Home / Health Insurance / Articles / Health Insurance Plans / Convalescence Benefit in Health Insurance

Convalescence Benefit in Health Insurance

Team AckoMay 24, 2024

The demand for health insurance policies in India has surged in the wake of the pandemic, prompting many previously unaware individuals to recognise its importance. Amidst this heightened awareness, one overlooked yet significant feature of health insurance policies is the Convalescence Benefit. This benefit provides financial support to policyholders during their recovery period after hospitalisation, compensating for potential loss of income.

With the increased focus on health insurance, more people are discovering the value of Convalescence Benefits, which offer a crucial safety net by ensuring sufficient funds to cover expenses during recuperation without draining savings. As individuals become more informed about the benefits of health insurance, including Convalescence Benefits, they are better equipped to make informed decisions to safeguard their health and financial well-being, reinforcing the essential role of insurance in providing comprehensive healthcare coverage. In this article, we shed light on everything you need to know about the Convalescence Benefit in Health Insurance.

Convalescence

Contents

What is Convalescence Benefit?
Understanding Convalescence Benefits in Group Health Insurance
From where you can claim Convalescence Benefit?
How much Convalescence Benefit can you claim?
When can I claim Convalescence Benefit?
Key Insights into Convalescence Benefits in Health Insurance
Example of Convalescence Benefit in medical insurance
Reasons Behind Insurer's Lump Sum Payment in Health Insurance
Things to be aware of while buying Convalescence Benefit in Health Insurance
Frequently asked questions

What is Convalescence Benefit?

The Convalescence Benefit in health insurance refers to the time spent recovering from an illness. It is a useful add-on, as it is a compensation for loss of income incurred when you are hospitalised. Many Health insurance companies provide this benefit under health insurance. However, policyholders may need to pay more attention to the coverage and claim as it compensates for the loss of income from extended hospitalisation.

The policy reinstates that since sometimes you may require a prolonged time (8-10 days) to recover, which invites unsolicited medical expenses and loss of income, hence convalescence policy covers it.

Understanding Convalescence Benefits in Group Health Insurance

Convalescence benefit is a crucial feature offered in group health insurance policies, providing financial support to policyholders during their recovery phase after hospitalisation. This benefit is designed to alleviate the financial burden that prolonged hospital stays can impose on individuals, especially concerning their ability to earn income during their convalescence period.

When an individual is hospitalised for a predetermined duration specified in the insurance policy, they become eligible for the convalescence benefit. This benefit ensures that the policyholder receives an additional fixed amount from the insurer, distinct from the reimbursement of medical expenses covered under the policy. Essentially, it serves as a form of income replacement during the period when the insured individual is unable to work due to their hospitalisation and subsequent recovery.

How To Check The Predetermined Amount

The predetermined amount for the convalescence benefit is established at the time of purchasing the health insurance policy. This amount is typically determined based on various factors, including the insured individual's occupation, income level, and the anticipated duration of hospitalisation required for recovery from certain medical conditions.

Manage Living Expenses Effortlessly

The lump sum payment provided as a convalescence benefit serves as a valuable financial cushion, assisting policyholders in managing their living expenses, ongoing financial obligations, and any additional costs incurred during their recuperation period. By receiving this benefit, individuals can focus on their recovery without worrying about the financial implications of being unable to work temporarily.

Enhances Value Of Group Health Insurance

Moreover, the convalescence benefit underscores the comprehensive nature of group health insurance policies, which extend beyond covering medical expenses to address the broader financial needs of insured individuals during challenging times. It enhances the overall value proposition of group health insurance by offering holistic protection against the financial consequences of unexpected health events.

Post-Hospitalization Recovery Benefits

Convalescence benefit in group health insurance policies plays a pivotal role in supporting insured individuals during their recovery phase following hospitalisation. Providing a predetermined lump sum amount ensures financial stability and peace of mind, enabling policyholders to focus on their health and well-being without the added stress of financial concerns.

From where you can claim Convalescence Benefit?

The Convalescence Benefit in health insurance may not be a part of every health insurance plan. You must verify it with the insurance company and see the associated document. You may also buy it as an add-on by requesting it from your health insurance provider.

How much Convalescence Benefit can you claim?

You can claim the benefit depending on the stipulated number of days mentioned in the policy. For example, if your health policy states that you will receive the Convalescence Benefit if you are hospitalised for ten days or more, then you can claim it only if you spend ten days in the hospital. You are not entitled to the benefit if you recover within five days.

When can I claim Convalescence Benefit?

Your policy should have this advantage as an inclusion in the policy document. If it is not stated or is part of the exclusions, you may not be able to make a claim. It can, however, be purchased as an add-on. In that case, the terms and conditions of the insurer will apply. The number of days beyond which you are permitted to use this benefit is also specified in the policy document.

For example, you cannot get this benefit if you are only hospitalised for five days and the benefit begins after ten days. So, be sure to read the health insurance policy document to understand the rules related to Convalescence Benefit. Then you can easily get this benefit along with the hospitalisation claim.

Key Insights into Convalescence Benefits in Health Insurance

The convalescence benefit in health insurance policies typically becomes accessible within 7 to 10 days following hospitalisation, subject to the specifics outlined in the policy's terms and conditions. This benefit isn't restricted solely to individual plans; it's also a feature of group health insurance schemes, offering financial support during recovery periods for both individuals and groups covered under the policy.

Some policies may extend the convalescence benefit to cover the expenses associated with compassionate family visits during hospitalisation. However, the inclusion of this feature varies among insurance plans, so it's essential to review the policy details to determine if this benefit applies.

Crucially, the convalescence benefit operates independently of the reimbursement for medical expenses incurred during hospitalisation. It's an additional component of the insurance coverage, designed to provide financial assistance specifically for the period of recovery post-hospitalization.

Often referred to as a recuperating benefit, it serves to offer policyholders peace of mind and financial stability as they focus on recuperating without worrying about the associated financial strain.

Example of Convalescence Benefit in medical insurance

Here's an example that will help you to understand the policy in a better way.

Example 1

Ms. A, a sales executive, is hospitalised due to some unfortunate accident. She is treated immediately, and the doctors advise her to rest for at least 15 days in the hospital. As a result, she cannot report to the office, and there is a loss of income. She receives Convalescence Benefits from the medical company to compensate for this loss of income. She received the benefit because her hospital stay lasted more than a week.

Example 2

Mr. B owns a stationery shop in the city of Bangalore. He suffers a heart attack and gets hospitalised for 2 weeks. His shop remains closed for that duration. Without the Convalescence Benefit in his health plan, he would suffer a loss of income. He made a reimbursement claim for treatment expenses and received the payment under the Convalescence Benefit as well.

Note that the terms for availing this benefit may vary from one insurer to another.

Reasons Behind Insurer's Lump Sum Payment in Health Insurance

The insurer pays the lump sum convalescence benefit to compensate policyholders for the potential loss of income during hospitalisation. This feature provides financial security by ensuring that individuals have adequate funds to cover expenses during their recovery period without needing to deplete their savings.

Often overlooked by policyholders, convalescence benefits offer a crucial safety net, alleviating financial stress and allowing individuals to focus on their health and recovery without worrying about income loss. By bridging the gap between medical expenses and lost earnings, insurers demonstrate their commitment to supporting policyholders through all stages of their healthcare journey, reinforcing the value and reliability of health insurance plans.

Things to be aware of while buying Convalescence Benefit in Health Insurance

Here are some things that you must know about before opting for the Convalescence Benefit in your health insurance plan.

The benefit is available for 7-10 days after hospitalisation, depending upon the terms and conditions mentioned in the health insurance policy.
The benefit is available to individuals and can be a part of group plans.
The benefit also includes the cost of family visits to the hospital. You can check the policy document to understand better what is included in it.
If the benefit is not included in the insurance plan, you can opt for an add-on by asking your insurance service provider.
The Convalescence Benefit is above the medical expenses incurred. It is sometimes referred to as a ‘Recuperating Benefit’.

Frequently asked questions

Following are some common questions about Convalescence Benefits in health insurance.

Is there any cap on the expenses covered?

Yes, different companies have different expense caps on Convalescence Benefit. Some insurance companies offer Rs. 1000/day for seven days, while others provide ten-day benefits. You need to read the coverages and terms mentioned in the documents to determine the exact benefit.

Are convalescence expenses a part of the standard health insurance cover?

No, the benefit is not a part of standard health insurance coverage. It can be an add-on that is available with certain plans. You must go through the terms of the health plan to see if it covers Convalescence Benefits.

Why is the Convalescence Benefit known as a hidden benefit?

The Convalescence Benefit is known as a hidden benefit because most people are unaware of it. You can contact your insurer to check if such a benefit is included in your health plan, so that you can claim it when there is a need and get financial relief.

Is the benefit paid as a lump-sum?

Yes, the benefit is paid as a lump-sum.

Are family visits covered under the benefit?

The cost of compassionate family visits is covered under the medical insurance plan under the ‘Compassionate Visit Coverage’. Such inclusion is mentioned in the policy document if it is applicable. Compassionate Visits are not a part of the Convalescence Benefit.

When does the Convalescence Benefit kick in?

The Convalescence Benefit kicks in after a fixed number of days in the hospital. The expenses paid under this benefit will differ depending on the policy offered by the insurer. You can claim the benefit when you are hospitalised or when the minimum period for eligibility has been passed.

Can you buy Convalescence Benefit in Health Insurance online?

Yes, you can enter your details and search for policies with Convalescence Benefits. Find a plan that suits you and purchase the policy.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes.