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Convalescence Benefit & Recovery Benefit In Group Health Insurance – Everything You Need to Know

By January 8, 2022January 9th, 2022No Comments

An Overview Of Convalescence And Recovery Benefits In Group Health Insurance 

Most organizations and businesses offer group healthcare insurance benefits to their employees. Any organization or startup having more than seven active employees can purchase the policies to confer to their employees. Depending on the insurance plan, the features differ in more than one way. Plan coverage, the network of hospitals, hospitalization expense coverage, and many more varies according to the insurance plan and premium rates. Most employers make a mistake by going for a generic plan without reviewing the benefits in detail. For this, most employers are unaware of features like the convalescence benefit or recovery benefit. 

An outline of group healthcare insurance

Before knowing about the recovery benefits, get an idea about the overall concept and working of group healthcare insurances. A GHI, also known as Employer healthcare policy, is a service-related concession most organizations provide to their employees. The employer buys the insurance and pays the premium to renew the insurance annually on behalf of the employees working in the organization. The insurance covers the employee and may or may not cover the medical expenses for their family members (spouse, children, and dependent parents), depending on the chosen plan features. 

A convalescence or recovery benefit is not a part of every insurance offered in India. The employer has to check the coverage features to ensure the inclusion of recovery payments in the group healthcare plan. 

What is the recovery or convalescence benefit in GHI?

As the term suggests, recovery or convalescence benefit in a group healthcare policy is the lump sum amount that the insurer pays to the policyholder during the recovery period. The insurance company provides such customer-oriented features to ensure better financial support during medical distress. The insurer pays an extra amount to the employee, who is the policyholder in this case, when they are at physical rest for recovery from a disease or injury. The insurance company will pay you the recovery lump sum, even if you have partially or completely exhausted the insured sum for treatment. 

How does the benefit work for the policyholder?

If the policyholder gets hospitalized for more than the pre-decided period, then the insurance company provides a lumpsum as per the policy features. This benefit falls under the terms and conditions of the chosen insurance. The amount received by the policyholder may vary depending on the specific terms and attributes of the group healthcare plan. It is also called resting period coverage because you get the amount while recovering from treatment or ailment. 

Understand with an example

It will be easier for you to understand the working process of the recovery benefits in a group healthcare policy. Suppose your employer has bought a group healthcare insurance that features recovery benefits as a part of plan coverage. After you have undergone treatment, the doctor has advised you to take a month-long rest. In such times, the convalescent comes to your rescue by offering financial support. By the terms and conditions of the GHI, the insurer will compensate for your loss of income during the recovery period. As you will not be able to attend work, the insurance company acts as financial support. You have to stay hospitalized for more than a week for valid medical treatment to avail of this benefit. 

How does it benefits you as an employee?

When an employee is in the recovery period and under complete physical rest, they cannot attend work. As a result, they can also get a pay cut for their absence from work. In such times, additional financial support works in more than one way. It helps in meeting the financial requirements as you can pay your dues with the lump sum received from the insurer. Thus, for an employee, the convalescence or compensation payment is highly useful when in need of financial support. 

What gets covered under the lump sum benefit?

The primary objective of providing such recovery benefits through group healthcare insurance is to support the policyholder financially. As the group healthcare insurance is part of a corporate plan, the money received from the insurer acts as salary support when you are away from work. Also, the convalescence amount helps in meeting the post-hospitalization charges. You can pay the medical bills without worrying about the sum limit provided in the insurance. 

Who can enjoy the convalescence benefit?

While a group healthcare policy may offer plan coverage for the dependent family members of the employees, but the recovery benefit may not be applicable for the same. Only the employee can enjoy the convalescence benefits under the insurance plan. However, it is on the insurance company to alter the norms of the insurance plan terms. Usually, the convalescent payment is only applicable for the employee who works in the organization under the employer, buying the insurance. 

When can you claim the recovery benefits?

There is a pre-defined period mentioned in the group insurance clause which determines whether you are eligible for getting the lumpsum payment. For most insurance companies, the recovery period lasts 7 to 10 days. It means, the policyholder can only apply for the convalescence payment after completing the tenure of 7 to 10days in the hospital. If they claim it before the mentioned time then they do not get any payment for recovery support. The pre-mentioned period starts from the first day of hospitalization. Hence, for a policy that mentions seven days as a recovery term, the policyholder has to more than seven days to claim the convalescence amount. 

Few points to note

  1. The amount that the policyholder receives for the recovery support can vary depending on the policy terms.
  2. The policyholder requires to stay hospitalized during the recovery process to qualify for the convalescence payment.
  3. The policy may or may not include the cost of hospital-visit by the relatives of the patient.
  4. The benefit does not fall under standard coverage plans and varies across the offers of different insurance companies. 
  5. This benefit is termed as a hidden benefit as most policyholders are unaware of such insurance features. 
  6. If the convalescence payment is not under a group healthcare plan, you can add on the feature by paying extra with the annual premium.

How do you find the right one?

Not every group healthcare insurance has such benefitting attributes for the policyholders. If you research on your own without seeking expert advice, you may not find policies that provide such benefits. For availing of a tailor-made plan and lucrative insurance benefits, you should always consult with the insurance provider or seller. They will guide you in the best way to find the right employer medical insurance among multiple options.

As an employer searching for group healthcare insurance, there is no better option than PlanCover. They bring to you the best group Mediclaim policies that serve right as per your expectations. Connect to them to purchase the best policy with recovery benefits under your budget. 

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