Medical or Hospitalisation & Surgical Insurance provide cover for treatment (admission) to a registered hospital. The benefits covered usually include hospitalisation room & board, surgical fees, medical treatment charges, pre and post hospitalisation diagnosis & treatment, outpatient cancer treatment, kidney dialysis, etc.
Medical insurance will provide hospitalisation and surgical treatment benefits only upon admission unless specifically excluded such as pre-existing or specified illnesses. The exception is treatment due to accident. In the event of an accident, the medical benefits can be claimed for outpatient treatment.
The hospitalisation and surgical benefits are claimable only after 30 days waiting period except in the event of an accident, where medical benefits are claimable immediately when the policy is inforce. There is also an exclusion period of 120 days for specified illnesses. Pre-existing illnesses may be excluded for 120 days or permanently depending on the severity.
Most hospitalisation and surgical policies come with a co-insurance of 10 percent with a maximum limit. Where the room & board upon admission is higher than the policy’s room & board, a co-insurance of 20 percent is applicable throughout all medical treatment charges.
Cashless admission may be available but is subjected to private hospitals’ arrangement with the Insurers. Otherwise, claims will be on a reimbursement basis. Most medical or hospitalisation and surgical policies provide cover up to age 80 years while some may cover up to age 100 years. Only renewals are allowed for life insured above 60 years or 69 years depending on Insurers.