What is covered under Health insurance plan

A health insurance inclusion means the type of services/procedures that are covered under your health insurance policy. That means if you make a claim of the items covered, you will receive the benefit as stated in your policy. The coverage offered by a health insurance policy is subject to the type of policy and the insurance provider. 

Following are some of the common health insurance plan inclusions-

In-patient hospitalization expenses

The expenses incurred for the treatment in a network or a non-network hospital for more than 24 hours. These expenses include several things-

  • Room rent of the hospital
  • ICU room rent
  • OT charges
  • Nurse’s fee
  • Doctor’s fee
  • Surgeon’s fee
  • Anesthetist's fee
  • Cost of medicine, blood, oxygen

Pre and post hospitalization expenses

Medical expenses incurred before hospitalization and after being discharged from the hospital (post hospitalisation) are covered under this. It includes diagnostic reports, medicines etc. for the treatment you are hospitalized.

Ambulance charges

Expenses incurred in taking the insured to the hospital for treatment in an ambulance are covered under this up to a certain limit.

 Daycare treatments

Under this, all those treatments/procedures are covered that require hospitalization for less than 24 hours. It includes chemotherapy, radiation, dialysis, cataract, lithotripsy, and so on. The list of such treatments can be found in the policy documents as well as on your company website.

 Organ donor expenses

Charges which are incurred in harvesting the organ from the donor as well for the transplant surgery are covered under this.

Domiciliary treatments

The charges incurred for the treatment availed at home due to non-availability of hospital beds or when the insured is not in the condition to shift to any hospital are covered under this.

Free health check-ups

Another benefit of health insurance policy is that it offers free periodic health check-ups to their policyholders in every 4 or 5 claim-free years. Insurers offer free health checks if tests are done at an empanelled hospital or center.

AYUSH treatment

Many insurers also provide coverage for alternative treatment such as Ayurveda, Homeopathic, Yoga and others. On buying a policy that covers this element, you will be able to make the most of the offered treatment without bearing expenses on your own. 

No claim bonus

No claim bonus or NCB is a health insurance element which is paid to the insurer if he or she does not file any claim for any treatment in a previous year. 

Daily hospital cash allowance

It is one of the hidden benefits of health insurance that lets policyholders take care of their additional expenses like food, travel, and others during hospitalization.

What is not covered under the health insurance plan?

While health plans are otherwise comprehensive in their scope of coverage, there are some instances which are not covered under most plans. These are called plan exclusions and include the following expenses and treatments –

  • Coverage of critical illnesses and pre-existing diseases is subject to a waiting period of 2 to 4 years
  •  Medical illnesses within the first 30 to 90 days of buying the policy
  • Specific treatments like joint replacement, hernia, piles, etc. are not covered in the first 2-4 years of the plan
  • Self-inflicted injuries
  • Injuries caused due to alcohol or drug abuse
  • Injuries caused due to a suicide attempt
  • Maternity related expenses unless the plan has maternity cover
  • Participation in military operations
  • Participation in extreme sports
  • Cosmetic/plastic surgery, replacement of hormones, sex change
  • Dental or eye surgery
  • OPD expenses unless the plan has an inbuilt OPD cover
  • Terminal illnesses, such as HIV/AIDS or other diseases of similar nature
  • War, riots and related perils and nuclear contamination
  • Bed rest/hospitalization and rehabilitation, common illnesses, etc
  • Treatment/diagnostic tests, post-care procedures
  • Treatment abroad or by an under-qualified medical professional

You would need good health insurance cover to tide over medical exigencies in your life. It will prove beneficial for you especially during hard times. You can take the most advantage of a health cover if it is equipped with the above-mentioned coverage.