With increasing healthcare expenses, health insurance has evolved into a fundamental requirement for everyone. A robust health insurance plan is essential for accessing necessary medical services without burdening your finances excessively. It includes various services, treatments, and procedures ensuring comprehensive healthcare access. Gaining a deep understanding of how health insurance policies work allows you to identify the most suitable plan tailored to your requirements. If you’re wondering what does health insurance cover, read more to find your answer.  

What Does Health Insurance Cover?

Here are some examples of what health insurance usually covers.

Note: The inclusions in a health insurance plan can vary depending on your age, pre-existing health conditions, insurance provider, and chosen plan.

1. Hospitalisation Costs

Hospitalisation costs typically encompass expenses such as doctor's consultation fees, room rent, nursing care, intensive care unit (ICU) charges, diagnostic tests, medicines and surgical procedures arising from illnesses or accidents. Health insurance extends coverage to visits with your primary physician, specialists and other healthcare providers. It also includes services received at hospitals, whether for surgeries, emergency care, outpatient care, or overnight stays. 

While you may incur expenses such as co-payments, deductibles, and co-insurance, a health insurance plan generally shoulders the majority of costs once you meet your plan’s deductible, provided you stay within the network and the care received is deemed medically necessary.

2. Pre- and Post-Hospitalisation Costs

Often, even a brief hospital stay can incur expenses beyond the means of an average individual. Therefore, it's crucial to verify before purchasing a policy if it includes pre- and post-hospitalisation coverage. Pre-hospitalisation charges encompass all tests conducted by the hospital within 30 to 60 days before admission. Conversely, post-hospitalisation costs, such as medical tests, ambulance expenses, and medicines are covered for up to 45 to 90 days following discharge from the hospital.

3. Pre-existing Conditions 

Pre-existing illnesses or conditions refer to those diagnosed before acquiring a health insurance plan. Coverage for such conditions differs amongst insurance providers. While some insurance plans offer immediate coverage for pre-existing illnesses, others may impose a waiting period. It's essential to disclose your medical history transparently when selecting a plan to prevent coverage disputes in the future.

4. Preventive Healthcare

Regular health check-ups play a crucial role in detecting and preventing diseases early. Certain health insurance plans provide complimentary preventive health check-ups, which may include full-body examinations, targeted screenings for specific diseases, vaccinations, and consultations. This benefit enables you to proactively manage your health and mitigate the risk of future medical complications.

5. Prescription Medications

Most health insurance plans are mandated to include coverage for prescription medications, although the specific medications covered may vary amongst insurers. Every plan maintains its formulary, which is a list of approved medications. You can access this list on the health insurer’s website or as part of the documents provided to you by your insurer. 

Alternatively, you can contact your insurer directly to inquire about the drugs included on the list. In certain circumstances, it may be possible to request an exception from your insurer to cover a medication not included in its formulary. This is particularly probable if none of the drugs listed on the formulary are effective in treating your condition.

6. Daycare Procedures

They encompass medical treatments that do not necessitate overnight hospitalisation and are typically covered by health insurance. These treatments may include cataract surgery, radiotherapy for cancer, dialysis, diagnostic tests, and more. Depending on your current health conditions, opting for a health plan that offers extensive coverage for daycare treatments is advisable. It's crucial to comprehend the list of covered daycare procedures and any exclusions specified in the policy.

7. Maternity Cover

Maternity coverage holds significant importance for expecting parents as it encompasses expenses related to childbirth, pregnancy, and newborn care. This coverage may include delivery charges, prenatal check-ups, expenses for the baby nursery, and vaccination costs. It's essential to note that the eligibility criteria, sub-limits, and waiting periods associated with maternity coverage can vary amongst health insurance plans.

8. Mental Healthcare

Mental illness is frequently stigmatised, yet mental health is essential for overall well-being. Acknowledging this importance, some health insurance providers now offer coverage for mental well-being. This includes consultations with psychologists, psychiatrists, and therapists, as well as hospitalisation for mental health conditions and specific treatments.

9. AYUSH Benefits

AYUSH refers to India's traditional system of alternate medicine, encompassing Ayurveda, Yoga, Unani, Siddha, and Homoeopathy. Some health insurance plans may provide coverage for AYUSH treatments alongside allopathic treatments, either for specific conditions or up to a certain limit.

10. New-age Treatment Cover

Cutting-edge treatments such as immunotherapy, stem cell therapy, robotic surgeries, and deep brain stimulation often come with hefty price tags. When selecting a health insurance plan, it's crucial to ensure that it covers these advanced treatments. Alternatively, you can opt for an add-on cover for these treatments to avoid out-of-pocket expenses if they are not included in the standard policy.

Conclusion

When it comes to buying health insurance, there are plenty of options to choose from. To make the best possible choice for yourself and your loved ones, it’s crucial to clearly understand the coverage of your plan. Knowing exactly what does health insurance cover and what it doesn’t cover to be better prepared for any medical emergencies that may come your way.

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