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Convalescence benefit in health insurance | Updated

Don’t forget to claim the hidden benefit or the convalescence benefits from your insurance. Read on to know more about the same.

After the disruption that the worldwide pandemic, coronavirus caused, insurance has been welcomed by people all over. The need to be financially stable in times of crisis is of utmost importance. But there are many aspects of an insurance policy that the general public is not aware of. It is no different for employees with group health insurance. There is a knowledge gap in knowing and understanding insurance benefits to make the best of it.

One of these many benefits is the convalescence benefit. The period of recovery from any illness or injury is known as convalescence. It is not claimed by the majority of people because of a lack of awareness of the same. Read more to find out about this hidden benefit in your insurance policy.

What is the convalescence benefit in group health insurance?

Also known as recuperating benefits, some insurance companies take care of the recovery expenses of policyholders. The convalescence benefit, simply put, helps a client to get a lump sum fixed payment amount in case of prolonged hospitalization. The time and amount will be pre-decided and notified to the client beforehand. Generally, it ranges from 7-10 days.

Convalescence benefit meaning

After treatment is over, a patient needs to fully recover before he or she can join their work. This period is also called the resting period. Before a patient is fully able to work, the post-treatment recovery and hospitalization charges are pre-decided and paid by their insurer.

Since a person is unable to work and suffers because of the same, group health insurance provides a client with a lump sum amount for the recovery period.

Features of convalescence benefit

1. Lump sum payment

After a patient’s treatment is over, the full recovery takes time. During this period a person may feel the financial burden piling up when still being in hospital. To reduce the same, group health insurance provides a benefit in its clauses. Through the convalescence benefit, an individual can claim a lump sum pre-decided amount to help them in their recovery period expenses while hospitalized.

2. Family visits

Often a patient’s family wishes to support and visit during a medical emergency. The convalescence benefit also covers the conveyance expenses in such cases. However, it may vary from insurer to insurer. You must check with the insurance provider if compassionate visits are included in your policy’s convalescence benefit.

Convalescence benefit example

To make it simpler, let us understand convalescence benefits through an example.

Rahul is a sales representative. His work requires him to do on-field duties. Unfortunately, he met with an accident and has to be hospitalized immediately for surgery. His group health insurance through his company covers the expenses for his treatment and surgery in a network hospital. But because of the accident, he is unable to work for a few days and is on bed rest.

In this case, he can claim the convalescence benefit to compensate for the loss of his working days. Because of 10 days or more of the hospitalization period, Rahul will get a lump sum amount after his recovery period.

When to claim convalescence benefit?

The buyer needs to check his or her policy to see if the convalescence benefit is inclusion or exclusion. If it is an exclusion, the insurance buyer will not be able to raise a claim against it. However, it is also available as an add-on benefit. You can buy the convalescence benefit as an add-on with your group health insurance policy by paying some extra amount for the same.

The eligibility to claim depends upon the insurer and may vary from company to company. Generally, it can be claimed after 7-10 days of hospitalization.

The amount will be pre-decided between the buyer and insurance provider. You can claim this benefit only after the specified duration. Otherwise, your claim will get rejected by your insurance provider.

Also Read: Exclusions in your insurance policy

How to claim the convalescent benefit?

When buying a group health insurance policy, you need to read the fine print beforehand to make sure you understand the terms and conditions.

The eligibility would be clearly mentioned in the clauses. However, claims would be done through reimbursements. The minimum days of post-treatment hospitalization, after which you can claim reimbursement will be mentioned in the policy itself.

Also Read: How to claim health insurance?

FAQs on convalescence benefit


Is the convalescence benefit in health insurance a standard cover?

No, it is not a standard cover as it varies from insurer to insurer. The time period and fixed amount also vary.

Why is this benefit known as a hidden benefit?

While buying health insurance, not many people are aware of this benefit. Lack of knowledge about the same resulted in this being a hidden benefit.

Why does the insurer pay in lump sum?

The buyer is compensated for the loss of his or her working days through this benefit. The amount is paid in a lump sum to cover the necessary expenses during the recovery period.

Is it available in only group health insurance?

The convalescence benefit may come as inclusion or can be bought as an add-on cover in both personal as well as group health insurance policies.

Do you get convalescence benefits if you recover from home?

The convalescence benefit provides some additional cash in case of prolonged hospitalization only. But you may still check with your insurance provider as it may vary from insurer to insurer.
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