What is Indemnity Health Insurance Plan – Coverage, Benefits & How to Claim
Under the Indemnity Health Insurance plan, policyholders get reimbursements for the costs of medical expenses up to the sum insured amount. For example, an individual purchases a health plan that offers a sum insured amount of Rs.5 lakh. The individual gets hospitalized and the hospitalization bill is Rs.2 lakh. Under an indemnity plan, the insurer will reimburse Rs.2 lakh.
‘Mediclaim Insurance Plan’ is one of the popular Indemnity Health Insurance Plans in India.
If you are considering opting for indemnity health insurance plan, know what is it, coverage, exclusions, benefits and the claims process. Read on!
Coverage Under Indemnity Health Insurance Plan
Indemnity health insurance policies offer the following coverages:
- Pre-hospitalization expenses
- In-patient treatments including ICU room charges, doctor’s fees, diagnostic tests, medicines, surgery
- Post-hospitalization expenses
- Daycare treatment
- Covid-19 treatment costs
Exclusions under Indemnity Health Insurance Plan
Here are some exclusions under an indemnity plan:
- Post-operative costs
- Medical treatments associated with plastic surgery, AIDS, etc.
- Incidents arising under the influence of narcotics or alcohol
- Loss of goodwill
- Criminal acts
Eligibility Criteria for Indemnity Health Insurance Plan
The following individuals are eligible for cover under this type of health insurance:
- Medical practitioners such as surgeons, pathologists, etc.
- Individual practitioners
- Aesthetic cosmetic practitioners
- Medical staff suppliers
- Obstetric scanning
- Mental health clinics
Benefits of Indemnity Health Insurance Plan
This type of health insurance policy comes with a host of benefits such as follows:
1. Flexibility while Choosing Hospitals
Policyholders prefer choosing their desired hospital or doctor for treatment. Considering this, indemnity plans offer a large network of hospitals and medical practitioners for the insured to choose from. On top of that, they can avail themselves of cashless facilities from these hospitals without worrying about bills.
2. Wide Coverage
It is evident from the above coverage list that these plans include an extensive scope of treatment expenses. Further, it covers actual hospital bills up to the maximum limit of the sum insured. Additionally, it provides coverage for Covid-19 treatment.
3. Low Premium Outgo
When it comes to health insurance, one must be aware of the premium outflow. An indemnity plan comes with a deductible that needs to be paid by an insured individual during the claim process. In this way, the insurance company lowers its risk and passes on a lower premium to the policyholder.
4. Cashless Treatment
Individuals opting for indemnity-based health insurance can get cashless treatment from one of the network hospitals. During cashless treatments, the insurance provider will directly settle the medical bill with the hospital, and the policyholder need not pay anything out of his/her pockets.
5. Co-payment Option
Health insurance plans with co-payment options state that an insured member must pay out a certain portion of the claimed medical bill, as fixed by the insurer. For instance, if a health insurance policy of Rs. 4 lakhs features a co-payment of Rs. 40,000, then after hospitalization, if the medical bill came out as Rs. 3 lakh, an insured must pay Rs. 40,000 out of his pockets. In this way, one can enjoy lower premium pay-outs.
Claim Process of Indemnity Health Insurance Plan
Take a look at the claim procedure under this health insurance policy:
- First, you need to inform your insurer about the immediate needs.
- Submit all the relevant documents for the indemnity plan claim procedure.
- Pay the respective deductible.
- The insurance company will go through your documents and arrange for a claim settlement.
Other than this, you can get comprehensive health benefits coverage from reputed insurance providers such as Navi. Download the Navi app on and enjoy cashless claims in under 20 minutes without any paperwork.
Also Read
Indemnity – Type Corona Kavach Health Insurance
This standard health plan covers hospitalization expenses for Covid-19 patients. Individuals between the age group of 1 day and 65 years can avail of this insurance policy and choose a sum insured amount between Rs. 50,000 to Rs. 5 lakh.
Further, the terms and policies under this indemnity plan remain similar across all insurers.
Check out the inclusions under this policy:
- Pre and post-hospitalization expenses including costs of PPE kits, oxygen cylinders, ICU charges, cost of treatment, blood tests, and doctor’s fees during hospitalization.
- Cost of co-morbidity treatments during Covid-19.
- Home care treatment expenses.
- AYUSH treatment expenses.
- Ambulance charges.
Final Word
To conclude, an indemnity health insurance plan provides extensive coverage for medical expenses except for a few. It also enables policyholders to avail health insurance coverage at a lower premium compared to other plans. However, insurers assign deductibles for this plan during the claim procedure. So, it is advisable to learn everything about the policy terms and conditions before proceeding to purchase one. If you are looking for affordable health insurance, download the Navi app on now and get your policy in under 2 minutes.
FAQs
Ans: No, you can choose a doctor or specialist of your choice for an appointment under this insurance plan.
Ans: You must furnish essential medical reports, hospital bills, and other medical documents during the claim process on your indemnity health insurance.
Ans: The policy term for the Corona Kavach Indemnity plan can be 3.5, 6.5, or 9.5 months.
Ans: You can use any medical provider with an indemnity plan. Either you or the provider sends the medical bill to the insurer. The insurance company pays part of the bill, and you must pay the rest in the form of a deductible.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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