Health Insurance - A Quick Guide

In-Patient Treatment

It is the case wherein the patient has been admitted in the hospital for more than 24 hours. Typically it provides a cover for room rent, boarding expenses, ICU, doctor’s fees, medicines, diagnostic procedures etc.

Pre-Hospitalization

Pre-hospitalization covers the expenses under diagnostics, medicines and consultation in reference to the treatment received before hospitalization. All these medical expenses incurred due to illness are reimbursed when the claims are accepted by the insurer. This cover is valid for 30 days prior to hospitalization.

Post-Hospitalization

Once the insured is discharged, the post-hospitalization expenses in relation to the treatment are covered under this section. This cover is valid for 60 days post hospitalization. It includes the cost of medicines and consultancy etc.

Domiciliary Hospitalization

At times, the insured needs to get medical treatment at home. Such a treatment is allowed only under the following two reasons –

• Could not be transferred to a hospital, or
• The hospital bed was unavailable

All sorts of medical expenses incurred during such treatments are covered under domiciliary hospitalization. The pre-requisite for this cover is that the patient needs to get a doctor’s recommendation and his illness should continue for at least 3 days.

Diseases not Covered Under Domiciliary Hospitalization:

Brain-related disorders (Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders etc.), diseases related to respiratory disorders (Asthma, Bronchitis, Cough and Cold, Influenza etc.), bone related disorders (Arthritis, Gout and Rheumatism) and kidney disorders (Chronic Nephritis, Diarrhoea, Dysenteries, Diabetes Mellitus etc.).

Day Care Treatment

Because of technological advancement, there are many diseases, the treatments of which do not require the patient to get admitted for 24 hours. Such cases are a part of in-patient treatment but because of the shorter time, these are categorized as day care treatment. The list of day care procedures covered may vary from one insurer to the other.  Few popular procedures under this section are - cataract eye surgery;  operations on the nose & the nasal sinuses; operations on the tonsils & adenoids;  cancer chemotherapy;  lithotripsy (kidney stone removal) etc.

Organ Donor Expenses

Donating organ is a noble cause and thus insurance companies provide a cover for the medical expenses on the treatment and recovery of the individual who volunteers to donate the organ. The pre and post hospitalization expenses of the donor are not considered under this feature, but yes all the medical expenses of the insured are taken care of by the insurer. They might not include the complications, which are likely to arise during the transplant process.

Waiting Period

When you buy health insurance, there is a waiting period of around 1 to 3 months, depending on the insurer. During this activation period, the insured is not provided with a cover for any illness apart from accidents.

Health Insurance Portability

With health insurance portability, one can change his/her insurance company without fear of surrendering the benefits of the waiting period. You can shift your company during the renewal processor when buying new insurance. It has become an integral part of health insurance from October 2011.