer if he/she is hospitalized for a certain period of time during the policy period. A certain amount per day would be paid for the total number of days hospitalized, excluding the deductible, which would be the first 3 days of hospitalization. It would normally be paid for a maximum of 10 days, excluding the first 3 days of hospitalization. The daily hospital cash benefit is to be reimbursed by the insurance company. Daily hospital cash benefit is intended to provide the insured customer with some amount as the patient would incur certain expenses towards food and other essentials for the family members visiting them. Daily hospital cash benefit is sometimes offered as an inbuilt cover and an add-on to pay an additional premium. In the case of an add-on, customers can select the daily hospital cash benefit limit, whereas in the case of an inbuilt, the limit would be pre-fixed.

For more details on the hidden benefits of your health insurance plans, please book a call with our health insurance experts at Ethika Insurance Broking.

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Susheel Agarwal

Namaste. I'm Abhinay Nedunuru, a Fellow of the Insurance Institute of India with a passion to make insurance simple and crisp. I write on insurance and investment. I have a passion for teaching and training in particular to insurance. I'm currently doing my PhD from IIM in Management.