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11 Overlooked Aspects of a Health Insurance Plan

, December 29, 2015, 0 Comments

health-insurance-plan-health-life-marketexpress-inMost individuals assume that health insurance plans only cover hospitalization expenses. This isn’t entirely true, as most insurance plans offer several other benefits to cover associated expenses that arise because of illness or accidents.

These benefits are often overlooked due to a lack of awareness. Even if your advisor has informed you about some of the benefits, it would be prudent to read the policy document and understand them thoroughly. Here are some of the aspects that you need to consider:

Inpatient Hospitalization

In case of hospitalization extending 24 hours, expenses incurred towards the following are reimbursed subject to the terms and conditions listed in the policy document:

  • Room rent
  • Fees for nurses, surgeons, dieticians, anesthetists, and other doctors
  • Charges for pathological, radiological, and other diagnostic tests
  • Cancer treatment, including chemo and radiation therapies
  • Prosthetics cost
  • Operation theater charges
  • Expenses for medications and drugs, pacemakers, surgical appliances, joint replacement implants, and prosthetic heart valves


Advances in medical technology have reduced the duration for certain procedures with some in-patient treatments requiring less than 24-hour hospitalization. Most health insurers provide a list of procedures that are covered under their plans and it is important to check the coverage before making your purchase. Some insurers will also reimburse the expenses if the procedure is pre-authorized.

Pre And Post-Hospitalization

Another of the health insurance benefits that is often overlooked is the coverage available before and after hospitalization. You should check the number of days during which this coverage is available and understand other terms and conditions that regulate this benefit.

Emergency Ambulance

Most people do not take into account the costs of transportation that can arise during an emergency. Your health insurance plan will reimburse a predetermined amount towards ambulance fees. Find out about the amount covered before purchasing your policy.

Donor Expense

If a policyholder requires an organ transplant health insurance companies often pay for hospitalization expenses incurred by the donor. The benefits of health insurance coverage may not extend to the costs of the organ itself, and this should be verified in advance.

Maternity Benefit

Certain types of family health insurance plans cover the actual medical expenses incurred for hospitalization during pregnancy or because of related complications. Coverage may also include medical termination of the pregnancy or delivery. Users are advised to read the terms and conditions associated with maternity benefits before availing a policy.

Hospital Cash

Individuals covered under medical plans will be paid a certain amount at hospital cash for hospitalization exceeding 24 continuous hours. The daily cash amount is variable and needs to be checked at the time of buying the policy.

Death Benefit

Death benefits in the case of the demise of the life insured are limited to the sum determined under the policy, as covered benefits. In case of family plans, the surviving members continue to receive the health insurance coverage until the premium due date. Surviving members can continue the policy, through a new agreement on the due date.

Wellness Benefit

Insurance companies provide policyholders free medical checkups at predetermined times under the health plan. These checkups can be conducted at network centers predetermined by your insurer. Certain insurers may reimburse the cost of these checkups if done at other diagnostic centers, but you need to make sure of this before purchasing a policy.

Multiplier Benefit

Insurers provide multiplier benefits that can be as much as 50% of the sum assured, for every no-claims year.

Restore Benefit

If the basic and multiplier sum assured is exhausted, insurers provide restore benefits subject to certain terms and conditions.

The list of benefits available under a health insurance policy is long. As a consumer, it is vital that you read the policy document and seek clarifications to get a better understanding of the coverage offered. This will help to maximize the benefits and avoid unnecessary complications, when the need for medical care arises.

Sponsored post by HDFC Health by HDFC Life