Convalescence Benefit in Group Health Insurance

  • Author :
  • TATA AIG Team
  • Published on :
  • 12/03/2024

A hectic lifestyle and stressing oneself at work to survive the rising economy are the realities of today’s world. Everyone needs to pay special attention to their health. This makes it essential for employers or companies to provide group health insurance plans to their employees as a sign of care.

With rising health concerns among employees, group medical insurance policies provided by the companies look like a good deal. These plans have a comprehensive perspective of looking at an employee’s health since the plans also cover their immediate families.

There is another peculiar characteristic to the group health insurance plans, and that is the convalescence benefits. This feature adds a layer of security for the employees since it extends the scope of policy coverage after the treatment.

What is Convalescence?

When a patient goes through treatment of any kind - surgery or otherwise, it takes time for them to recover completely. It can be a case of illness, accident, or maternity; there is a period of time the patient takes to recover.

The time that is taken by a patient to recover from an illness or surgery is called convalescence.

Convalescence Benefits: Meaning

As mentioned above, convalescence benefits are a unique feature that extends the scope of the policy coverage. Usually, an individual or family health policy provides coverage for treatment expenses, including doctor’s fees, pharmacy bills, outpatient care, inpatient costs, etc.

But with health insurance that provides convalescence benefits, the policy will also cover your recovery expenses. It is designed to cover the recovery period expenses after the hospitalisation or surgery. This coverage offers financial compensation for components like loss of income that is experienced during the rehabilitation period.

Convalescence Benefit In Group Health Insurance Plans

When we integrate convalescence benefits with group health insurance, the synergy creates an all-inclusive solution for all the potential financial losses for the employee. When all the features and components of group health insurance work in accordance with these benefits, it promotes a more holistic welfare of the company.

These benefits assure the employees of further financial assistance from the company. Since they cannot work for the company for a certain amount of time, it will affect the employee’s financial income.

Without convalescence benefits, the concerned employee will have to take unpaid leaves to take care of their health and recover. But with convalescence benefits, the employee gets financial compensation for their treatments as well as they get a lump sum amount for the loss of income they incurred while being absent from work.

Convalescence Benefits In Group Health Insurance Of An Employee: An Example

Let’s say Miss Sadhana was severely ill due to a pancreatic infection. She has been hospitalised under a group medical insurance policy provided by the company she works for. The doctor has prescribed 2 weeks of hospitalised care and treatment along with 1 week’s bed rest at home on discharge.

This entire situation translates to Miss Sadhana having to stay away from work for a total of 3 weeks. She will have to bear the loss of income due to all the leaves she opted for over and above her sick leave quota.

But the catch is that this group health policy has an add-on feature; it has convalescence benefits. This feature financially covers her treatment expenses as well as loss of income during the bed-rest period. This has two positives: she does not have to incur a loss of income, and the company will not have to pay for her extra yet genuine sick leaves unfairly.

Convalescence Benefits Claim

If you want to claim the convalescence benefits for your financial loss due to the recovery period, you will have to look for a number of details in your insurance policy.

Since it is an insurance policy designed and customised by the company and the insurance provider, the employee might not be completely aware of the terms and conditions mentioned in the policy.

This situation makes it very important for the concerned employee to read the terms and conditions and understand the scope of their coverage.

Here are a few things that might help you raise a claim for your convalescence benefit.

When?

Your policy specifies the number of days you have to wait before raising a claim for your hospitalisation period. If your policy mentions that you can apply for a claim after a week of hospitalisation, you will have to wait for those many days to get the process started and apply for the claim. If you try and apply for a claim within 5 days, your application will be rejected.

Usually, the insured has to wait for 7 to 10 days since that is the case with the time limit of most insurance policies that include convalescence benefits.

For What?

Your policy mentions all the terms and conditions for settling the claim. You will have to meet those criteria and terms in order to receive your claim amount. You need to ensure that the reason for your hospitalisation is not included in the exclusion list of the policy but in the coverage.

How Much?

The amount you can claim from the insurance company under the convalescence benefits of your group health insurance is always mentioned in the policy. It is pre-determined with the help of your company’s and your personal financial records. That way, it is easy to calculate the approximate loss of income you incurred and cover for that.

Group Health Insurance: A Comprehensive Care Unit

Buying a group medical insurance policy is an essential strategy for a company that wants to nurture and retain its talent. Experience all the different add-on features and riders to maximise provisions and benefits for employees’ all-round welfare.

With benefits like convalescence benefits, coverage for family, and cashless healthcare, the employees experience the best of financial security.

Even if it is a small and medium enterprise, SME insurance and group health insurance make policies customisable, flexible, and affordable to boost growth and promote employee wellness.

Final Thoughts

Convalescence benefits in context with group health insurance is a robust financial solution for your small, medium, or large-sized business. If companies can make an effort to look after the welfare of their machines by maintaining and updating them, building a solid support system for their human base is the bare minimum they can do.

Build trust, a strong workforce, and well-cared relationships with the help of this group's health insurance. Let us solidify our commitment towards a healthy lifestyle, a healthy workplace, and a healthy body!

FAQS

How to buy group health insurance with a convalescence benefits add-on?

You can enquire about the same to your employer, the company’s management or finance team, or the insurance provider. You will find a way to integrate convalescence benefits with the group health insurance.

Why is the convalescence benefits claim paid in lump-sum amounts?

The convalescence benefit amount is pre-determined at the time of making a contract with the concerned insurance company and business. Since it cannot exceed the mentioned limit, it is not paid in instalments but in a lump-sum format.

Why don’t most companies opt for the convalescence benefit?

Most companies are not aware of any such cover available with the insurance company. This is also a significant reason why this benefit is also called a hidden benefit!

Disclaimer / TnC

Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.

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