Rohan Mehta, 32, a marketing professional from Pune, suffered a ligament tear during a gym workout. His insurer covered hospitalization but denied physiotherapy expenses. He later added a personal accident plan for wider protection.
What Is Covered What Is Not
If you are a gym rat or into sports, your health insurance covers you for most injuries; however, there may be certain exclusions. We take a look.
Most of the health insurance plans cover accidental injuries that need hospitalization, even if they happen during gym workouts or casual sports. “But minor injuries (like muscle pulls, sprains, etc.) or those from professional or adventure sports are usually not included, so it’s important to check the policy details, as the claim completely depends on the nature of the injury and the policy terms and conditions,” says Sarita Joshi, head of health and life insurance, Probus.
Regular health insurance may not cover everything, like physiotherapy or loss of income during recovery; hence, it is advisable for regulars to opt for such specialized plans.
How To Stay Protected
“A personal accident or sports cover goes beyond basic healthcare and offers wider protection (covers disabilities, fractures, recovery expenses, etc, for those who train or play sports regularly), so having such an additional layer of protection ensures complete peace of mind,” says Joshi.
In most cases, policies usually cover hospitalization and major treatment due to gym workouts or while playing sports. Major injuries and surgeries are usually a part of the inclusions, and some insurers also provide plans for follow-up care after discharge.
However, exclusions remain a key area to watch and often include minor sprains, professional or risky sports, and injuries under the influence of alcohol or drugs.
“So common exclusions include expenses for treatments arising from participation as a professional in hazardous or adventure sports, treatments for substance abuse or addictive conditions, and such. Normal gym injuries are generally covered under the plan, subject to policy terms and conditions,” says Dinesh Mosamkar, senior VP – consumer underwriting, TATA AIG General Insurance.
Cosmetic treatments or hospitalization needed for minor injuries are not usually included. “Regular players or trainers must consider opting for specific policies for sports or fitness injuries for complete protection,” says Joshi.
What To Consider
Read the terms and conditions, and check for exclusions or restrictions related to any adventure sports, waiting periods, and any limits or restrictions on particular treatments.
