Does Health Insurance Cover Ambulance Charges?

Posted on: May 12, 2023 | | Written by:

Does Health Insurance Cover Ambulance Charges?

Published on May 11, 2023. EST READ TIME: 3 minutes

A medical emergency can emotionally and financially drain you and make things difficult for the entire family. While you can’t predict or control such situations, the least you can do is stay prepared financially with an adequate health insurance policy. A healthcare plan offers a host of benefits to policyholders and saves them from financial setbacks.

One significant benefit of health insurance is the compensation it provides to policyholders against ambulance expenses incurred during a medical emergency. So, if there is a medical emergency, you can avail of ambulance services without a second thought. These vehicles are equipped with advanced equipment for immediate medical care and are the best bet in such situations. Although most ambulance services are chargeable in India, you will not have to worry about the bills if your health insurance covers ambulance costs.

Read on to know about road ambulance cover in health insurance, ambulance charges, policy exclusions, and more.

What are ambulance charges in India and how are they determined?

Ambulance services are counted among the most important medical facilities. These vehicles have important medical devices or equipment that can come in handy during a medical emergency.

That brings us to the question: what are ambulance charges in India?

What Are Ambulance Charges In India?

Ambulance charges usually depend on the ambulance type (road or air), size, cost levied by the service provider, facilities available in the ambulance, and more.

Most ambulances have a bed and some basic yet vital life support facilities, such as heart rate monitors, transport ventilators, oxygen supply units, spinal boards, and medical equipment for stabilising blood pressure, intubation, etc.

In most cases, hospitals and ambulance providers charge a higher fee for bigger and better-equipped ambulances. Also, air ambulances are way more expensive than road ambulances.

Types of ambulances in India

There are two main types of ambulances in India: road and air ambulances.

1. Road ambulances:

These are most common in the country. Many hospitals and privately owned ambulance companies provide road ambulance services on a chargeable basis. The service charges mainly depend on the following:

• Vehicle type

• Number of kilometres covered for transporting the patient to the hospital

• Healthcare facilities and medical equipment available in the ambulance

• The city in which you avail the service (ambulance charges vary from city to city in India).

There is no fixed rate or standard pricing for road ambulances in India. However, the government has capped the maximum amount a private ambulance can charge in cities like New Delhi.

Road ambulances can be further divided into the following types:

• Basic ambulances:

These ambulances come equipped with important life support equipment, such as a stretcher, oxygen supply units and a blood pressure monitor.

• Advanced life support ambulances:

Advanced life support ambulances have basic as well as advanced medical equipment, such as ECG monitors, nebulizers, defibrillators, resuscitation kits, suction units, transport ventilators and more.

• Patient transport ambulances:

These ambulances are used for transporting patients who do not require emergency medical assistance or intensive care. They contain some basic medical equipment, such as a blood pressure monitor or a pulse monitoring device. These ambulances are used for wheelchair-bound patients who require clinical monitoring.

• Neonatal ambulances:

These special ambulances are used for transferring sick newborns. The vehicles contain basic medical equipment and incubators.

• Mortuary ambulances:

These ambulances are used for carrying dead bodies from one place to another. They mainly contain a freezer box.

2. Air ambulances:

These are planes or helicopters modified into ambulances and equipped with important medical devices. If a medical emergency requires specialist treatment available in another city, opting for air ambulance services can help. These are equipped with important medical equipment and devices to assist patients during transit. The average cost of air ambulance service in India can run from INR 1.5 lakh to INR 2 lakh per hour. The charges may vary depending on the patient's medical condition, aircraft type, and distance travelled.

Does health insurance cover ambulance charges?

Most health insurance companies in India cover road ambulance charges up to a certain amount. If you file a claim for the reimbursement of ambulance charges, the insurer will refund a certain percentage of the sum insured, as mentioned in the policy terms and conditions.

Some insurance companies may also offer unlimited coverage for road ambulances. This can be a good option for parents health insurance or those suffering from life-threatening conditions.

In case your health insurance policy does not cover ambulance charges, you can check with the insurance company if they offer ambulance coverage as an add-on. You can buy the same by paying a nominal premium at the time of policy renewal.

Since air ambulance services are expensive, insurance companies may cover the costs only for policies with a high sum assured. This again varies from one insurance provider to another.

What is road ambulance cover in health insurance?

Road ambulance cover is an emergency coverage that insurance companies offer to policyholders. The insurer will cover the ambulance charges if a medical emergency requires ambulance services for transporting the patient (policyholder) to the hospital.

While many insurance companies offer ambulance cover as an in-built policy benefit, there is an upper cap. This means that even if you spend a higher amount on ambulance services, the insurance company will cover a certain percentage of it. The percentage of road ambulance coverage mostly depends on your policy’s sum insured.

For example, you have a health insurance plan for a sum insured of INR 3 lakh, and your insurance provider offers road ambulance cover for 1% of the sum insured (i.e., INR 3000). There was a medical emergency, and you had to spend INR 5000 for the ambulance. In this case, the insurance company will cover INR 3000as ambulance costs, while you must pay the remaining INR 2000 from your pocket.

What is the importance of road ambulance cover in health insurance?

An ambulance cover can come in quite handy during a medical emergency. If an ambulance is used to transport the policyholder to the hospital, the insurance company will cover the costs.

Some insurance companies also cover ambulance charges for patients with life-threatening conditions. So, in a medical emergency, you can call an ambulance quickly without worrying about the charges.

Although non-medical modes of transport are available, it is always wise to transport a patient to the hospital in an ambulance. Here’s why:

• Road ambulances are equipped with vital medical equipment that the paramedics can use while transporting the patient to the hospital. This pre-hospital care during transit can prevent the medical condition from worsening.

• The paramedics in the ambulance can get in touch with the hospital and tell them to be prepared for the incoming medical emergency. This will ensure immediate patient care and quicker treatment at the hospital.

• An ambulance can be way quicker than any non-medical mode of transport. In case of a life-threatening condition, the sooner the patient reaches the hospital, the better will be his/her chances of survival.

What are the conditions to claim road ambulance charges in India?

The following are the conditions to claim a reimbursement of road ambulance charges from insurance companies:

1. The insurer will only reimburse the road ambulance charges if they accept your health insurance claim under hospitalisation coverage.

2. The ambulance used during a medical emergency must be from a registered hospital or a registered ambulance service provider.

3. Policyholders must submit a certificate from the treating medical practitioner confirming that the ambulance was necessary for transporting the patient to the hospital.

4. As stated earlier, the claim amount will be restricted to a certain percentage of the sum insured (usually 1%).

What are the exclusions under a road ambulance cover?

The exclusions under road ambulance coverage are:

• In some cases, insurance providers do not reimburse ambulance charges for planned hospitalisations.

• The insurance provider will not cover recurring ambulance expenses once the patient returns home after the treatment.

Essentially, insurance companies cover road ambulance expenses in case of medical emergencies only. If you call an ambulance otherwise, you cannot file for are fund.

FAQs

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

Some insurance companies in India offer two types of road ambulance covers:

• Emergency ambulance cover:

This coverage entitles policyholders to claim reimbursement only if they avail of ambulance services during medical emergencies.

• Comprehensive ambulance cover:

This provides reimbursement of ambulance expenses incurred during emergency as well as non-emergency situations.

2. Is Road ambulance coverage included in all health insurance policies?

Most health insurance policies in India cover road ambulance charges. Even if you take a base healthcare plan, the insurer will reimburse ambulance charges depending on the sum insured.

For instance, if you have a healthcare plan with a sum insured of INR 5 lakh, your insurance provider may offer ambulance cover for INR 5000 (1% of the sum insured). The reimbursement percentage can vary from insurer to insurer.

3. What do I do if my healthcare plan does not have road ambulance coverage?

If your health insurance policy does not cover road ambulance charges, you can take it as add-on coverage at the time of policy renewal.

4. How many times can I use road ambulance coverage in one year or during the policy tenure?

The number of times you can use road ambulance coverage in one year will vary from insurer to insurer. While some insurance companies allow policyholders to avail of the coverage more than once during the policy tenure, others may not. You can either check the policy terms and conditions or get in touch with the insurance company for better clarity.

Conclusion

To sum up, ambulance cover is an important feature of health insurance plans. So, whether you are buying health insurance for individuals, parents’ health insurance or a family floater policy, make sure ambulance coverage is a part of the policy inclusions. If you have a healthcare plan without ambulance coverage, check with the insurer if you can take the same as an add-on. This will save you from considerable out-of-pocket costs during medical emergencies.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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