Mediclaim policy owners often mention the shortage of coverage for small or more than the counter medical costs to meet their needs. Their complaint is that doctor’s fees and the associated medicine expenses involve sizeable costs which are not reimbursed by healthcare plans.
In fact, IRDA urged insurance companies in India to introduce more ‘day-care’ based coverage, emphasizing on the fact that non-hospitalization amount is around twice the hospitalization expenses. Due to advanced medical technology, many medical treatments don’t need the 24-hour hospitalization.
Majority of policyholders fallaciously believe that their basic health insurance does not include expensive treatments relating to critical illnesses, since these do not demand 24-hour hospitalization.
In case person buys OPD health cover instead under this misconception, as regular health insurance plans do include various day-care procedures. ‘Day-care’ term is used to define treatment procedures which need hospitalization for less than 24-hours.
This term may include radiation, chemotherapy, dialysis, lithotripsy, cataract, tonsillectomy etc. Insured person can be found the list of such treatment procedures in the insurance documents. Don’t purchase the policy simply because of the number of processes included.
Some plans may provide coverage for certain illness which has a broad definition, while other plan may separate this further into another several illnesses. As an effect, the list of ailments covered will increase, but certain illnesses could be left out in the procedure.
Generally, public sector insurance companies in India use a broader definition even though the number of procedures is an in-built feature. Some insurers may ask for prior intimation to activate the cashless facility. Few insurers offer plans to cover outpatient department, maternity and dental expenses.
These plans include treatments which neither need 24-hour hospitalization nor they include a list of ‘day-care’ procedures. Unlike basic healthcare plans, these products pay for dental treatment, consultation fees, diagnostic tests, pharmacy bills and maternity expenses.
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