Everything about Health Insurance Add-Ons/Riders you should know
You have bought a standard health insurance plan and are comforted by the fact that all your health-related expenses are covered from this point of time. But there are certain requirements that a standard health insurance plan does not cover.
What about them, then?
Here is where health insurance riders come into the picture!
If you already hold a health insurance policy, it is highly likely that you have heard the terms add-ons or riders. It is now time to divulge into the details of what they entail.
What is Health Insurance Rider or Add-On?
These terms, in essence, are additional benefits or coverage which do not come within the existing features of a health insurance policy but have to be added separately in exchange for an additional premium.
Health insurance add-ons or riders can be taken on and above your existing health insurance policy to enhance its benefits or sum insured to be availed on account of pre-determined events.
According to the Insurance Regulatory and Development Authority of India (IRDAI), the collective premium for all riders or add-ons availed under a single health insurance policy cannot exceed 30% of the original premium amount.
For instance, you avail a family floater health insurance policy at Rs. 5000 per annum premium for a sum insured of Rs. 700000. You also decide to include 5 add-ons to your health insurance policy. In that case, the additional premium you will need to pay for those add-ons cannot exceed Rs. 1500 (5000 x 30%) as per regulations mentioned by IRDAI.
What are the Different Types of Health Insurance Add-Ons?
The different types of add-ons in health insurance plans in India are mentioned below.
Health Insurance Add-On
What is Covered?
Room Rent waiver
With this health insurance rider, you can either increase the sub-limit provided for hospital room rent under your policy or opt for no sub-limit on room rents.
This rider covers all expenses related to pregnancy and childbirth.
Hospital cash cover
It is a form of daily cash allowance provided by the insurer to the insured individual during hospitalisation.
Critical Illness cover
This add-on provides financial coverage for expenses borne due to critical illnesses such as cancer, cardiovascular diseases, etc.
Personal Accident cover
This add-on provides compensation for all kinds of accidental injuries sustained by an individual, including disability, death, etc.
This add-on allows the insured individual to avail additional financial assistance depending on which zone he/she is seeking treatment in.
AYUSH Treatment cover
Under this add-on, you receive financial coverage for alternative treatment methods (Ayurveda, Yoga, Unani, Siddha, and Homeopathy).
Types of Add-Ons in Health Insurance Policies - Explained
1. Room Rent Waiver
In a standard health insurance policy, hospital room rents are capped to a certain limit. When you include a room rent waiver add-on to such health insurance policies, it either increases that limit, or no-limit is imposed.
In the case of no cap, room rent is allowed to the extent of the sum insured. It is a crucial health insurance rider if you are hospitalised in a metropolitan city, where hospital room rents are considerably higher.
For instance, your standard health insurance policy caps the room rent limit at Rs. 1500 per night. You find it inadequate to meet room rent expenses in hospitals you would prefer to be admitted. Hence, you take the room rent waiver add-on and increase such sub-limit to Rs. 4000 per night.
2. Maternity Cover
With a maternity cover, you receive coverage for all expenses related to pregnancy and childbirth. Some insurance companies also provide coverage for the child’s expenses either up to the policy’s maturity period or up to 3 months from the child’s birth under maternity cover.
3. Hospital Cash Cover
Under this health insurance rider, you are provided with daily cash allowance by the insurer for the period during which you are hospitalised. The insured individual must be hospitalised for more than 24 hours or 1 day to receive the allowance.
It is provided to compensate for the loss of pay during hospitalisation and can be utilised to meet necessary expenses like that of conveyance, food, etc.
4. Critical Illness Cover
Under this add-on, insurance companies provide a lump-sum amount to the insured when diagnosed with any critical illness, irrespective of the cumulative treatment expenses.
Suppose, you have availed a health insurance policy with a sum insured of Rs. 5 lakh. You also decide to avail a critical illness cover add-on which offers a sum assured up to Rs. 15 lakh.
In case you are diagnosed with cancer, and you raise a claim with the insurance company, it will immediately pay out a lump-sum of Rs. 15 lakh even though your total treatment costs stands at Rs. 9.5 lakh.
5. Personal Accident Cover
This add-on provides financial coverage on account of accidental damages suffered by the insured individual. It includes partial disability, permanent disability, death, etc.
In case of death, due to an accident, the insured individual’s family receives a lump-sum amount under this add-on.
6. Zone Upgrade
With a zone upgrade, you can avail higher financial coverage for treatments at different city zones. Zones are classified as per the city’s medical expenses. The higher the medical expense in a particular region, the higher it is placed in such classification.
This add-on allows you to account for the disparity in treatment costs across different regions or zones with a slightly higher premium. But subsequently allows you to save on your total premium by 10%-20%.
Different zones in India:
- Zone A - Delhi/NCR, Mumbai including (including Navi Mumbai, Thane and Kalyan)
- Zone B - Hyderabad, Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, Chennai, Pune and Surat.
- Zone C - All Cities apart from A & B belong to Zone C
Currently, at Digit, we have two zones: Zone A (Greater Hyderabad, Delhi NCR, Greater Mumbai) and Zone B (All other places). You get an additional discount on premium if you are based in Zone B. Not just that, we have No zone-based co-payment.
Zone Based Premium Calculation with an Example
Premium is Rs. 5315 with 20% Co-payment
Premium is Rs. 5882 with 10% Co-payment
Premium is Rs. 6448 with 0% Co-payment
Pay Rs. 567 (Zone C -> B) as Zone Upgrade Add-on Charges
Pay Rs. 1133 (Zone C -> A) as Zone Upgrade Add-on Charges
Save 10% Co-payment Charges
Save 20% Co-payment Charges
7. AYUSH Cover
You can avail financial coverage for hospitalisation expenses related to alternative treatment methods which include – Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
This cover is only available for senior citizens or individuals above the age of 60.