Nursing Expenses in Health Insurance

Yes, most health insurance policies offer coverage for nursing expenses. Nursing expenses refer to the expenses incurred when a nurse or attendant is hired to take care of the insured member after his/ her discharge from the hospital. While nursing expenses are generally covered, it largely depends on the insurance policy that you have. Nursing expenses are included in post-hospitalisation expenses, which are covered by a policy for a specific number of days only. Therefore, it is highly recommended that you confirm the coverage of the nursing expenses and the number of days for which the coverage is provided.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

When you buy a health insurance policy, the following expenses are generally covered under it:

• Emergency services

• Hospital expenses like surgery

• Ambulance service

• Maternity and new-born care

• Prescription drugs

• Mental health and substance use disorder services (inclusive of counseling and psychotherapy)

• Habilitative and rehabilitative services and devices

• Pediatric services

• Preventive and wellness services and chronic disease management

• Laboratory services

• Post-hospitalisation services

This would differ from policy to policy.

When you buy a medical insurance policy, it covers the hospital and post-hospital expenses incurred for a defined number of days. This varies from one health insurance provider to another. If the hospital costs are for the same medical condition for which the insured individual was hospitalized, then the hospital charges incurred in a specified period is payable by the insurance company. The insurance company also admits the in-patient hospital costs claim.

You can claim the nursing expenses only if your health insurance provider has added nursing expenses in the post-hospitalisation expenses. Usually, medical insurance policies cover post-hospitalisation expenses related to consultation fees, diagnostic charges and medicine costs. But, if your insurer has added nursing expenses under the category, you can claim these expenses by submitting the original bills, doctor’s certificate, and a discharge summary to the insurer.

Usually, a medical insurance policy covers all the medical treatments recommended by a doctor. But, there might be a few exceptions in certain cases. If you have a test or treatment where hiring an attendant is necessary, the expenses of hiring an attendant or nurse may not be covered by your insurance policy. Such a situation can lead to health insurance claim rejection. Majority of the cases are subjected to this situation since many insurers don't cover nursing expenses. However, with the right to appeal the decision, you can still pursue your insurance provider to cover the expenses. Before that, you have to make sure that you are acquainted with the appeal process of your insurance company. The process will be discussed in your plan handbook.

It is always wise to be well-versed with your medical insurance policy to avoid the occurrence of such situations. Read the fine-print of the insurance policy thoroughly and ask necessary questions to your insurer while buying a health insurance. It is best to be well-acquainted with the policy coverage and health insurance claim process as that will help you in future.