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What is Road Ambulance Cover in Health Insurance & How it Works?

With the burgeoning prices of healthcare facilities, health emergencies bring great financial turmoil. Often these unfortunate crises drain a family’s savings and cripple them financially and emotionally.

Especially, when the healthcare requirement is an emergency like an accident and swift action is the utmost priority, Road Ambulance Service plays a vital role.

Given their 24 x 7 availability, swift response, trained caregivers and highly equipped advanced medical facilities, modern day ambulances cost an extravagant amount of charge.

Team Digit

What is Road Ambulance Cover in Health Insurance?

An ambulance insurance cover provides financial compensation against ambulance expenses incurred during a medical emergency with an insured individual.

Nowadays, most health insurers provide ambulance coverage in their regular health insurance policies, with an upper cap. This upper cap is mostly a certain percentage of the sum insured in health insurance.

Let us take an example for better understanding:

Suppose you have health insurance with a Sum Insured of 5 lacs. It provides an ambulance cover of 1% of the sum insured, i.e., Rs. 5000. Now, in an unfortunate incident, you had to book an ambulance that cost you Rs. 6000. In this case, the insurance provider would cover Rs. 5000 in your ambulance expense and the remaining Rs.1000 you would need to pay from your side.

Some insurance providers do not provide ambulance cover as part of their policy but cover it under an Add-On that can be separately purchased and accordingly paid for.

At Digit, we cover Road Ambulance expenses as a policy feature under our health plans. The coverage is usually 1% of the Sum Insured, with an upper cap, depending on your policy.

Importance of a Road Ambulance Cover

With a Road Ambulance Cover in place, when we don’t have to worry about the cost of the facility, we can focus better on the primary objective, i.e., getting the necessary medical assistance for the patient.

A Road Ambulance has many benefits over and above any non-medical, on road mode of transport:

Besides being the emergency transit provider, Road Ambulance also serves to provide the prehospital medical care by being equipped with advanced medical facilities.
The clinical environment of ambulances ensures a consistent patient care from the spot of emergency to the hospital.
As the ambulance is the first point of contact for the patient and the trained staff in it provides the primary medical care, the hospital can be better prepared to deal with the incoming situation.
Road ambulances are operated by skilled drivers and trained medical staff. Hence, they can reach the crisis spot within the allotted time. They provide speedy and effective service to patients.

How does a Road Ambulance Cover Work?

Most insurance companies cover Road Ambulance expenses for emergency hospitalisations with the following conditions:

The insurer pays for the above mentioned expense, provided they have accepted a claim under their Hospitalisation Cover.
In a case when you cannot be satisfactorily treated at the first medical centre and must be transported to another, you get reimbursed for the road transportation expenses.
The total claim must be within the availability of Sum Insured as mentioned in your Policy Schedule.

Exclusions under Road Ambulance Cover

There are a few exclusions with most of the insurance providers, including: 

The Ambulance cover benefits are not available in case of planned hospitalisations. It only covers expenses in case of emergency hospitalisations. 
Recurring commute expenses incurred after reaching home are not covered by this benefit.

A well-equipped ambulance becomes a necessity in case of emergency medical assistance. However, it must not hit your pocket. Most health insurance plans these days cover ambulance charges as a certain percentage of the sum insured. You must check your policy document for the complete details about ambulance cover.

FAQs about Road Ambulance Insurance Cover

All

What is Planned Hospitalisation?

If you or any of the insured family members might require hospitalisation in the near future, such as in the case of planned surgeries, you may inform your TPA in advance. This makes the whole claim process much more hassle-free and convenient. However, most insurance companies don’t provide ambulance cover in case of planned hospitalisation.

What is the maximum number of claims allowed in a policy year for ambulance cover?

Usually, there is no restriction on the number of claims. However, the total claim amount of all the claims must be within the specified limit of ambulance cover provided by the insurance company. However, you should always check the complete details with your policy document.

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Disclaimer

For policies with a risk commencement date on or after October 1, 2024, all servicing activities, including without limitation claims processing and grievance redressal, shall be in compliance with the provisions of the IRDAI (Insurance Products) Regulations, 2024 dated March 20, 2024 and IRDAI (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024 dated March 22, 2024 read with relevant Master Circulars.
For more details on risk factors, terms and conditions, please read policy wordings available under download section carefully before concluding a sale.
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Go Digit General Insurance Limited | Corporate Office Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru 560095 | Registered Office Address: 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, Shivaji Nagar, Pune-411005, Maharashtra | Trade logo of Go Digit General Insurance Ltd. displayed above belongs to Go Digit lnfoworks Services Private Limited and is provided and used by Go Digit General Insurance Ltd. under license.