If you have a health insurance and happen to fall ill with the cold or flu, you might not be able to make claims under your insurance plan. Why? Because common ailments such as the cold or fever are treated by doctors in the ‘out-patient department’. This is obviously because hospitalisation is not required. However, you do incur expenses for such ailments. Sometimes the tests written for these ailments can run into thousands of rupees. So, are there health insurance policies that cover outpatient expenses?
Yes. There are policies covering these expenses and are offered as part of regular health insurance plans. Most of the times outpatient expenses include doctor’s consultation fees, diagnostic tests, health check-ups, pharmacy bills and dental treatments.
In most health insurance policies with outpatient benefits, the policyholders can claim reimbursement of these expenses multiple times during the policy period. Such policies also cover bills for medicines and other treatments that might not be covered under a basic health insurance plan.
The sum assured for these expenses is based on the age of the insured. Outpatient medical expenses can usually be claimed within 90 days of getting the health insurance plan. Here are some policies that cover out-patient medical expenses.
Cigna TTK ProHealth Accumulate Plan
The plan tries to cover all health-related expenses of a policyholder instead of covering only the regular hospitalisation expenses. Cigna TTK Healthcare provides the policyholder with a Personal Health Wallet. This wallet can be used to meet out-patient expenses. Cigna TTK Healthcare customers can choose from Rs 5,000, Rs 10,000, Rs 15,000 or Rs 20,000 for meeting their out-patient expenses such as doctor’s consultation, pharmacy expenses, diagnostic tests, alternative forms of medicines and more.
Another advantage is that the plan will also cover dental treatment, cost of spectacles, lenses and hearing aids. The plan provides customers with a guaranteed cumulative bonus of 5% year on year. The amount in the Personal Health Wallet can be used for the payment of any deductible, co-pay or non-payable component of a claim.
The best part is that any unutilised balance in the Personal Health Wallet plus earned cumulative bonus can be carried forward to the next policy year along with the allocation for the wallet that year.
Apollo Munich Maxima Health Plan
Apart from the regular pre-hospitalisation, post-hospitalisation and hospitalisation expenses, This plan from Apollo Munich will also cover out-patient medical expenses such as doctor consultation. The number of consultations will be 4, 6 or 8 based on the plan chosen by the policyholder.
The plan will also cover pharmacy expenses and cost of diagnostic tests taken by the policyholder or any of the covered family members. The policy will cover specific dental treatments, cost of spectacles & contact lenses up to a certain limit. Any policyholder above the age of 18 years can undergo an annual health check-up using the policy.
This plan offers the advantage of carrying forward 50% of any unutilised entitlement certificates to the next policy year. This excludes the health check-up expenses
Bajaj Allianz Tax Gain Plan
Unlike other plans, this is a family floater health policy that covers outpatient expenses and hospitalization expenses. There are no restrictions or waiting period to claim out-patient expenses. Policyholders can claim for dental procedures and treatments under the policy. The cost of spectacles, dentures and crutches can also be claimed.
10% co-payment of the claim amount will be applicable if the treatment is taken in a non-network hospital. The co-payment can be waived on payment of additional premium. The plan provides the benefit of health check-ups at the end of each four claim-free policy period. This benefit is for one insured member.
There might be many terms and conditions of claiming out-patient expenses. It is better to check the policy document before you choose a health plan that covers out-patient expenses.