Buying a health insurance policy for yourself and your family is important because medical care is expensive, especially in the private sector. Hospitalization can burn a hole in your pocket and derail your finances. It will become even tough, if the person, who brings in the money, is now in a hospital bed. All this can be avoided by just paying a small annual premium which would lessen your stress in case of medical emergencies.
A good health insurance policy would usually cover expenses made towards doctor consultation fees, costs towards medical tests, ambulance charges, hospitalization costs and even post-hospitalization recovery costs to a certain extent.
What do Health Insurance Plans cover?
The health insurance coverage differs from one insurance company to another. All you can do is compare different health insurance policies provided by different health insurers keeping the coverages and exclusions in mind. Usually, a health insurance plan covers the following medical expenses;
Health insurance plans offered in India provide cover for the following essential health benefits:
In-Patient Hospitalization - Medical expenses related to hospitalization due to an illness or an accident, which is for a period of more than 24 hrs.
Pre-Hospitalization - Medical expenses that one incurs due to illness during the days immediately preceding the hospitalization.
Post-Hospitalization - Medical expenses that one incurs for a certain period after being discharged from the hospital.
Day-Care Procedures - Medical expenses for treatments, which do not require 24 hours hospitalization due to technological advancement.
Domiciliary Treatment - Covers the expenses for treatment done at home for which hospitalization would be needed.
Emergency Ambulance - Costs related to using ambulance service for reaching the hospital.
Ayush Benefit - Treatment done using Ayurveda, Unani, Sidha and Homeopathy.
If there is an organ transplant of the insured, all the donor's expenses would be covered.
You can also opt for additional Riders along with a Comprehensive Health Insurance Policy to enhance your health insurance plan even better. This may include,
Room Rent Waiver
Maternity Cover
Critical Illness cover
Hospital Cash
Personal Accident Rider, etc.
What do Health Insurance Plans not cover?
Mentioned below is the list of the exclusions in a health insurance:
Pre-Existing Diseases: In case you are suffering from any illnesses or health conditions before buying a health insurance plan, are known as pre-existing diseases. Usually, every health insurance company has a waiting period of 2-4 years or more that would roughly depend upon the type of disease as well as the risk in case your health insurer agrees to cover it. Certain pre-existing health conditions such as cataract, few chronic diseases, joints treatment, kidney stones, arthritis, etc. could be the exclusions in a health insurance plan.
Cosmetic surgeries: Cosmetic surgeries are one of the most common health insurance exclusions. However, cosmetic or plastic surgeries that are performed after accidents are covered in several health insurance plans. Also, joint replacements and dental treatments are usually excluded in health insurance policies.
Injuries caused during suicidal attempts/ Addictive conditions/ Adventurous or Hazardous sports: An insured is not covered in case he intentionally causes harm to himself. Hence, injuries caused during suicidal attempts/ Addictive conditions/ Adventurous or Hazardous sports are not covered in health insurance plans by any insurance provider.
Therapies: Health insurance plans do not cover therapies such as acupuncture, naturopathy, magnetic therapies and alternative forms of therapies.
Pregnancy: Certain medical expenses including child birth, pregnancy, vaccination, etc. could not be covered under a health insurance policy. There would be a waiting period of around 1-2 years. Post completion of this waiting period, you will be eligible for receiving decent benefits in case you plan for a child.
Waiting Clause: Almost every health insurance company do not cover illnesses that are a part of the inclusions of the health insurance plan. However, there are certain exceptions such as accidents and deaths. A waiting period of 1-2 months would be applied post which you will get the advantages of the policy.
Surgeries: Certain surgeries such as dental surgery, joint replacement, cosmetic surgery, etc. are generally not covered in a health insurance policy.
