Aditya Birla Sun Life Insurance Company Limited
Imagine you wake up in the morning feeling fine but then, out of nowhere, you get an unexpected health issue. A nagging headache, a persistent cough, or perhaps an upset stomach. Health issues can be unpredictable, striking us when we least expect them. That is why having health insurance is crucial. It provides you with financial support during medical needs, ensuring that your hospital bills don't drain your savings. However can you claim health insurance if you don’t require hospitalisation? What if you’re simply prescribed a treatment that spans a few hours and does not requires a hospital stay? Let’s discuss - in this article!
A health insurance claim refers to the formal request you make to your insurer when you need coverage for your medical expenses. If you receive medical treatment or services covered by your insurance policy, you can submit a claim to the insurance provider, seeking reimbursement or financial coverage for the expenses incurred for your medical needs.
Health insurance claims are generally of two types –
With cashless claims, the insurance company directly settles the medical bills with the hospital. For this, you must be admitted or treated at a network hospital, i.e., one that has a tie-up with your insurance company. For example, Rakesh is having eyesight issues and consults with his doctor, who suggests cataract surgery (a part of day-care procedures). Rakesh then visits a network hospital of his insurer for the surgery. As Rakesh gets treated at a network hospital, the insurance company directly settles the surgery expenses with the hospital.
In reimbursement claims, you must pay the medical expenses from your pocket and later request the insurer for reimbursement. These claims can be made for treatments received at both network and non-network hospitals. For instance, Rita met with an accident and the treatment cost her Rs. 15,000. She paid the hospital bills herself and submitted all required documents to her insurance company. After reviewing her claim and the insurer reimbursed Rs. 12,500 for the eligible expenses incurred during her hospital stay.
Health insurance goes beyond just covering expenses related to hospitalisation – it provides coverage for various medical services and treatments that don’t always necessitate a hospital stay. These plans are designed to support you in times of medical need, regardless of whether you require hospitalisation or not. Health insurance plans usually cover the following medical costs where hospitalisation isn’t necessary –
The Outpatient Department (OPD) is a hospital/medical facility section where patients can receive various healthcare services without being admitted to the hospital. It treats patients who don't need to stay overnight but still require medical attention like consultations, examinations, treatments, etc.
Health insurance plans often include coverage for diagnostic tests that are performed on an outpatient basis including blood tests, X-rays, ultrasounds, CT scans, MRIs, and other imaging procedures. However, only some insurance companies offer coverage specifically for OPD services.
Outpatient coverage can come with certain conditions and limitations, like
These are checkups that motivate you to take responsibility for your health and identify possible medical problems at an early stage. Different health insurance companies will have different terms for the frequency and extent of the covered checkups.
There can be certain conditions associated with the coverage of preventive health checkups
Health insurance is an essential tool that provides coverage for various medical treatments, even without the need for hospitalisation. It ensures that you can thus seek necessary medical care and receive financial support for treatments whether or not it mandates a hospital stay. It is the best way to get access to quality healthcare while also protecting yourself from exorbitant healthcare costs.
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Whole Life Insurance with Cash Bonus
Flexible Bonus Payouts
Two options for benefit payouts
Life Cover
Tax Benefits^
Give:
₹1 lakh for 6 years
Get:
₹14.48 lacs*
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ABSLI Salaried Term Plan (UIN:109N141V03) is a non-linked non-participating individual pure risk premium life insurance plan; upon Policyholder’s selection of Plan Option 2 (Life Cover with ROP) this product shall be a non-linked non-participating individual savings life insurance plan.
*LI Age 21, Male, Non Smoker, Option 1: Life Cover, PPT: Regular Pay, SA: ₹ 1 Cr., PT: 10 years, Annual Premium: ₹ 6100/- ( which is ₹ 508.33/month) Premium exclusive of GST. On death, 1 Cr SA is paid and the policy terminates.
ADV/9/24-25/1775
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