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Convalescence Benefit in Group Health Insurance

Team AckoMay 4, 2021

Health insurance, of any kind, can be of huge help at the time of a financial crisis. Usually, people feel their savings can do such a job. But they tend to forget that those savings will deplete if they have to pay hospital bills. This is where health insurance helps by paying the hospital bills. In addition, there are numerous advantages like Convalescence Benefit in a health insurance plan, including Group Health Insurance, that can help you during medical emergencies. Read ahead to learn more about Convalescence Benefit.

Convalescence Benefit in Group Health Insurance

What is Convalescence Benefit in Group Health Insurance?

Convalescence Benefit in health insurance is a policy inclusion that helps you to receive a fixed amount of money if you are hospitalized for more than a pre-decided period.  This is a lump-sum amount given as per the terms and conditions of the policy.

Convalescence Benefit Meaning

The word convalescence can be understood as a resting period to get better from a disease or a medical procedure. It is the time during which you are on the road to recovery. When it comes to health insurance, the benefit associated with the convalescence period is known as the Convalescence Benefit.  

Understanding Convalescence Benefit

Health insurance is usually about helping you pay the medical bills. However, its scope does not end there. It takes a holistic view of offering financial assistance to a policyholder facing a medical emergency. 

For instance, if you are hospitalised for a few weeks, it can affect your work. You will not be able to work during that period, possibly leading to a loss of income. This loss of income is partly substituted by a lump-sum amount as a part of the Convalescence Benefit. Such a benefit can be a part of different types of insurance plans, including Employee Insurance.

Group Health Insurance: Convalescence Benefit Example

Here’s an example to help understand the Convalescence Benefit in a better manner.

  • Pooja, a Field Sales Executive, gets hospitalised due to an accident.

  • She is treated immediately but is hospitalised for a fortnight so that she can recover well.  

  • As a result, she is unable to report to work during her recovery period, which leads to loss of income.

  • To compensate for this loss of income, Pooja receives a fixed amount as Convalescence Benefit.

She receives the benefit because she has been hospitalised for more than a week. This period (of a week) and the lump-sum amount is as per the details mentioned in the policy document and can vary from one insurer to another.

When to Claim Convalescence Benefit?

First, your policy should mention this benefit as an inclusion in the policy document. If it is not mentioned or is a part of the exclusions, then you might not be able to claim against it. However, it can be purchased as an add-on. In that case, the add-ons’ terms and conditions shall be applicable. Overall, your policy should include such coverage and you should meet the terms and conditions to claim Convalescence Benefit.

Note that the number of days after which you are allowed to avail of this benefit is also mentioned in the policy document. For example, if the benefit starts after ten days of hospitalisation, you cannot claim it after just five days of hospitalisation.

The amount received under this benefit is pre-decided. Details can be checked in your Individual/Group Insurance Scheme document or by getting in touch with the Customer Care team.

Points to Know About the Convalescence Benefit:

Here are the things to know about this benefit.

  • This benefit can be a part of individual and group health insurance policies.

  • Usually, the period after which this benefit can be availed is seven to ten days of hospitalisation.

  • The policy might include the cost incurred for family visits to the hospital.

  • This benefit is over and above the cover for medical expenses and is also known as Recuperating Benefit.

Also, read: Top 7 Pros and Cons of Group Health Insurance

Frequently Asked Questions:

Here’s a list of queries that might be buzzing in your head when it comes to Convalescence Benefit in individual/group mediclaim policy.

Does ACKO’s Group Health Insurance Policy offer the Convalesce Benefit?

Currently, the Convalescence Benefit is listed as an exclusion in ACKO’s Group Health Insurance Plan. However, if you want to offer this benefit to your employees under your company’s Group Health Insurance Plan, it can be purchased as an add-on. The details about the period and the amount can be discussed at the time of purchasing the policy, as such benefits are customisable.

Is the Convalescence Benefit a standard cover?

No, it is not a standard cover as it varies across insurance companies.

Is this benefit paid in lump-sum or as per the income of the patient?

This benefit is paid in lump-sum. The amount is pre-decided and does not take into consideration the income of the patient.

Why is this benefit known as a hidden benefit?

The Convalescence Benefit is known as a hidden benefit as people are not usually aware of it. Thus, it is crucial to make an informed decision when it comes to health insurance.

Are compassionate visits by concerned members of the family covered under this benefit?

In some cases, the cost for compassionate visits can be covered to an extent under this benefit. Such an inclusion should be mentioned in the policy document for it to be applicable.

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