Does Health Insurance Cover Ambulance Charges?

Like the many unwanted guests in life, medical emergencies might feature on the top of everyone’s list. When a medical emergency takes place, there are different things which you must deal with. Getting a bed at a good hospital, availability of your preferred doctor, and lesser admission charges, are just some of them. However, the most important step is always going to be getting an ambulance to take the patient to the hospital. As most ambulances are private, their charges differ. Thus, to answer ‘does insurance cover ambulance fee?’, it is important to understand if your individual or family health insurance provide coverage for ambulance charges or not.

What Are Ambulance Charges In India?

Ambulance charges in India vary based on factors such as the type of ambulance, distance traveled, and location. Basic ambulance services typically cost between ?500 and ?2,000 for short distances. Advanced life support ambulances, equipped with medical staff and life-saving equipment, can cost ?2,500 to ?5,000 or more. Air ambulances, used for critical and long-distance transfers, are significantly more expensive, ranging from ?1.5 lakh to ?5 lakh or higher. These charges may also differ between urban and rural areas. Many health insurance plans cover ambulance costs, subject to policy terms and limits.

Types of ambulances in India

There are different types of ambulances you can avail in India. They are:

1. Land-based ambulance

The most common type of ambulance is the land-based ambulance. In India, you can find ambulances in different sizes on the road. Most of these ambulances are privately owned or may be provided by certain hospitals. Many ambulances are actually passenger vehicles modified into an ambulance.

2. Water-based ambulance

This type of ambulance is usually created on small tugboats easy to operate and navigate. Water-based ambulances are not available everywhere and are mostly used in remote locations (having a lower road accessibility and also prone to flooding). In such situations, boat ambulances may come handy. These ambulances are either provided by governments or NGOs.

3. Air-based ambulance

Air-based ambulances are generally planes modified into makeshift ambulances. These are operated by government entities. Air ambulances are used during emergencies. This could include an area affected by an earthquake or by a flood or any other similar calamity, where people require immediate medical assistance. Helicopters are also used for immediate treatment and evacuation to the nearest location. Often times, air ambulances are sent to foreign locations as well, depending on the severity of the situation.

Services provided in ambulances

The availability of services in the ambulance depend on the type of ambulance you select:

1. Basic ambulance

In the basic ambulance, you are provided with basic services such as a monitor to check the heartbeat, pulse, and blood pressure. It also has provision of saline stand and oxygen cylinder and mask, if the patient has breathing issues.

2. Advanced ambulance

Advanced ambulances are bigger in size, when compared to basic ambulances. They offer more services compared to basic ambulances. These services include a doctor for immediate assistance in case the patient is in a critical condition. Along with from saline and IV supplies and monitors, advanced ambulances come equipped with defibrillators and nebulizers.

3. Neo-natal ambulance

As the name suggests, this type of ambulance is used for babies requiring intensive neo-natal care. Babies born prematurely or facing post-birth complications, require neo-natal care. These ambulances come equipped with incubators, where the babies are kept for recovery.

Does Insurance Cover Ambulance Fee?

If you have a senior family member requiring hospitalisation and covered by health insurance for senior citizens, you might assume the cost of ambulance is covered by default. However, this is a misconception many may not be aware about. Most insurers offer to cover the ambulance fees in the form of an additional cover. This is usually sold as ambulance cover wherein the insurer offers to cover ambulance fees up to a certain limit. * For example, consider for a moment that a family member requires hospitalisation, and you call for an ambulance. The cost of ambulance is about Rs.3000. If the ambulance cover in the policy offers ambulance coverage of up to Rs.5000, the fees would be covered in total. However, if the ambulance fees exceed the approved limit, you might be required to pay out of pocket. * Some insurers might offer to allot a certain percentage of the sum insured towards the coverage of ambulance fees. This might vary from insurer to insurer, who have this provision. If the ambulance fees come within the approved limit, you will not have to pay anything. However, if the fees exceed that limit, you might have to pay out of pocket. *

Exclusions Under Ambulance Cover

Ambulance cover in health insurance may not include certain scenarios or expenses. Common exclusions are:

1. Non-emergency transport: Transport for routine check-ups or non-critical conditions is usually excluded.
2. Private vehicle costs: If you use a private vehicle instead of an ambulance, these expenses are not covered.
3. Beyond policy limits: Expenses exceeding the predefined ambulance coverage limit in the policy are excluded.
4. Unregistered ambulance services: Services from unregistered or unauthorized providers may not be covered.
5. Pre-existing conditions waiting period: Ambulance charges related to pre-existing conditions may not be covered during the waiting period.
6. Exclusions in policy terms: Specific exclusions like war injuries, self-inflicted harm, or substance abuse-related emergencies are not covered.

Should you purchase the cover?

In the event of a medical emergency, there are different costs you are required to cover before you can file a claim and get compensated. Adding ambulance fees to these expenses means spending more of your savings. Instead, you can add the cover to your policy at a minimal cost and get peace of mind as the ambulance cost is covered by the policy. *

Conclusion

While not every insurer might offer default coverage for ambulance fees, by going for the ambulance cover in your health insurance in India, you could end up saving money for other emergencies. Do get in touch with an insurance agent to know more about this and the different add-ons you can include in your policy to get enhanced coverage.

FAQs

How many types of road ambulance covers do insurance companies offer?

Insurance companies typically offer two types of road ambulance covers:

1. Basic Coverage: Includes expenses for emergency medical transport to the nearest hospital.
2. Enhanced Coverage: Covers additional services such as advanced life support (ALS), air-conditioned ambulances, or long-distance transport.

Q2: What do I do if my healthcare plan does not have road ambulance coverage?

If your health plan lacks ambulance coverage, consider:

1. Opting for an add-on ambulance cover with your existing policy.
2. Upgrading to a comprehensive health insurance plan that includes ambulance charges.
3. Checking if standalone personal accident insurance policies offer this benefit.

Q3: Are ambulance charges typically covered under personal accident insurance?

Yes, many personal accident insurance policies cover ambulance expenses as part of the benefits. However, the extent of coverage and conditions may vary between insurers.

Q4: Is there a limit on the amount covered for ambulance charges in health insurance?

Most health insurance plans have a predefined limit for ambulance charges, typically ranging from ?2,000 to ?5,000 per claim. Review your policy to confirm the limit.

Q5: Are ambulance charges reimbursed for non-network hospital treatment?

Yes, insurers may reimburse ambulance charges even if the treatment is taken at a non-network hospital, provided the expenses are within policy terms and limits. * Standard T&C apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.