Tarun got admitted for his weekly dialysis and his hospitalisation expenses came to Rs 50,000. He also incurred hospital food expenses and medical test charges of Rs 5,000. Yet, Tharun didn't really bother about these overhead expenses because he assumed his health insurance would cover all the expenses. But when he filed a claim, his insurer explained that his policy covered only hospitalisation expenses, and not other miscellaneous expenses.
In the same hospital, Bhargav underwent heart surgery and his hospitalisation expenses totalled Rs 1,00,000. Additionally, he incurred some miscellaneous expenses too. As expected, his health insurance covered his hospitalisation expenses, but he did not have to pay for any extra expenses from his end. This is due to the reason that Bhargav had initially opted for hospital cash benefit along with his health insurance policy - which explains the extra expense coverage.
Health Insurance Policies Offer Two Types Of Benefits To Cover The Extra Expenses -
Let’s see how they work and what conditions apply.
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What Is The Hospital Cash Benefit?
The hospital cash benefit provides you a fixed amount of money for each day of hospitalisation. This money will help you cover any extra expenses related to your hospital stay, such as food expenses, any medical tests, etc.
Conditions Associated With Hospital Cash Benefit
Now, let’s have a look at the various conditions that may crop up if you claim the hospital cash benefit. Please note that these conditions may vary across insurance companies. Ensure you go through your policy documents carefully.
At Least 24-48 Hours Of Hospitalisation Is Necessary
You will be given the daily cash allowance only if your hospitalisation goes beyond 24-48 hours.
Example - Arun is hospitalised for 3 days and his policy specifies that he’ll receive the hospital cash benefit after 24 hours. In this case, the insurer will pay a cash benefit for 2 days. The initial hospitalisation period of 24 hours will not be taken into account.
Daycare Treatment - Not Covered
A hospital cash benefit is not provided by most insurers for daycare procedures, i.e., treatments or surgeries carried out within a span of 24 hours.
For instance, Manoj injured his hand while working with machinery. He needed immediate first aid and a few stitches. As he did not require a hospital stay, his health insurance did not cover the treatment.
Domiciliary Hospitalisation - Not Covered
If there is an unavailability of beds in the hospital or if you can’t be moved to the hospital due to severe injury/illness, you can receive treatment from the comfort of your home under a certified doctor's supervision. This is called domiciliary hospitalisation. However, several insurers do not provide a hospital cash benefit for domiciliary hospitalisation.
For example, Max Bupa doesn’t cover domiciliary hospitalisation.
For example, Divya was cleaning her loft, when she slipped and broke her leg. As she can’t be moved to the hospital in this condition, her doctor arranged for domiciliary hospitalisation. She incurred additional expenses for blood tests and other tests in addition to her treatment costs. Since, her health insurance doesn’t provide hospital cash benefits for domiciliary hospitalisation, she had to bear these extra expenses.
Double Cash Allowance For ICU Admission
For every 24 hours you spend in the Intensive Care Unit (ICU) of a hospital, some insurers will double the daily cash allowance specified in your policy’s hospital cash benefit. The expenses in an ICU are significantly higher than a regular room, which explains the higher pay.
For example, Care Insurance and Digit Insurance provide double cash allowance.
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What Is Shared Accommodation Cash Benefit?
In certain policies, while you are eligible for a private room or any room, if you choose to get admitted to shared accommodation - a hospital room with two or more beds, you can avail the shared accommodation cash benefit in your health insurance policy. A fixed amount of cash is provided for each day you're hospitalised. It is a reward from the insurance company for choosing a lower cost room, despite being eligible for a better facility.
Conditions Associated With Shared Accommodation Cash Benefit
Please note that these conditions may vary across insurance companies. Ensure you go through your policy documents carefully.
Mandatory Stay Of At Least 24-48 Hours At A Network Hospital
Some insurance companies offer this benefit only if you’re admitted to a hospital for at least 24-48 hours.
Claim Under Inpatient Benefit - Mandatory
Some insurers restrict this benefit to inpatient hospitalisation only. You must be admitted to the hospital for at least 24 hours and your insurance company must approve your inpatient benefit claim.
Only Network Hospitals Are Covered
Insurers will usually provide a shared accommodation cash benefit only if you get treated at a network hospital, i.e., a hospital listed with them.
For instance, Ravi receives treatment for his heart problem in a private hospital not listed with his insurance company. As he was not treated at the network hospital, he is not eligible for the shared accommodation cash benefit.
Cash Allowance Is Available Up To Certain Limit
A specific amount is set as the daily cash limit for the shared accommodation cash benefit by every insurer. Detailed information about this limit can be found in your health insurance policy document.
No Coverage For ICU Admission
Many insurers don't offer the shared accommodation cash benefit if you're admitted to the ICU.
For example, Megha chose a shared accommodation when she was admitted to the hospital for a surgery. Her condition dipped and she was transferred to the ICU. And so, she didn’t receive the shared accommodation cash benefit.