Road Ambulance Cover In Health Insurance

If you live close to a busy road in a city, you would have heard ambulance sirens during the day, and god save you if you live near a hospital - then it is a way of life.

Ambulance siren gives us an immediate signal that someone’s not well, and needs immediate treatment.

What if god forbid, we need it? Does health insurance cover ambulance charges? Are there any conditions related to the coverage of road ambulance costs in health insurance that you must be aware of?

Let’s find out!

Are Road Ambulance Charges Covered By All Health Insurance Plans?

Emergency road ambulance costs are covered by nearly all health insurance policies in the country. You’ll have to check the policy document or brochure of your health plan. If it is mentioned explicitly, only then will the ambulance costs be covered.

Are All Types Of Ambulance Expenses Covered?

The insurance company will usually cover the costs of the emergency road ambulance that transports you from the scene of the emergency to a nearby hospital. The expenses incurred for transporting you from one hospital to another hospital for better treatment will also be covered by the insurance company, provided such transportation must be advised and prescribed in writing by the treating doctor. Which means, that if the treatment required is not an emergency, or there is no requirement of an ambulance as per a medical professional, it may not be paid by your insurance plan.

Conditions For Road Ambulance Coverage Under Health Insurance Policies

Here’s a quick rundown of some conditions for coverage of road ambulance charges under health insurance.

• Covers Only In Case Of Emergency

Like we said, the insurance company will cover the ambulance expenses only if the ambulance service is used in case of an emergency.

But, what does ‘emergency' mean?

‘Emergency’ refers to a serious medical condition or symptom resulting from illness/injury that arises suddenly and unexpectedly, and requires immediate attention from a medical practitioner, usually within 24 hours of the condition’s onset - to prevent death or serious long-term impairment.

For instance -

1. Mr. Raichand suffered a heart attack in the middle of the night and was taken to the hospital immediately for treatment.

2. Dhruv was involved in a major road accident where he sustained some serious injuries. He needed immediate medical care and hence, was rushed to the hospital.

   Such situations will be considered an ‘emergency’.

3. Mr. Khan has been complaining of a stomach ache for a few months. The doctor has advised a small surgery in his hospital in a couple of weeks. Mr. Khan is all hail and hearty except for this stomach issue on the day of the hospitalisation, and can travel by regular transport, say a cab.

   In this scenario, insurance plans may not consider this as an emergency and hence pay for an ambulance service.

• Approved Inpatient Hospitalisation Claim

  Most policies will cover the ambulance charges only if you’re later admitted to the hospital and the insurer has approved a claim under inpatient benefit. Which means that if you travel in an ambulance for an emergency medical requirement, but once you reach the hospital, the doctor after observation does not recommend any hospitalisation, and asks you to rest at home, with some oral medication. In such a scenario, the ambulance charges will not be payable in the plan.

• Prescribed In Writing By A Medical Practitioner

  You cannot take an ambulance for transportation and claim for the ambulance expenses if local transportation could have been used. Hence, most insurance companies put an additional condition that they will cover the ambulance charges only if it is prescribed by a medical practitioner in writing that the patient was in a condition and needed an ambulance. This document may be usually required in situations where it is not explicitly evident that an ambulance was required. For instance, if it is diagnosed that the patient had a heart attack, then the insurer may not ask for such a document.

• Transportation Only To A Hospital Is Covered

  Mostly, the insurance company will pay under this benefit only if the ambulance service is used to take the patient to the hospital. The costs will not be covered if you use the ambulance service for any other purpose, such as for going to a hospital diagnostic centre for evaluation purposes.

  You may get admitted to a small hospital which may not have all the infrastructure. Say for a specific test, you are transported to another hospital and got back, this ambulance charge may not be payable under your health insurance plan.

  A few health insurance policies, like the Max Bupa Companion Policy and the Max Bupa Reassure Policy, have explicitly mentioned in their policy wordings that they will not cover the costs if the emergency ambulance service is used to visit a hospital diagnostic centre for evaluation purposes.

• Coverage Limits

  Under most health insurance plans there is a financial limit up to which they will cover the ambulance costs under the health plan. Very few plans come without a limit. , such as the Star Health Comprehensive Plan, there are no restrictions on the coverage for an emergency ambulance. There, however, are insurance companies that

  For instance, say Amey is covered under health insurance with a sum insured of Rs. 10 Lakhs. There is a limit of Rs. 2500 on the coverage of ambulance expenses under his policy. This means that if Amey undergoes hospitalisation and is taken to the hospital via an ambulance, the insurance company will only cover the ambulance costs of Rs. 2500. Any extra expenses incurred towards ambulance expenses will have to be paid out of his own pocket.

• Not Able To Use Other Mode Of Transport

  Another condition you must be aware of is that the cost of ambulance service under some plans will be covered only if you are unable to be transported to the hospital by any other mode of transportation, such as a car or a two-wheeler.

• Return Transportation May Not Be Covered

  Most insurance companies will not cover the cost of return transportation via the ambulance, i.e., from the hospital to your residence. There, however, are some insurers that cover the return transportation costs, only if the treating doctor has certified in writing that the return transportation via the ambulance is medically necessary.

• Registered Ambulance Service Provider

  The ambulance charges will be covered only if the ambulance service is provided by a registered service provider or health care centre.

Note: The conditions and limitations for coverage of ambulance costs in health insurance may vary across insurers. So, make sure you go through your policy document before going ahead.

Wrapping Up!

If it’s mentioned in your policy document, then the road ambulance costs will be covered by your health plan. The costs, however, will be covered only if specific conditions are met. Make sure you’re aware of these conditions before you go ahead and buy the policy - to avoid any hassles in the future.