OPD expenses are usually not covered under indemnity health insurance

—Name withheld on request

Regular consultation and medical expenses are OPD (outpatient department) expenses, which are usually not covered under an indemnity health insurance policy. Typically, the policy only covers hospitalization (in-patient department) expenses when active treatment is performed or surgery is performed. However, there are some health insurance products available in the market that cover OPD expenses as well.

My son complains of hearing problems; The pediatrician has suggested getting it checked in the hospital. Can I use health insurance if the hospitalization took less than a day?

—Name withheld on request

As per the policy ‘hospitalisation’ means hospitalization for at least 24 hours. A customer can definitely claim insurance benefits if there is no hospitalization for 24 consecutive hours under defined day-care procedures. Each health insurance policy covers specific procedures defined under the list of day-care procedures that do not require 24-hour hospitalization. Day-care treatment can be availed due to advances in medical technology, otherwise 24 hours hospitalization would be required. Some of the common treatments that come under the day-care list are chemotherapy, glaucoma and radiotherapy.

I have filed a claim after the expiry of the date of my policy for an accident that occurred during the policy term. Will I still get the claim?

—Name withheld on request

Any injury, illness or loss that persists within the policy term is eligible for claim, subject to other terms and conditions of the policy. Most policies have a stipulated time within which the insurance company has to notify the claim. It is advised to stick to this time to avoid any kind of trouble at the time of need.

Atul Deshpande is Head – Claims, Digital & Projects at SBI General Insurance. Questions and thoughts at mintmoney@livemint.com.