Standard health insurance policies cover some pre- and post-hospitalization expenses

Published in Mint on 7th November, 2017. Written by Abhishek Bondia

Is regular physiotherapy after an accident covered by insurance policies in India? Can I take an add-on cover for it?

—Sanket Bhatia

No. In general health insurance policies, physiotherapy expenses are not covered. Health insurance policies require minimum hospitalization of 24 hours for claims to be admissible. Select health insurance policies provide an add-on for OPD expenses. In case the policy covers for OPD, then you may claim for physiotherapy expenses.

However, physiotherapy recommended by the doctor after hospitalization, could be paid under post-hospitalization expenses. Standard health insurance policies cover 30 and 60 days of pre- and post- hospitalization expenses.

I had bought a family floater policy covering my two children and my wife some years ago and was continuing with it till now. Two months ago my divorce was finalised by the court and the custody of my children is with my ex-wife. Am I still legally allowed to include them in a family floater plan? If I should choose to re-marry later, can I continue to include my children in the insurance plan?

—Gyan Prakash

You can cover your children under your family floater plan. Coverage of spouse is not mandatory to buy a family floater health insurance. Actual custody of the children is also not relevant. You can buy a cover for self and two children. You can place a request with the insurer to delete your ex-spouse from your policy.

If you re-marry later, you can include your spouse in the same plan. The relationship of all dependents is linked to the primary member. So, even if the children are not from the same spouse, it does not affect the coverage under a family floater.

In case your ex-spouse wants to buy a separate family floater to include the children, that’s fine too. In case of a claim, either of the policy can pay. In case the sum assured gets exhausted in one of the plans, the other plan can reimburse the balance expenditure.

I have an insurance plan that covers maternity. Please let me know what all it covers. Will it cover hospitalisation arising from complications, such as miscarriage? Please also let me know if there are any specific instances that such policies do not cover. In case any such complication is not covered, I am assuming that the larger mediclaim policy will cover it. Please clarify if that is so.

—Upendra Lalwani

The standard add-on of a maternity policy covers the cost of delivery. Hospitalization expenses linked to either normal or caesarean delivery can be claimed under the policy. Any complication arising in the delivery such as need for forceps delivery will be covered. Major life threatening complications such as ectopic pregnancy will be covered beyond the maternity add-on limit and within the overall policy sum assured. Miscarriage is also covered under the policy.

Voluntary termination of pregnancy is generally not covered. Further, in select situations doctors may advise hospitalization only for the purpose of observation or diagnostics. Such instances are not covered by the policy. It is necessary that some treatment should have been delivered for a claim to be admissible.

I have a Husky dog who is 2 now years old. Can I buy policy that will cover his hospitalisation and OPD expenses? We had him neutered some time ago and the expenses for pet care, I found out, can be substantial.

—Nandan Gupta

Typical pet insurance available in the market only pays for death or disability of the pet. It does not cover hospitalization or other OPD expenses for the pet. In case of death of the dog, you will be paid a lump sum. Generally, insurance policy pays 80% of the agreed sum assured and premium charged is about 5% of the sum assured.

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