Health Insurance Coverage Inclusions & Exclusions

Understanding the Inclusions & Exclusions in Health Insurance coverage

Health concerns can arise anytime, regardless of how old or young, healthy or unhealthy you are. We might suddenly need to be hospitalised, which would be very stressful for us emotionally and financially. 

It is preferable to plan ahead and invest in a decent, all-inclusive health insurance policy that offers coverage for various ailments and diseases rather than stressing on how finances may be managed in such difficult times. 

Additionally, it’s vital to read the terms and conditions to fully understand the details of your insurance policy, including the list of illnesses that are not covered by health insurance.

What is covered in health insurance?

Some of the common medical expenses covered by health insurance include:

In-Patient Hospitalisation / Daycare Expenses – As long as the Hospitalisation lasts longer than 24 hours, the hospitalisation costs incurred during the treatment of a sickness or injury are covered. In addition, daycare procedures are covered.

Pre-Existing Illnesses or Diseases – You can get covered for treating any pre-existing illness or condition after the waiting time has expired.

Pre and Post-Hospitalisation Expenses – The insurance provider will pay pre and post hospitalisation expenses like Investigations, consultation and medicine charges when the Hospitalisation is admissible as per the policy terms and conditions.

Ambulance Charges – The expenses incurred for transportation of the insured person by ambulance service from one hospital to another is covered and the amount of coverage is as per the Policy terms and conditions.

Delivery and Newborn Cover – The cost of delivery and the newborn baby coverage is provided only in certain policies and coverage period differs from policy to policy.

Preventive Health Checkups – The insurer provides health Checkups in certain policies every claim-free year.  In some of the other policies, preventive Health checkups are provided when the policy is in force.

Daycare Treatment – Daycare treatment means medical treatment and/or surgical procedure which is undertaken under General or Local Anesthesia in a hospital/daycare centre in less than 24 hrs because of technological advancement and which would have otherwise required Hospitalisation of more than 24 hours

AYUSH Benefit – A health insurance policy may also cover the expenses of Ayurveda, Unani, Siddha, and homoeopathy treatments based on the policy terms and conditions

What isn’t covered in health insurance?

The following medical expenses are not covered by a health insurance plan:

• Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.
• Claims arising out of adventure sports injuries.
• Injuries caused by war, terrorism, or nuclear activity are not covered under health plans.
• Hospitalisation due to self-inflicted injuries is not payable.

Cosmetic surgeries like Liposuction, Botox, implants and similar surgeries are excluded from a health insurance policy.
Understanding your policy

It’s important to buy health insurance that covers your requirements and needs. Consider your family’s and your medical requirements, and choose a plan that provides the appropriate benefits.

Comparison of various plans based on their coverage, benefits, and costs is one of the best ways to choose the best health insurance. Comparison enables you to identify the plan that provides the greatest coverage within the budget. Read and understand the wording of the insurance policy carefully to choose the right health insurance policy.

It’s important to understand your health insurance policy, benefits, coverage and requirements to ensure you receive the care you need and avoid unexpected costs. Hence, get yourself secured with good health insurance plans to safeguard you and your family from unexpected financial hassles