Convalescence Benefits - Meaning, Benefits & FAQs

One of the most important cornerstones of a sound financial plan is a robust health insurance policy . Health insurance works by reimbursing your medical treatment or hospitalisation bills in case you’re admitted to a hospital or undergo medical treatment during the policy tenure.You’re supposed to pay an annual premium in order to gain the benefits of a health insurance policy. A basic health plan would cover major illnesses, hospitalisation, treatment, ambulance services, etc. However, health insurance providers also offer add-ons to a vanilla health plan which provide additional benefits like accident cover, critical illness cover, etc. for an additional premium.One such added feature of a health insurance plan is the convalescence benefit. Let us look at the convalescence benefit in individual as well as group health plans in detail.

The convalescence benefit is a fixed amount that the insurer is liable to pay you in case you’re hospitalised for a pre-decided period of time as per the terms and conditions of the health insurance policy. This is in addition to the medical costs incurred and reimbursed by your policy.The convalescence benefit is an income replacement since prolonged hospitaliszation would mean that you won’t be able to carry on professionally, which might hamper your work income. The convalescence benefit is pre-decided when you purchase the health insurance policy, and if you fulfill the criteria during a claim, then it is paid as a lump sum amount.

The term ‘convalescence’ means the time one spends recovering from an illness or the resting period during or after an illness. During this phase, you may be unable to work. Hence, a convalescence benefit can provide financial relief. Thus, a health plan with a convalescence benefit takes care of your medical expenses and partially restores any income loss you face due to your hospitalisation.

During the convalescence or recovery period of an illness, one is usually still admitted to the hospital and has to take a necessary hiatus from work. There may be a loss of income during this time since most employers provide a limited number of paid sick leaves. Higher leaves may lead to a deduction in the salary as per the employer’s contract. During this difficult time, a convalescence benefit can help restore this loss in income. This benefit is available both in individual as well as group policies. It is paid as a lump sum amount. The amount and criteria for convalescence benefit are fixed during policy purchase.

Let us look at the convalescence benefit with an example.

• Consider Gaurav, an IT professional working in an IT firm. He is part of a group health insurance policy that provides a fixed lump sum amount as a convalescence benefit for a minimum hospitalisation of 10 days.
• Gaurav turns ill and must be hospitalised for treatment. He is on his road to recovery, but he must be hospitalised for at least 15 days.
• Hence, he is unable to continue working, and a loss of income is expected.
• Since his group policy provides the convalescence benefit, he stands to receive a lump sum amount as a substitute for the loss of income.

One must understand that Gaurav can claim the fixed lump sum amount because he was hospitalised for the required number of days as per the terms of the policy. The convalescence amount, as well as the hospitalisation period, may differ from one insurer or plan to another.

The convalescence benefit is not a part of all health insurance plans. Check your policy document to see if it’s included. You may also purchase it as an add-on from your insurance provider.You can claim a convalescence benefit if you are hospitalised for more than the stipulated number of days in your policy. For example, if your health policy specifically states that you must be hospitalised for 10 days or more, then you can only claim the convalescence benefit for that number of days. If you recover and are discharged in 5 days, then you cannot claim the convalescence benefit.

• The benefit is usually available 7 to 10 days after hospitalisation, depending on the terms and conditions of your health insurance policy.
• The convalescence benefit may be available for individual as well as group plans.
• The benefit sometimes includes the cost of compassionate family visits to the hospital. Check the inclusions of your plan to see whether this benefit is included.
• The convalescence benefit is over and above the medical costs incurred. It is also known as a recuperating benefit.