Does Health Insurance Cover Fractured Bones Caused by an Accident?

With the advancement in medical procedures, the treatment for fractured bones is quick and simple but is often associated with high costs of surgeries, hospital stays, medicine, etc., and can be overwhelming. This raises an important concern: Does health insurance cover fractured bones caused by an accident? Getting familiar with the scope of your accident insurance policy is crucial and can make a difference in times of medical need. Let’s explore whether fractured bones are covered by accident insurance and maximise your insurance benefits in case of an accident.

Understanding Health Insurance and Accidental Coverage 

Health insurance is one of the most prudent financial decisions that you can make as it provides coverage against medical expenses, cashless treatments at network hospitals and protects you against medical inflation. Various insurance providers offer accident cover as a part of their health insurance plans but it often comes with limitations and an upper limit. 

Hence, it is advised to secure separate personal accident coverage along with your health insurance policy to maximise your benefits and get coverage in case of any mishap.

What Does a Personal Accident Policy Cover?

Let’s discuss the coverages of a  personal accident policy in detail:

• Accidental death: The accident policy pays 100% of the sum insured in case of the unfortunate demise of the insured person. 
• Hospital cash: Daily hospital cash allowance is provided to the insured person in case of hospitalisation due to a critical illness or accident.
• Burns: Accident policy also provides some amount of the sum insured in case the person incurs burns according to terms and conditions.
• Fractured bones: The policy provides coverage for the treatment of fractured bones in case the insured person requires hospitalisation for more than 24 hours.

Are Fractures from Accidents Covered by Health Insurance?

Fractures refers to a medical term for a broken bone and can happen due to a sudden slip, a road accident, or a workplace injury. Fractures incurred due to accidents are not usually covered by health insurance policy and only provide coverage in case you are admitted to a hospital for over 24 hours. Fractures are usually treated in the out-patient department (OPD) and do not require any emergency hospitalisation in most of the cases, and hence are exempted from accident cover policy.

How to Choose the Right Accident Insurance?

Personal accident insurance is a type of insurance that provides financial security in case of an accident or injury to you and your family. But choosing the right accident insurance is an important part in securing your future and keeps you stress-free about any what-ifs. Check out the 5 essentials below to choose the right accident cover policy:

Coverage of the Policy

The most essential step is to check the extent of the coverage provided by the policy. Look for a policy that covers accidental death, total or permanent disability, medical expenses, rehabilitation costs, etc. Moreover, look for a policy that offers add-ons such as hospitalisation allowance and ambulance charges among others.

Sum Insured, Compensation, & Exclusions in the Policy

Look for a policy that offers sufficient sum insured to cover your long-term financial needs in case of any disability or injury. You can also look for the compensation structure of the policy, whether it is paid in lump sum amounts or regular payouts. Moreover, the insurance plans should be compared on the basis of exclusion in the policy and choose the one with the maximum coverage in case of an accident or injury.

Claim Process and Settlement Ration

Opt for a policy that offers an easy and hassle-free claim process with quick reimbursements. You can choose the insurer that has a high claim settlement ratio (CSR) and cashless treatment at a wide network of hospitals.

Conclusion

So, are fractured bones covered by health insurance? The answer largely depends on the extent of the injury and is only covered if the insurer requires in-hospitalisation for more than 24 hours. Most of the accident insurance policies do not provide comprehensive coverage for fractured bones if treated in out-patient departments. Nonetheless, choosing the right accident insurance plans is a wise investment due to an array of reasons, such as coverage for hospitalisation, surgery costs, medication costs, etc. Check out our website and choose the right insurance plan that fits your needs and get access to quality healthcare facilities. 

Frequently Asked Questions (FAQs)

1. Can you claim for fractures?

   In general, you can only claim for fractured bones only if you require in-hospitalisation for more than 24 hours and are exempted from any claim in out-patient procedures.

2. What are the differences between health insurance and personal accident insurance?

    Health insurance provides coverage for the expenses that arise due unexpected health issues whereas personal accident insurance provides coverage for expenses that arise due to accidents or injury. 

3. What are the different things covered under an accident insurance policy?

   Accident insurance policy provides coverage for expenses to the insurer in case of accidents or injury and affects the ability of the person to work in the same capacity.