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What is a Medical Indemnity Insurance Plan?

All that you need to know about the Medical Indemnity Insurance Plan!

Accessing quality healthcare in India is quite a costly affair. While you can try and save up money for a medical emergency, the bills can run high and go from attainable to unaffordable very quickly. Especially in the case of serious medical emergencies or conditions. That is why it is advisable for people to invest in an indemnity health plan. Medical indemnity insurance plans for doctors exist as well, to give them a safeguard against potentially unfavorable outcomes of treatments.

A Medical Indemnity Insurance Plan is a safeguard for your health and the health of your loved ones. It helps you anticipate and be financially prepared for any potential medical emergencies. Often referred to as a fee-for-service plan, an indemnity plan allows you to choose your doctor and hospital without any restrictions or limitations. The insurer reimburses you for any costs incurred from medical treatments. These plans are on the costlier side compared to other types of insurance, but the amount of ease and flexibility they offer people makes it all worth it. 

Plan Types 

Typically, medical indemnity insurance plans come in two general types. 

  • Hospital-surgical Coverage: This type of plan is built to pay the costs of having surgery done or being hospitalized. For example, if an individual were to suffer a heart attack, a hospital-surgical coverage plan would cover and reimburse all the costs that have been incurred. 
  • Major Medical Coverage: This type of insurance plan is designed to pay for all the medical expenses that come along the way due to a long hospital stay, chronic illnesses, and conditions that require multiple different types of procedures and specialist doctors. For example, if a patient were to undergo extensive treatment for cancer, it will be covered by this type of plan.
  • Comprehensive Coverage: This is a medical indemnity plan that is a mix of the above-mentioned plans and gives you the best of both worlds. It offers you the best way to safeguard your health from unforeseen conditions.

Deductibles & Co-pays in Medical Indemnity Plans

Contrary to popular belief, having an indemnity insurance plan does’nt mean you will not have to bear any other expenses. Many plans require you to pay some amount of the treatment cost out of your own pocket, in addition to the premiums. 

Deductible refers to the monetary amount that you gave to incur before your insurance starts paying or reimbursing you for any portion of your expenses. 

Co-pay refers to flat amounts of money that you must pay your doctor per office visit. Co-insurance refers to the percentage of care costs that you must incur until you reach the maxim out-of-pocket expense limit of your policy. For example, if you have a policy with an INR 50,000 deductible and 20 percent co-insurance with an INR 25,000 out-of-pocket limit, and you have a heart attack that costs INR 1,50,00,000 to treat, you’d pay an INR 50,000 deductible and INR 20,000 in co-insurance on the first $10,50000 in cost. The insurer would pay the remaining INR 147,50000.

Medical Indemnity Insurance Plan: For Doctors

While it is true that doctors are incredibly qualified and save lives on a daily basis, it is also a fact that sometimes, treatments do not go to plan. A patient’s condition could be too bad for them to recover, there could be complications in identifying the right condition or even during surgeries. 

In such cases, doctors and medical practitioners require a safeguard against legal fees and claims for compensation made by patients in incidents of legal row. This is exactly what a professional medical indemnity insurance plan offers doctors.

From a legal perspective, it represents an exemption from any liabilities for damages done during the course of treatment. One of the greatest fears doctors have is uncertainty when it comes to determining the total amount of compensation to be paid. This amount is usually subjective and varies depending on the context of individual cases. 

Sometimes, mental trauma caused to the patient and stress that the course of the treatment has caused is used as a reference to determine the amount of compensation. In such a situation, the patient’s expectations of monetary compensation can be quite exorbitant. Some patients even misuse this system in order to make some quick money. There has been a steady rise in litigations against doctors, as well as frivolous charges. This is the reason why most doctors have decided to protect themselves through indemnity insurance plans. Often doctors pay lakhs of rupees each year for these plans.

Statistics show that senior surgeons estimate that around 10% of their annual income goes towards paying the premium on their professional medical indemnity insurance. 

The rates for these premium covers usually range from around 0.3% to 1% of the total sum insured.

Coverage under the policy

Most of the time, the professional indemnity policy offers cover to the medical practitioner depending on the features of the policy, such as:

– The extent of financial damage or loss to the victim which is not a result of willful neglect

– Unintentional errors and omissions

– Insurance extended to other qualified employees, unqualified employees, and partners in the same practice

– Cost of defending oneself in the court of law

Situations excluded from the policy

A professional indemnity may not cover the claims arising from the following aspects of practice:

– The medical treatment is given for weight loss, plastic surgery, genetic damages, and conditions associated with AIDS

– A criminal act, penalties, fines, punitive, and exemplary damages

– Intentional non-compliance, willful neglect, deliberate act

– Loss of goodwill

– Medical practice is done under the influence of alcohol or narcotics

Hospital Indemnity Insurance Plan

Often times, medical treatments come along with a host of accompanying costs, such as paying for parking, hotel rooms, or making up for lost days of work. Hospital indemnity plans help patients and their family members manage these additional costs in a way that doesn’t cause them any additional stress.

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