Last time we talked about the general features of a health insurance policy. Today we are going to talk about its special features. It is to be noted here that not all companies provide these features as they are special. To take advantage of this, make an informed decision after making inquiries with the company in advance. However, it is determined that these features increase both the value and importance of the policy. If you find these issues important, do not delay in adding them to your policy.
If the insured decides to seek treatment outside India, the cost can be claimed within the limits of the policy. The condition here is that the disease must be diagnosed within India. In these circumstances the treatment received by the patient during hospitalization or day care is covered and his claim is settled on reimbursement basis. Cashless facility can also be availed in some cases. Claims under this facility are settled in Indian Rupees. The insured is required to submit additional documents in support of his claim:
- Proof of diagnosis in India
- Passport and visa of the insured
Restoration benefit can be used if the sum insured starts falling after a big claim. If this benefit is selected, the policy also provides for the facility of restoration in case of more than one claim due to related or unrelated illnesses within a year. It remains to be seen to what extent the company has provided this facility in addition to the insurance cover of Rupee.
From Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathic treatment under all these therapies and/or hospitalization is considered as Ayush treatment. This treatment is covered only if it is taken in government hospitals or in a government accredited and/or institution with accreditation of Quality Council of India National Accreditation Board on Health. If AYUSH is used for healing, rejuvenation, beautification, punchkarma, purification etc., it is not covered under the policy.
Home Hospitalization Domiciliary
Hospitalization Home hospitalization is usually called home hospitalization domiciliary hospitalization. The circumstances are as follows:
- In case it is not possible to move the patient to the hospital for treatment.
- When there is no room available in the hospital, the patient has to be taken home and treated.
In case the insured wants to donate someone’s organ, the cost of the services and surgery applicable for obtaining the organ is covered under the policy. However, the following conditions apply:
- According to the terms and conditions of the Transplantation of Human Organs (Amendment) Bill, 2011, the organ of the donor is to be taken and that organ is to be taken for the policyholder.
- If the insurance company has approved the insured’s claim for treatment in the hospital.
In case of emergency air ambulance has to be used. This feature is useful if a person is injured during a trip and needs to be transported to a hospital for medical treatment, but it is not possible to use an option other than air travel.
Insurance companies do not cover routine dental treatment in health insurance. In case of any accidental injury, dental treatment is covered under this facility. It is worth mentioning here that some companies cover treatments like tooth cleaning, polishing, root canaling, etc. after a certain waiting period.
Lastly, to say that all the above facilities are available under health insurance, but it is up to each one to decide which of these facilities to avail.