Coverage on injuries in health insurance

Any damage that occurs in the body, such as falling, slipping or any object hitting the body rapidly, is called an injury. Sometimes, the upper layer of the skin peels off and bleeds due to the injury, while other times, there is no bleeding but the site turns blue and there is pain. Skin peeling, wound formation, bruising, bone fracture, sprain, muscle strain and burns are some of the prime examples of injuries.

(Read more: Muscle cramps)

Injuries are mainly divided into two types, general injury and serious injury. Common/general injuries can usually be cured at home with first aid and home remedies, or else doctors give some medicines to quicken the healing process. However, in case of serious injuries, the condition can become serious, in which case the patient may have to be hospitalized for several days and may even have to be admitted to the ICU, depending on the severity of the injury. Some examples of common and serious injuries are given below.

Common injury: An injury affecting a small part of the body is called a general or common injury. They are simple injuries and nothing to worry about; only in very rare cases can they cause complications. In common injuries, the doctor first examines the injury and determines whether it needs medical treatment or not. Common injuries include:

• Scratching
• Skin peeling
• Slight skin burn (blistering)
• Insect bite wound
• To be allergic to something
• Mild sprain
• Small blue bruise

 Serious injury: When a major part of the body is affected due to an injury, it is called a serious injury. Some serious injuries may require the patient to be hospitalized at the earliest, otherwise, the patient could die. Some examples of serious injuries are:

• Large wound on any part of the body
• Visible bone or tissue at the wound
• Excessive bleeding
• Severe head injury
• Burning a large part of the body
• Unbearable pain on falling or slipping
• Bleeding from the mouth, nose or ears after an accident
• Sudden loss of consciousness after injury
• Spinal cord injury or neck injury
• The patient's pupil does not move or the patient's breathing stops after an accident.

Simply put, a normal injury is one in which a small part of the patient's body is affected and the patient is fully conscious. A serious injury is one in which a large part of the body is affected or damaged and the patient is not fully conscious.

(Read more: First aid for head injury)

Every day, thousands of people are involved in accidents in factories, roads and many other places, all of which result in some injuries. Sometimes the injury is so serious that to save the life of the person, they have to be admitted to the ICU, which can result in a hefty hospital bill. This could lead to all your savings being used up or, if you do not have savings, being in debt for many years.

Considering the above and the rising inflation in hospitals, buying a proper health insurance plan for yourself and your family is not only a good move but a necessary one. If an accident does occur, the family of the insured can save their life without worrying about the cost of the treatment. If you have not bought a health insurance plan yet, then you should consider getting one as soon as possible.

If you are thinking of buying a health insurance plan, then myUpchar Bima Plus can be a good option for you. myUpchar Bima Plus provides you coverage for critical medical conditions like COVID-19 treatment, pre and post hospitalization, pre-existing diseases, road ambulance and daycare treatment. Apart from this, you also get the facility of 24x7 free tele-OPD in myUpchar Bima Plus health insurance policy.

(Read more: myUpchar Bima Plus for Elderly)

It can be a bit difficult to state the coverage, as each company operates according to its own different criteria. However, most insurance companies provide coverage on the treatment of injury in the following situation:

• Those who have to be hospitalized: If you have an injury that requires hospitalization for more than 1 day, you get coverage of medical expenses.
• Those who do not need to be admitted: If there is an injury that requires hospitalization, but does not need one to be admitted. For example, there is a wound that needs to be bandaged at the hospital. However, if OPD is not covered in your plan, you may not get coverage for such expenses.
• Daycare treatment: If you have to stay in the hospital for only one day due to injury, then your medical expenses are covered by health insurance. For example, if a bone is broken in an accident, you may need to stay at the hospital for a day.
• Treatment at home: Your insurer will also provide cover if you have suffered an injury and the doctor treats you at your home rather than at the hospital. It is also called domiciliary treatment, which is usually needed more in situations like epidemics.
• AYUSH treatment: If you do not take allopathic medicines and get yourself treated with Ayurvedic medicines in case of an injury, then your treatment gets covered under the health insurance plan. However, this is possible only if your insurer has an Ayurvedic hospital in its network. Some companies impose capping in Ayurvedic hospitals, which means that you can claim a percentage of the sum insured and the rest amount has to be paid from your own pocket.

(Read more: Dental Health Insurance)

If you are insured or thinking of buying a health insurance plan, then you should also know about the injuries not covered under the policy. Following are some situations in which injuries sustained are generally not covered:

• Injuries caused by self-harm or attempted suicide are not covered under health insurance plans.
• Injuries caused by fights or during service in the armed forces are not covered by the health insurance plan.
• If you participate in bungee jumping, scuba diving, rafting, gliding, rock climbing or any other adventure sports, injuries sustained during will not be covered by your health insurance plan.
• If you consume alcohol or any other intoxicant and you get hurt in a road or other accident while intoxicated, then it will not be covered in the health insurance plan. On the contrary, if you are driving under the influence of alcohol and get into an accident, then the insurances of both you and your vehicle are cancelled. Not only this but a case can also be registered against you for illegal activity.

Nowadays, the cases of accidents due to roads and big machines have increased a lot. Keeping that and inflation in mind, it becomes clear that buying a health insurance plan is a must for every individual. A good health insurance plan not only helps in saving the life of an individual but also prevents financial burden on their family.

(Read more: Difference between health insurance and life insurance)