What is Convalescence Benefit in Health Insurance meaning?

Hospitalisation in an emergency can be difficult for the patient in more ways than one. One is of course the physical trauma of being in the situation and then there are the emotional effects of the situation on the mind; not to forget, the financial implications on your pocket as well.

Interestingly, the period of recovery from an illness/health condition (for which hospitalisation was required) can also sometimes be equally difficult. Agreed, it brings rest and relief from the condition, assuring you that the worst is over. However, sometimes an extended period of recuperation may result in the lapse of sick leave granted by your employer, even resulting in salary deductions/income loss.

This can be difficult to take. For times like these, in other words, for the period of convalescence (the time of recovery or recuperation from a medical condition), some health insurance plans offer the convalescence benefit to policyholders. Let’s learn all about it in this blog.

What is Convalescence? 

The benefit mentioned above is offered in health insurance only to a convalescent meaning a person who is recovering from an illness, injury, or a medical treatment performed for a particular health condition (such as surgery). Hence, the name convalescence benefit is given to that feature of health insurance policies that covers the loss of income for the patient in case of extended hospital stays for complete recovery.

Let us understand this feature in detail through the following example:

Ravi works in a multinational in Bangalore. As part of his employment with the company, he has been granted 5 Sick Leaves (SLs) for the whole year.

Note: The SL is a benefit offered by the employer to cover times of emergency for the employee, such as when they get sick or need urgent medical treatment. It is a predefined number, pre-fixed for the entire year at its beginning.

One day on his way to work, Ravi meets with an accident on the road and gets severely injured, fracturing his right arm in the incident. He also suffers some minor internal injuries, for which the doctor advises an additional 3-4 days of stay in the hospital to ensure that his internal wounds are completely healed before discharge.

Ravi applies for leave from work; however, he had only 2 remaining in his account at the time of the accident (since he had already used up 3 leaves in the previous months during an illness). And now with the doctor’s advice for an extended stay in the hospital, he wouldn’t have enough SLs to cover up for it. This would mean the remaining days of leave deducted from his monthly salary, which in turn means loss of income for Ravi for the duration he needs to stay in the hospital for complete recovery from the accident’s impact.

However, to Ravi’s advantage, his employer had purchased a group health insurance policy that provides employees the benefit of convalescence in cases like the one Ravi had encountered. As part of the convalescence benefit of the health insurance plan that Ravi was also a part of (as an employee of the company), he would be compensated by the health insurer for any loss of income incurred by him during his recovery period.

For the total number of days that Ravi would need to be on leave from work, the total income deducted consequentially would be covered by the insurance company in a lump sum. This means that Ravi would not have to worry about loss of income while recovering at the hospital and focus only on getting better without worry on his mind!

Benefits of the Convalescence Feature in Health Insurance Plans: Convalescence Benefit in Health Insurance

This benefit has several advantages for the employees, some of which are listed below:

• Convalescence benefit is provided in both individual and group health insurance plans.
• The insurance company agrees to pay a lump sum to the policyholder (employee) for covering the loss of income to them in case his/her allotted leave lapses owing to a medical emergency.
• The Convalescence Benefit may also sometimes cover family visits to the patient during their time of hospital stay. In case the family lives far from the hospital, the cost incurred by them as conveyance would be covered by the insurer.
• This benefit is provided in addition to all other medical expenses incurred as part of hospitalisation. It is therefore also known as a recuperating benefit and is paid by the insurer over and above the claims for hospitalisation from the insured.
• The benefit is generally covered for 7-10 days after the patient’s hospitalisation.

When Can You Claim the Convalescence Benefit?

This feature is not available as a standard in all health insurance policies. Currently, only some insurers provide this benefit to their policyholders. Also, it may be mentioned in very fine print in your health insurance policy document, so make sure to read it very carefully at the time of purchasing the plan. You can also check with your insurer specifically about any such provision they might offer.

Here’s when you can claim convalescence benefit as part of your health insurance plan:

• It needs to be mentioned in your mediclaim policy. If it is stated as part of ‘Exclusions’ in the plan, you cannot claim it.
• You can avail convalescence benefit by purchasing it as an add-on benefit, in case it is not already provided as part of your insurance policy.
• You can only claim this benefit if your period of hospitalisation or recovery exceeds the number of days already covered in your plan (for hospital stays).
• The benefit would be available only after the number of days specified in the plan. You cannot claim against it before the period specified.
• The amount covered under the benefit is predetermined by the insurer at the time of policy purchase.