Rahul was involved in a bad car accident on his way to work. He was seriously injured and was taken to the nearest hospital. His family was informed and they rushed to the hospital. The hospital enquired whether Rahul had a health insurance plan or not? His wife, Seema, knew that Rahul had purchased a health plan just a week ago but wasn’t sure of the coverage. She feared that the health insurance plan might not cover Rahul’s hospitalisation so soon. They were a middle-class family and this sudden emergency posed a threat to wipe out their finances. Seema was worried, both for her husband’s safety and also for the financial nightmare that loomed. Was her financial worry justified?
Though many of you buy a health insurance plan, you are often confused about the possible coverage benefits. Just like Seema, many of you don’t know whether a health plan covers accidental injuries. Does it?
Yes, it does. Health insurance plans do cover accidental injuries. As Seema informed the hospital about the existing health plan, she was educated about the coverage benefits which her plan would allow and which is common to all health plans. Let’s see what she found out –
- Ambulance costs – the first coverage which Rahul’s plan allowed was the ambulance cost incurred in bringing Rahul to the hospital. Like Rahul’s plan, most health plans cover ambulance costs up to a specified limit.
- Inpatient hospitalisation – the treatments which Rahul would receive, doctor’s fees, room rent, surgeon’s fee, operation charges, etc. would also be covered. Normal health plans also cover these expenses which incur when you are hospitalised for accidental injuries
- Post-hospitalisation expenses – Seema was also told that the expenses incurred on monitoring Rahul’s health after he would be discharged from the hospital would also be covered. This coverage is available for a specified number of days after being discharged.
Seema’s worries were placed to rest. She was glad that the health plan would take care of Rahul’s medical expenses. Moreover, the fear she had about getting coverage early was also laid to rest. She found out that health insurance plans covered accidental injuries right from the first day of the plan. There is no waiting period. So, Rahul’s medical costs incurred due to accident were covered. He made a speedy recovery and was discharged within a fortnight.
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The same holds true for all health insurance plans. They cover medical expenses which incur due to accidental injuries. There is no waiting period and coverage is allowed from Day 1. However, there are some facts, about accidental injuries and health plans, which you should know. Here they are –
- Accidental deaths – health insurance plans pay for the medical costs incurred on hospitalisation, whether such hospitalisation is due to any ailment or accident. In case of accidental death, however, the plan does not pay any benefit. If the death is immediate, the health plan is not even triggered. If, however, post an accident, you are hospitalised and death occurs during successive treatments or after hospitalisation, the health plan would pay for the hospitalisation and treatment costs. No benefit would, however, be paid on subsequent death.
- Accidental disablements – accidental disabilities are also not paid for by health insurance plans. You would get coverage for treatment of your injuries but if you become disabled, the plan would not pay any special benefits.
- OPD expenses – in case of minor accidental injuries, if you incur expenses on an outpatient basis, your health plan might not cover you. Many health plans do not cover OPD expenses. Some of them which do have a restriction on the coverage amount. So, find out whether your plan has OPD coverage and up to what amount.
Rahul had no such instances and so he didn’t know what was not covered under his health insurance plan. But you should know. Your health plan would cover your accidental injuries but know the above-mentioned exclusions as well. If you need coverage for accidental deaths and disablements, you can buy a personal accident plan or opt for a personal accident rider, if available, in your health plan. While health insurance would cover for accidental hospitalisation, any major contingency, like death and disability would be covered by a personal accident policy. So, supplement your health insurance plan with a personal accident plan as well for a better coverage.
Does your health insurance plan cover all expenses? Find out now!
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