Are Diagnostic Charges Covered by Health Insurance?

What are Diagnostic Expenses?

Diagnostic tests are simply different types of invasive or non-invasive tests to confirm or rule out health risks in a person’s body. The cost of these tests varies with multiple factors — method, type of diagnostic equipment, etc.

Some common diagnostic procedures include Magnetic Resonance Imaging (MRI), X-Rays, Ultrasound, Mammography, CT scans, Fluoroscopy, PET scans, blood samples, colonoscopies, biopsies and a lot more.

These checkups can cost anywhere from a few hundred rupees to thousands, especially for people who may be suffering from pre-existing diseases or have a sick family member.

Will I get Coverage for Diagnostic Expenses?

Yes. Most diagnostic tests are covered by health insurance plans, including the cost of tests like X-rays, blood tests, MRIs and so on. However, these are covered only when they are associated with the insured patient’s stay in the hospital.

This stay must be as per the policy’s minimum stay duration, in most cases 24 hours or more. Other than these, diagnostic tests prescribed to OPD patients are usually not covered under health insurance plans. However, there are many exceptions to this which are discussed later.

How Can I Save Money on Diagnostic Charges?

Whatever the test may be, it can be quite a burden especially when you're above 40-50 years of age or have many members in the family relying on your financial support.

As we already discussed, diagnostic charges are only covered when the insured is hospitalised for at least a day or more. Other than these, tests and checkups required during your OPD visit won’t be covered.

However, there are ways to get claim benefits in case of diagnostic expenses without hospitalisation. These are discussed below:

Buying an OPD Cover

Many health insurance policies in India have started offering this cover that helps you claim expenses other than those incurred during hospitalisation. These include pharmacy expenses, costs incurred during diagnostic tests and other health check-ups depending on the insurer.

In most health insurance plans with OPD cover, you can also claim reimbursement multiple times during the policy tenure and save plenty of money on different diagnostic expenses.

Opting for Preventive Health Check-ups

You can opt for a preventative healthcare package according to your or your family's needs. This will let you monitor different health conditions at an affordable premium and help reduce the chances of developing any hard to detect condition.

Many health insurance plans in India also provide free preventative health check-ups to the insured when they renew their policy.

These preventative check-ups include several diagnostic tests such as lipid profile, pap smear, pelvic exam, eye examination, cancer screenings, heart disease screening, dental exam and more.

The exact coverage will depend on the type of plan you buy. As per section 80D under the Income Tax Act (1961), those below 60 years of age can avail of tax benefits up to INR 25,000 and INR 50,000 in the case of senior citizens.

Wrapping it Up,

Diagnostic tests are among the primary and most important expenses that a person must bear. However, you can easily minimise these expenses through health insurance plans with OPD coverage. Other than reimbursement benefits, there are several tax benefits and exemptions that you can claim by buying such health insurance policies. By investing some of your time smartly, you can afford quality healthcare without worrying about money.

Health insurance companies

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

*The values taken for effective cost calculation are indicative values and may change as per the selected plan.

*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

*The scope of coverage may vary from plan to plan.

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