What are Health Insurance Riders?
A Health Insurance policy will designate which Health Care Services are covered, how much you will pay for them, and which providers you can see to obtain these services at these costs. Insurance Riders are amendments to your Health Insurance policy that expands, sets limits, and even dictates exclusions to this coverage. So simply put, a Health Insurance rider is a modification made to your insurance policy regarding the clauses and provisions of the policy. Health Insurance Riders can enhance the cover of an insurance plan. They will vary by company and policy but are also specific to you and your individual health. Insurance Riders will affect your monthly premiums and may indicate additional costs you may need to pay during the life of your policy. We will go over each of the topics regarding Health Insurance Riders so you can better understand what they’re about!
Expansion of Coverage
Riders may exist to provide additional coverage beyond that specified in your basic policy. Generally, you will pay additionally for these riders, but will not need to draft a new policy or rewrite an existing policy. If you’re concerned about coverage of specific services or situations, riders can be a great option. Examples include the long-term care rider, which can cover long-term care, unskilled nursing, respite care, durable equipment such as walkers, therapy, and the extended stay rider, which expands the amount of time of hospitalization per incident.
Limitation of Coverage
The most common limitation of coverage is for “pre-existing conditions.” If you have a current medical condition, called a pre-existing condition in the Health Insurance world, your plan will usually include a rider that limits your coverage for care related to that condition for a certain amount of time (usually one year). If you have a wrist injury for example, your health insurance company may limit the amount they will provide for imaging services, surgeries, prescriptions or other care for that specific pre-existing condition. After the time period is complete, companies will cover all services normally, no matter if it is for your pre-existing condition or not.
Exclusion of Coverage
These riders will deny coverage for illnesses, certain medications, or entire classes of services. In the case of pre-existing conditions, while some policies will merely limit the amount of coverage, others will simply just exclude these conditions from coverage completely. When this happens, companies often offer addendum policies specifically for that pre-existing condition. Usually these come with hefty premiums but may offer an important alternative to paying out-of-pocket fees for conditions that may require a lot of care.
Other Examples of Health Insurance Riders
Other than the ones previously mentioned, there are many other reasons that call for Health Insurance Riders. Here’s a few more examples of Health Insurance Riders.
Room Rent Waiver: The insurer states the max amount they will pay for room rent, in case of hospitalization of the policyholder. This is mostly included in the form of sub-limits on room rent. The room rent limit is a percentage of the sum insured. By including a room rent waiver rider in your basic policy, you are eligible for higher sub limits on room rent. The normal sub limits help get general or semi-private rooms at network hospitals. With a room rent waiver rider, you will be able to avail a room of your choice, without paying anything out of pocket.
Maternity Cover: The basic Health Insurance plans generally do not offer built-in maternity cover. Therefore, the maternity rider helps the insured avail insurance benefits for the expenses incurred during maternity and childbirth. Typically, the maternity benefit rider cover has a waiting period of about 9 months. So, the rider bust be availed at least a year in advance to enjoy the benefits. The maternity benefit rider covers the cost of hospitalization for delivery, ambulance charges, delivery charges as well as offers complete insurance cover the mother and the newborn.
Daily Hospitalization Cash Allowance: This is one of the most basic riders added by customers to enhance the base plan. The main benefit of this rider is that it offers a pre-determined amount for daily hospital expenses, when the policyholder is hospitalized. The policyholder who avails this rider becomes eligible for a daily compensation. However, this waiver comes with certain restrictions, so the insured bust read the policy document carefully, before needing to use this rider.
Critical Illness Cover: The critical illness rider pays a lump sum amount to the policyholder; in case they are diagnosed with a critical illness as mentioned in the policy. Critical illness like cancer, heart attack, or kidney failure can derail the finances of the policyholder or lead to massive debt. A critical illness cover helps protect the insured against financial losses. As these illnesses require extensive and quality medical care, critical illness cover is crucial to help the policyholder get quality treatment at the best network hospitals in the country.
Personal Accident Cover: The personal accident cover helps the policyholder get compensation for partial or total disablement, temporary disablement or death in an accident. This rider comes at a nominal cost and adding this to your base insurance policy means additional cover against accidents. This rider also helps the insured cover the medical expenses incurred in an accident. This rider is also referred to as Double Indemnity Rider.
It’s important to remember with Health Insurance the need to read and understand your policy and the riders attached is These examples are just a few instances of expansions, limitations and exclusions: know what coverage you do have, and what coverage is limited or outright excluded, to avoid any surprise costs and hidden fees.
If you have any questions regarding adding a Health Insurance Rider to your Insurance Policy please let us know! Feel free to fill out the contact form below!