These are the benefits you can't compromise on. Whichever insurance company you choose, the first thing to check is whether these 6 must-have benefits are covered for the full limits of the policy.
The cost related to organ donor’s treatment is covered only from the time the donor is admitted to hospital for transplantation surgery, the organ is harvested (removed) and till the time the donor is discharged upon recovery. Such transplantation should be medically advised and approved by law.
The policy will not cover:
The cost of Organ
Any payments for tests or screening for donors to ensure his organ matches
The insured is fit for transplantation.
Any payments to Govt. Body for getting approval for transplantation.
Any pre or post hospitalization costs related to donors.
Any complications arising out of transplantation to the donor are not payable under the recipient's insurance nor in the donor's personal medical insurance.
Also, if the donor has undergone the transplant voluntarily then he/she will not be covered by their medical policy.
Not all plans provide similar cover, neither any plan provides complete cover. In some plans it’s an inbuilt cover whereas sometimes it has to be selected as a special benefit upon payment of additional premium.
The irony is, the donor is not covered fully in the recipient’s (Insured’s) policy and in his personal medical insurance as well for donating his organ.
How many of you have read about Modern Treatment Methods and Advancement in Medical Technologies?
As a result of these advancements in medical technology, we are now able to operate the human body without shedding a single drop of blood. That's good news.
In the future, most treatments will be performed through modern treatments, which will cost an arm and a leg. That's bad news.
Recently, even IRDAI has made it compulsory for all Insurers to cover this disease in Health Insurance.
Many insurers now cover Modern treatments, but apply sublimits. The whole purpose of taking health insurance at all will be diluted.
Hence we need to ensure that our Health Insurance is covering these treatments without any sublimits.
So to conclude, please note two things
If your budget is limited, opt for a super top-up policy. Although it may not cover you for small treatments ( which might not have any drastic effects on your financial wellbeing) it can certainly be a blessing when it comes to large claims ( which can put us 10 years behind).
Insurance companies now cover not only our health coverage, but also the costs associated with mental illness. Depending on the policy, some companies provide coverage up to the policy's sum assured while others only offer coverage up to a certain amount.
There are differences between companies in terms and conditions as well as waiting periods for Psychometric coverage.
The Company shall indemnify the Hospital or the Insured the Medical Expenses (including Pre and Post Hospitalization Expenses) only under certain conditions as:-
Having this coverage has come as a blessing in the case of Covid-19. During the covid-19 pandemic, almost half of the population of India has faced a shortage of beds in hospitals, and the onset of domiciliary care has been a "Blessing in Disguise.". Why is that so? It is so because with this coverage a person can take treatment at home if the condition that needs treatment would otherwise have required hospitalisation, provided that either:
Initially only allopathic treatments were covered under health insurance. In 2012, as per a circular from IRDA, Ayush treatments were allowed to be included in health insurance coverage. Currently there are more than 15 insurers providing health insurance cover for Ayush treatment either as an additional rider or as inbuilt cover.
As per IRDA, “AYUSH Treatment refers to the medical and / or hospitalization treatments given under ‘Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems. The IRDA Definition is simple enough to understand. Let's know its impact.
Impact: Although IRDA has granted permission to cover non-allopathic treatments, there are certain limitations as follows.
The treatment has to be done by the Govt. Hospital, or in any Institute recognized by Govt. And/or accredited by Quality Council of India or National Accreditation Board on Health. There are more than 3600 such hospitals all over India.
Cashless facilities are not available under such treatments.
Most of the insurers are applying a capping or sub limit for such treatments.
Any outpatient cost like Doctor Consultations, medicines, health tests, taken before or after the Inpatient Hospitalization, then those get covered under Pre-Post Hospitalization cover.
However the outpatient expenses should be pertaining to the same treatment for which the main medical claim is accepted.
Insurance companies put a cap on these expenses, usually expenses incurred within 30/60 days respectively for pre and post hospitalization.
For some expenses like domiciliary, maternity and organ donor, the pre and post hospitalization cover is not applicable.
Some insurance companies started putting additional caps like 1% of Sum insured on these expenses. Some started disallowing physiotherapy expenses under pre and post hospitalization.
So it is better to check the policy before purchasing.